It’s inevitable that NHS resources will be prioritised. The victim of a major and life-threatening trauma, for example, will always be treated before someone whose medical needs are less immediate.
But these decisions are based on medical need and clinical knowledge of which patient needs to be treated most urgently. The questions now being asked with greater frequency are not only where care or treatment can be prioritised, but when it can be denied on the basis of cost and a lack of resources.
The root cause is of course the NHS’s perilous financial situation. Experts have predicted the health service could face a deficit of £30 billion by 2021. To put this into context, that’s roughly the equivalent of a fifth of the entire national budget deficit. The funding gap has been exacerbated by the ever-increasing demands on the health service’s resources by a growing and ageing population. Quite simply, the NHS pie isn’t big enough to go around.
The result has been delays to operations, but increasingly restricted access to care and medication – with NHS managers having to tackle the philosophical and ethical questions of whether it is right to deny patients access to particular medications because of their cost, or to deny treatment on the basis of a patient’s age, condition and life expectancy. The National Institute for Clinical Excellence has regularly been in the newspapers in recent weeks for prohibiting the use of particular medications on the NHS on the basis that the medications are expensive or do not offer sufficient value for money. There are also numerous examples of media stories in which official guidance has been published that would limit access to life-extending treatments for patients with severe conditions – again made on the basis of expense and cost-effectiveness.
Most recently, the Cancer Drugs Fund has been granted £160 million in additional funding to provide patients with access to life-extending medications – again highlighting the demands on the health service.
So how can the NHS be tackled in order to provide more resources and better access to care? The answers have been plentiful: increases to the NHS budget, an NHS tax, the introduction of charges for the likes of GP services, and of course increased use of the private sector to deliver NHS services and achieve financial efficiencies
There’s no silver bullet to solve the financial woes of the health service, and ultimately increasing its budget will provide no more than temporary respite from the demands on its resources. Even if funding is substantially increased by new charges, increased taxes or taking from the likes of defence, international development or the welfare state, the reality is that demand will always outstrip supply.
In the context of the general election, this means that the political parties and their health spokespeople will not be able to just set out a vision for the future of the NHS but will have to answer uncomfortable questions about how current resources are allocated, even if this means some patients do not have access to the treatment and medication they require.
