20 pages worth of notes containing lecture notes, summary of academic literature and relevant case law and legislation. Considers resource allocation in the NHS, with a particular focus on scarcity and rationing strategies [and the legal and ethical implications of them].
The Provision of Healthcare Services: The NHS, Resource Allocation and Public Health:
- Need to think about demand- how to make the demand for NHS less [rather than looking solely at the abilities of the
NHS]
- Pressures in social care as the NHS’s greatest external threat
- Need to distinguish between fair and unfair rationing
- Need to look to the social and economic drivers of ill health - not all within the remit of NHS restructuring
Scarcity in the NHS:
- 1948- creation of the welfare state
- Initially assumed that the population would be healthier- and costs would decline [not the case]
o David Hunter- NHS founded on a fallacy that there was a finite amount of ill-health, that once removed, would
result in the maintenance of health and provision of healthcare becoming cheaper as the need for it dropped off.
Why are resources so scarce despite increased funding?
- Ageing population.
o 2018 Drazi Report:
Number of people over 65 will increase by 33% in 2030- Will drive a rising tide of chronic illness.
o Alongside higher life expectancy, we haven’t improved the health side of it- longer lives doesn’t mean that costs
should increase inevitably – it’s that they have health issues.
o It’s when we are old that use the most healthcare
o Funding crisis- old people don’t pay tax but they’re using the most
- Technological and scientific progress has led to more and better treatments
o They’re also more targeted
o Also normal conditions like menopause and high blood pressure being treated now- increasing the number of
people eligible to become patients- just an overall higher standard
- Patients’ expectations have risen dramatically (fuelled by ‘self-diagnosis’ via the internet)
o 1948- expectations were low
o Now, everything provided
o Taking things for granted
- When a service is provided free of charge, there are fewer constraints on demand - elastic demand- people wanting to ask
for help for small illnesses
- Burden of clinical negligence claims- has increased
- Providing the whole population with optimum medical care is unaffordable.
o Impossible to give everyone the best treatment
o We have scarce resources and need to do the best with them
Rationing in the NHS
- Alan Maynard: the important task is to ensure that rationing is fair and transparent [as he believes that rationing is
inevitable]. How we ration as the most important.
o A health service in political denial stunts the development of socially agreed rationing principles
- Ted Schrecker: more should be done to interrogate the assumptions about scarcity
o The inevitability of scarcity rests on the assumption that the current budget is an appropriate one- questionable
o Should be subject to political and ethical analysis
o Why are resources scarce in some setting but not all?
o We accept that the NHS contains the inevitability of hard choices in healthcare- but comes with little scrutiny of
the disabling if not homicidal impact of those choices- people not critiquing the political commitments driving
them or acknowledging that they seldom affect the rich
Organisation of the NHS:
- Activities of the NHS can be split into 3: commissioning services, providing them and monitoring their provision.
- Money no longer awarded in block grants- but instead following the patient- hospitals now have to compete for business-
an aspect the Conservative govt believed would drive costs down and quality up
Constitution:
1. The NHS provides a comprehensive service, available to all …
2. Access to NHS services is based on clinical need, not an individual’s ability to pay …
3. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of
finite resources.
- A balance
Clinical Commissioning Groups:
- 2018-9: CCGs received £76.5bn of NHS England's total budget of £113bn
- Similar competitive motivations - but according to Lindsay Stirton, in practice it has proved difficult or introduce
competition to the health service
o People don’t shop around for healthcare and have little information regarding their best options despite an active
attempt to provide more info for people
- All GPs involved
- 195 CCGs control around two-thirds of the NHS budget. All GP practices are members.
- Conflicts of interest inevitable?
o Criticisms of the reform that took place in 2012
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