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Academics call for explicit ‘menu’ of NHS services

Politicians who avoid their responsibility to engage openly and constructively in debates over NHS rationing are taken to task in a new King’s Fund report.

The report, Rationing in the NHS: principles and pragmatism, argues that explicit national policy should override local discretion in setting out which services the NHS will provide — that is, ‘what is on the menu’.

The authors, Bill New and Julian Le Grand, accept that the task of ‘choosing from the menu’ for different patients is best left to individual clinicians.

But they point out that the Department of Health has failed to provide any consistent national guidance to health authorities on what should, or should not, be regarded as universally available NHS provision. The result is that some services, such as IVF or continuing care, are available in some parts of the country but not others. The report acknowledges that there is little public acceptance of the need for rationing and that even minor attempts to limit services have met with great difficulties.

‘We cannot continue to let rationing decisions be made arbitrarily and spontaneously, in response to excessive coverage in the media’, said Robert Maxwell, chief executive of the King’s Fund.

But although the debate over health care rationing will intensify as a general election approaches, politicians of both left and right will continue to avoid any explicit statement on how, or what, the NHS should ration.

Rationing in the NHS: principles & pragmatism. £9.95. King’s Fund: 0171 307 2591.