Rationing in the NHS

Our second policy briefing in the run up to the General Election 2015 provides an overview of the current difficulties in making decisions about rationing healthcare in England.

Briefing

Published: 19/02/2015

Download the report [PDF 161.6KB]

Our second policy briefing in the run up to the General Election 2015 provides an overview of the current difficulties in making decisions about rationing healthcare in England, and sets out some of the challenges faced by policy makers in the future. 

We are producing a series of policy briefings on the issues and challenges that are critical to the longer term success of the health and social care system - the issues any Government after 2015 will need to prioritise.
Rationing in the NHS, by Nigel Edwards, Helen Crump and Mark Dayan, is the second policy briefing in our series. It looks at what public attitudes to rationing and policy-setting are; how rationing decisions are currently made and how much explicit rationing there is; how NICE and the Cancer Drugs Fund are working; and how much money rationing can save. With a series of messages for policy-makers, this briefing is intended to be a useful appraisal of current approaches to rationing for Members of Parliament (current and prospective) and does not seek to be a comprehensive exploration of what is a highly complex subject.
The rationing process in the NHS is messy. Policymakers, commissioners and clinicians have muddled through and have made a series of compromises and trade-offs. This has resulted in reduced access to treatments in some areas for reasons that have not been made clear and it has led to cancer drugs receiving priority over other treatments at a national level.  Nigel Edwards, Nuffield Trust Chief Executive and lead author
In the paper, we argue that while some rationing is inevitable in any health system, we must do better at avoiding ‘fudges’ when it comes to making decisions about which drugs and treatments should be funded by the NHS. The briefing warns policymakers and commissioners not to overestimate the ability of rationing approaches to reduce NHS expenditure.

The briefing argues that despite the lack of public support for rationing decisions, there is room to improve the level of transparency in the system. It suggests a greater use of public consultation and better communication about local commissioning decisions. The briefing commends the approach of the National Institute for Clinical Excellence (NICE) in appraising new technologies and says that NICE should be given responsibility for decisions about expensive cancer drugs currently considered under the Cancer Drugs Fund.

Alongside our policy briefings, we are also regularly surveying a panel of 100 health and social care leaders in England for their views on a range of issues, including the state of the NHS and social care system, and what they believe should be the priority areas for reform during the next Parliament. The latest survey finds that over a third of respondents felt that the current approach to rationing healthcare was unfair and 7 in 10 said that the Cancer Drugs Fund should be wound up.

Suggested citation

Edwards N, Crump H and Dayan M (2015) Rationing in the NHS. Briefing. Nuffield Trust.

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