NHS rationing must be based on spending rules, not treatment blacklists

NHS rationing must be rooted in rules on how public money is spent, rather than explicit lists of services the NHS must or must not provide, a health think tank has argued.

The Nuffield Trust looked at the feasibility and desirability of introducing an explicit, national package of care for the NHS in England.

The trust concluded that developing a detailed national package of NHS services was ‘likely to be unworkable, and implementing it may lead to adverse consequences’. Any list of NHS services would be technically challenging to develop and enforce, limit local autonomy and be vulnerable to national political pressure, it said.

The Nuffield Trust said the NHS should instead establish a set of principles to ‘shape how public money is spent in the NHS and, conversely, inform decisions about what will no longer be paid for’.

In addition, the NHS Commissioning Board should use NICE guidance as the basis for a list of the treatments that public money should not be spent on in the NHS, the trust said.

Commissioners should also be benchmarked for how effectively they follow guidance on cost-effective commissioning, it argued.

Dr Judith Smith, head of policy at the Nuffield Trust, said the NHS reforms were entering a new era ‘which could result in more variation in the care that is provided to patients’.

‘The current system for defining what is in and out of the NHS 'offer' is far from ideal,' she said. 'Many people believe it is opaque and that your postcode can determine whether or not you get access to certain treatments.

‘The NHS Commissioning Board should work closely with clinical commissioning groups to ensure they are not deviating from national guidelines about what to fund and what not to fund, unless there are good reasons for doing so, and that any decisions made locally are subject to proper public scrutiny,' she said.

‘A failure to get this right could lead to greater calls for defining at a national level what is funded on the NHS and what is excluded, which we believe would have significant drawbacks in terms of limiting the autonomy of local clinicians to make decisions based on what is best for their communities.’

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