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At the heart of general practice since 1960

We need to talk about NHS rationing

Dr David Turner

A woman requesting breast reduction.

A child with severe behavioural problems in need of psychological assessment

A seventy year old brought to tears daily with knee pain, waiting for physiotherapy.

A new cancer drug costing thousands per month that has just received NICE approval.

What have these patients got in common? They all have a legitimate claim on the NHS pot of money for funding.

The recent announcement that NICE has approved nivolumab for treating patients with certain types of advanced lung cancer is fantastic news for those patients and will add valuable months to their lives.

There is, though, a rather large pachyderm in the room, which sooner or later needs to be faced. I’m afraid all of us – doctors, patients, managers and politicians – seem reluctant to address the rather obvious reality that NHS coffers are not infinite. Funds for healthcare are always going to be finite and even with the best political will in the world (and we certainly don’t have that at the moment) we cannot pay for everything.

Funding an expensive cancer treatment to give someone extra time on earth will impact on other aspects of healthcare. Increase funding to one area and others will suffer with reduced services and longer waiting lists.

Do we say only disorders that can be fatal go to the front of the queue?

Many will say we should prioritise the most serious illnesses which can kill quickly such as heart disease or cancer. Nobody dies from osteoarthritis, but thousands suffers tremendous pain every day while waiting joint replacement surgery. It’s also not unheard of for people with mental illness to kill themselves while waiting to see a psychiatrist.

Name virtually any condition or disease and there will be individual sufferers and support groups making their case as to why more taxpayers' money should be spent researching into or treating their disorder.

The reality is everyone’s health matters to them more than anything else and few people will be altruistic enough to say public money should be spent treating others before themselves and their loved ones.

I don’t claim to have the answers, but unless we start to talk more openly about the very real issue of rationing in the NHS we are just postponing some very serious questions for the future and they are not going to get any easier to answer.

Dr David Turner is a GP in west London

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Readers' comments (6)

  • How do we get Joe Public to start recognising this and start the debate proper?

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  • It's political suicide for Labour or Tories to discuss rationing. One side promises a ruinous blank cheque, the other sticks its fingers in its ears and sings "La La La" whilst pumping out statistics showing that everything is rosy.
    Resolution by crisis is the only answer. As services collapse domino style in the next decade the politicians will have to face the music.

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  • Only way this debate will ever start is when service is about to collapse. No politician will go anywhere near it till NHS is dead.
    At present all they are doing is leaving that dirty work to us/ CCG. We gladly comply with it by reducing referral, trying to cut down medicine cost,seeing extra patient so as to reduce A&E attendance and doing unfunded work.
    If we work to rule and don't bend our back backwards. secondary care will not be able to cope with extra work coming their way. And they will pressurize politicians to think along lines of rationing.
    But GPs think its their duty to save NHS.

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  • Doctor McDoctor Face

    94 year old patient with dementia and other morbidities just had a stroke. Thrombolysed, prolonged hospital admission now discharged to a state funded nursing home on statins and all sorts. We need a grown up debate about when intervention actually has a purpose.

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  • Sadly Politics tends to swing from one extreme to another. Liberalism died with Lloyd George

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  • The big folly is the belief that preventative medicine is cost effective. Anything that increases the number of elderly, almost all of whom will rely on the state to some degree to care for them, increases the financial burden on that state, doesn't decrease it. The other thing we are fighting is the emotional power of the word cancer. At any charity running event there will be far more people running for cancer research than mental health, even though chronic mental illness is a miserable state. And god help anyone that asks for money to help with addiction research.

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