Rationing health care: is it time to set out more clearly what is funded by the NHS?

In an era of unprecedented financial challenge, our research asks whether the time is now right to specify what is and is not covered by core NHS funding.


Published: 27/02/2012

ISBN: 978-1-905030-53-8

Download the report [PDF 508.9KB]

Four experts provide their perspective on whether the existing NHS settlement will remain affordable in the long term.

The National Health Service in England currently faces the challenge of deriving, by 2015, an estimated £15-20 billion more value from the overall budget in order to meet rising demand but without a corresponding increase in funding.

At the same time, political debates over the Secretary of State’s duty to provide ‘a comprehensive health service’ have thrown a spotlight on how the NHS interprets national guidance at a local level. The drive to devolve greater responsibility for decision-making to local clinicians is expected to result in wider variations in funding and purchasing decisions, and some fear this could result in greater inequities in access to care.

The NHS Commissioning Board should work closely with CCGs to ensure they make decisions within an agreed set of principles and guidance, and that any decisions made locally are subject to proper public scrutiny

Dr Judith Smith, Director of Policy, Nuffield Trust

Against this backdrop, Rationing health care: is it time to set out clearly what is funded by the NHS? by Dr Benedict Rumbold, Vidhya Alakeson and Professor Peter Smith, examines both the feasibility, and the advantages and disadvantages, of setting out explicitly the care patients are entitled to, in the form of a nationally specified NHS ‘benefits package’.

It draws on the experience of countries that have sought to explicitly define the health care benefits that their publicly-funded health systems will pay for.

The report outlines the current system in which decisions for determining which treatments are funded by the NHS are arrived at implicitly. It makes several recommendations for how the system could be improved. These include:

  • Establishing a set of principles that would shape how public money is spent in the NHS;
  • Producing a national list of the treatments that public money should not be spent on in the NHS (unless there are exceptional circumstances);
  • Ensuring that decision-making by clinical commissioning groups is transparent.

Doctors.net.uk and Nuffield Trust survey of GPs

Alongside this report, the Nuffield Trust and Doctors.net.uk, the largest online professional network of doctors, have conducted a survey of GPs in England to test opinion on whether – given the financial challenge facing the NHS – they believe the NHS will have to further restrict what is, and what is not, available to patients free at the point of use.

A regionally representative sample of 1,009 UK GPs took part in the survey – of which 821 were practising in the NHS in England. As the issues raised in the survey are most pertinent to the English NHS, all results included in this slideshow relate to the 821 GPs in England alone. The survey – known as the ‘medeConnect GP omnibus’ – is a regular monthly, online study of doctors drawn from the Doctors.net.uk community. It ran from the 15 to 21 February.

The findings from the survey can be accessed in a slideshow, as well as a downloadable document which includes a full breakdown of the survey data

This report and survey form part of the Nuffield Trust’s wider programme of work on efficiency. It will be of interest to policy-makers, commissioners, managers and academics with an interest in health system efficiency and equity.

Suggested citation

Rumbold B, Alakeson V and Smith C (2012) Rationing health care: is it time to set out more clearly what is funded by the NHS? Research report. Nuffield Trust.