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NHS cash pressures causing bad rationing decisions

Most health/social care leaders want Cancer Drugs Fund to end

Adrian O'Dowd

Thursday, 19 February 2015

The NHS is starting to make unfair and inappropriate decisions on rationing healthcare in England due to growing financial pressures on the health service, according to a leading health think tank.

The Nuffield Trust has today published a briefing paper Rationing in the NHS aimed at current and prospective MPs in which it warns that there is a growing lack of legitimacy in the way many rationing decisions are being made.

A Nuffield Trust survey of 100 health and social care leaders, also published today, has found that more than a third of respondents feel the current approach to rationing healthcare is unfair and 7 in 10 want the Cancer Drugs Fund to be wound up.

In the paper, Nuffield Trust’s chief executive Nigel Edwards argues that some rationing is inevitable in any health system.

However, he says that the NHS has to do better at avoiding “fudges” when it comes to making decisions about which drugs/treatments should be funded by the NHS, whether these are made at a local level through commissioning policies, or at a national level through policies like the Cancer Drugs Fund.

Policymakers and commissioners should also not overestimate the ability of rationing approaches to reduce NHS expenditure, he added.

“The rationing process in the NHS is messy,” said Mr Edwards. “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.

“This approach worked while there was money in the system. But as funding pressures grow, the messiness of these compromises becomes rather harder to defend.

“This leads to decisions of questionable legitimacy like throwing large amounts of money at individual conditions, or commissioners having to use clinical criteria as a mechanism to make savings. We must do better at avoiding the worst of these kinds of fudges in future.”

Although rationing decisions were unpopular with the general public, there was room to improve the level of transparency in the system, said the authors, who proposed greater use of public consultation and better communication about local commissioning decisions.

The accompanying survey of health and social care leaders found that more than a third (36.7%) of respondents felt the current approach to rationing was unfair, but more respondents (43%) said it was fair.

Many (59%) of the leaders said the Cancer Drugs Fund should be wound up and responsibility handed to NICE, while 11% said the Fund should be wound up and responsibility handed to another body.

The briefing paper recommends that NICE should be given responsibility for decisions about expensive cancer drugs currently considered under the Cancer Drugs Fund.

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