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Funding for the NHS is an ongoing topic of debate. But how funding impacts on the treatment doctors can provide goes beyond debate, and becomes a reality that affects patients’ lives every day.
The benefit of the NHS system in the UK is that treatment is available to all patients who need it, regardless of their financial or social status. But given that the majority of treatment is free of charge for those who receive it, who is it that pays for these services to be provided? Well the simple answer to that is that the large majority of this is funded by way of general taxation and National Insurance contributions paid by the public, with the remainder of this being made up from the services that do cost the patients such as prescription charges and NHS dental care. However, it is the government who allocates the funding to the NHS and this then has to be distributed accordingly by the various Clinical Commissioning Groups within the NHS to the various services that they provide to the public.
The BBC Health News website has recently published an article concerning the impact of funding on providing operative procedures and drug treatments and how decisions are made into which treatment can and cannot be provided. Below we will consider this topic in further detail and the overall impact of this on the patients requiring treatment.
Are operative procedures and drug treatments being rationed?
According to a recent study performed by the British Medical Journal vital NHS operations and drug treatments are being increasingly rationed in England. They report, for example, procedures such as hip and knee replacements, cataract surgery, and the provision of drugs for conditions such as arthritis – care that historically has been given routinely – is being cut back. The restrictions that are now being placed on ‘non-emergency’ treatment are seen as unfair and are resulting in patients spending longer in pain or receiving no treatment at all.
When a treatment is not routinely funded on the NHS doctors can use the ‘exceptional cases’ system to make special appeals to those in charge of distributing the funding to get their patients treated. This system is normally used for things such as new drugs not yet available on the NHS or to pay for expensive treatments in unusual circumstances, but is now having to be increasingly used for vital ‘non-emergency’ services. The findings by the BMJ show that from 2013/14 to 2016/17 the overall number of requests made through the ‘exceptional cases’ system rose by 47%, with one of the staggering examples being hip and knee surgery which went up from 49 to 899 requests per year. However, just over half of the total requests made through this system were approved.
Drug treatments have been equally as affected as operative procedures. One example given in the BBC Health News article is the drug Rituximab, used in the treatment of Rheumatoid Arthritis – some local health authorities do not routinely fund this and for patients in need of this treatment their doctor will have to make a special request for this every 6 months to ensure that this treatment can continue. Having to make requests in this way can lead to delays in obtaining permission and gaps in the patient’s treatment, which can lead to periods where the patient’s pain is not being managed.
The need for doctors to try and work their way around this system certainly causes difficulties – for every case where an exceptional argument has been made, there will be plenty more which will not succeed and the patient will have to go without care. This causes inconsistencies in the treatment received by patients and can result in what is effectively a postcode lottery that will depend upon the amount of funding being applied for in each community.
The stance of the NHS and the impact upon the patient
With funding tight and the financial pressures the NHS are under ever growing the choices they are having to make become increasingly difficult.
Julie Wood, chief executive of NHS Clinical Commissioners, has been quoted by the BBC as saying, “Unfortunately, the NHS does not have unlimited resources and ensuring patients get high-quality care against a backdrop of spiralling demand and increasing financial pressures is one of the biggest issues [Clinical Commissioning Groups] face. As a result there are some tough choices that have to be made, which we appreciate can be difficult for some patients.”
It is widely accepted that the position the NHS find themselves in is not easy, but this is not to say that this makes it any easier for those patients in need of treatment which are having to wait or go without as a result of funding issues outside of their control. For each individual that cannot have the treatment they need to manage their condition funding decisions can have a huge impact on their quality of life, and it must be remembered that they are individuals rather than a simple statistic. This is not an entirely new problem and it is not something likely to go away any time soon but we must live in hope that things will change as the current situation cannot go on indefinitely.
If you have any questions about issues you have experienced with the management of your condition by your medical professional and you are concerned that you are not being provided with the necessary treatment to address this please contact a member our specialist team here, who will be happy to answer any queries you have.