Rationing in the NHS

This briefing sets out to highlight some of the key issues and dilemmas facing policy-makers and practitioners in the area of rationing. It does not attempt to be comprehensive, but is intended to be a useful appraisal of current approaches to rationing for Members of Parliament (current and prospective).

The paper puts forward some ideas and views that we believe should be taken into account when considering how rationing decisions are made in the NHS. It is also informed by literature in this field and by an analysis we have undertaken into the nine publicly available sets of policies covering a non-representative selection of 15 clinical commissioning groups (CCGs). These cover a mix of both urban and rural areas, as well as different levels of deprivation.

The key message is that rationing is a fraught and difficult area with no easy answers. Decisions can only be made on an objective and scientific basis up to a point, as they embody societal and personal values which are often fundamentally irreconcilable and sometimes not consistent over time or between different cases. Trade-offs and compromises are inevitable and attempts to avoid making rationing decisions are common. We can, however, do better at avoiding the worst of the fudges and some common errors, including assuming that rationing some treatments will make a significant difference to NHS finances, or that there are satisfactory technical answers that will remove postcode variation without unintended consequences…

Read the report at Nuffield Trust.