Healthcare rationing is used by health insurers, the government and individuals to save money. Most of us believe that if there is a treatment available, no matter what it costs, and no matter what chance there is for a positive outcome, it should be made available to us. We get frustrated when we are told we can’t have it or we’ll have to pay extra for it. However, since funds are limited, then our options are limited, too, in a variety of ways.

A survey of almost 3,000 doctors by Doctor and Hospital Doctor newspapers found that one in five doctors know patients who have suffered harm as a result of rationing. More than 5% of GPs surveyed also said they knew of patients who had died as a result of being denied treatment on the NHS. (2009)

Waiting lists, clinical decisions, approved drug lists and spending priorities are all mechanisms to manage limited resources. Choices have always been made about which patients should receive treatment and which should not. Many people feel uneasy with the process of rationing due to the fact that decisions are being taken on an ad hoc basis by individual Primary Care Trusts (PCTs) in England, Wales and Health Boards in Scotland.

Critics have pointed out that if the health service is to remain a national one, it is unacceptable that treatments are available in one area but not in the next. A recent example of this ‘post code lottery’ is the use of the drug herceptin in tackling the early stages of breast cancer. While some PCTs were prescribing the drug, others were refusing to prescribe it due to cost. (2006)

In the UK health authorities take guidance from the National Institute for Health and Clinical Excellence (NICE) in England and Wales and the Scottish Medicines Consortium (SCM) in Scotland. These bodies decide if new drugs are cost effective and if they should be offered to NHS patients or not. A recent example of this is, in 2006, the SMC decided not to recommend Temozolomide (a brain tumour therapy treatment) as it declared the drug did not represent value for money. This decision was taken despite 36 of Britain’s leading cancer specialists writing to Patricia Hewitt, the Health Secretary at Westminster asking that the drug be freely available on prescription.

East Suffolk NHS Trust was heavily criticised for proposing that obese people should not receive hip and knee replacements. The ban would apply to people with a Body Mass Index (BMI) of 30. (This would be, for example, a woman who is 1.58 meters tall and weighs 75 kilos, or a man who is 1.78 meters tall and ways 93.8 kilos)