1. Equity and rationing in the English NHS Findings from a survey of BMA members July 2013

2. Background Online survey sent to 2,000 doctors working in England in July 2012, via the BMA’s Intouch Research Panel Doctors surveyed were a broadly representative sample of consultants, junior doctors, GPs, staff grade, specialty doctors and associate specialists 575 doctors completed the survey, giving a response rate of 29 per cent Three BMA discussion papers provide a fuller analysis of the findings and the implications for policy. See www.bma.org.uk

3. 1.Which of the following most closely aligns with your understanding of the term universal? Percentage Everyone has access to the same range of services44.0 Everyone has access to the same quality of services20.0 Access to services is based on need 15.0 NHS offers a range of services that meets the needs of everyone11.0 NHS offers a range of services that it is feasible to offer9.0 Every possible service is available on the NHS1.0

4. 2.Which of the following most closely aligns with your understanding of the term comprehensive? Percentage* NHS offers a range of services that meets the needs of everyone37.0 NHS offers a range of services that it is feasible to offer34.0 Access to services is based on need 9.0 Everyone has access to the same range of services9.0 Every possible service is available on the NHS7.0 Everyone has access to the same quality of services5.0 * The percentages do not add up to 100 due to decimal rounding

5. 3.How universal is the NHS? Defined as ‘access based on clinical need, not ability to pay’

6. 4.How comprehensive is the NHS? Defined as ‘a range of services that meets the needs of everyone’

7. 5.How much importance do you attach to universality vs. comprehensiveness? Universality defined as ‘access based on clinical need, not ability to pay’ Comprehensive defined as ‘a range of services that meet the needs of everyone’

8. 6.At what level of the health system should the following be applied? Percentage (all respondents) NationalRegionalSub-regionalLocal Restrictions around who can receive certain services/treatments 85.06.03.06.0 Reductions in what services/treatments are available on the NHS 83.08.04.06.0 Regional given as NHS England sectors (4) Sub-regional given as NHS England local area teams (27) Local given as clinical commissioning groups (211)

9. 7.Which national body should make decisions on restrictions around who can receive certain services/treatments? National bodyPercentage* All RespondentsGP Commissioners NICE32.031.2 Department of Health27.021.9 NHS England27.037.5 Elected officials/Parliament 14.09.4 * Percentage of respondents who answered ‘national’ to question 6

10. 8.Which national body should make decisions on reductions in what services/treatments are available on the NHS? National bodyPercentage All respondentsGP commissioners Department of Health30.023.3 NICE26.016.7 NHS England26.036.7 Elected officials/Parliament 18.023.3 * Percentage of respondents who answered ‘national’ to question 6

11. 9.At what level of the health system should the following be applied? Percentage (all respondents) NationalRegionalSub-regionalLocal Maximum waiting times 75.011.05.010.0 Decisions around access to new drugs/technologies 67.024.04.05.0 Minimum waiting times60.010.07.023.0

12. 10.Which national body should make decisions on maximum and minimum waiting times? National bodyPercentage* (all respondents) Maximum waiting timesMinimum waiting times Department of Health 28.031.0 Elected officials/Parliament 10.011.0 NHS England 33.032.0 NICE28.026.0 * Percentage of respondents who answered ‘national’ to question 9

13. 11.How much importance do you attach to local autonomy and freedom vs. national uniformity?

14. 12. Assuming there will always be a shortfall between demand and available resources in a given year, which of the following are most acceptable to you? Rationing by selection phrased as ‘tighter restrictions around who can receive certain treatments/services’ Rationing by denial phrased as ‘reduction in the range of treatments/services that are available’ Rationing by delay phrased as ‘patients wait longer for treatments/services’

15. 13. Assuming there will always be a shortfall between demand and available resources in a given year, which two of the following are most acceptable to you? Rationing by selection phrased as ‘tighter restrictions around who can receive certain treatments/services’ Rationing by denial phrased as ‘reduction in the range of treatments/services that are available’ Rationing by delay phrased as ‘patients wait longer for treatments/services’