Again today I had to tell a patient that an effective treatment was not available for them because NICE had deemed it to be "not cost-effective", which makes me wonder what we should be providing on the NHS. Here's 5 yes and 5 No:
Yes:
1) Cancer drugs-nearly all of them (OK I'm an oncologist, so I'm biased, but I seriously object to the way NICE works against non-curative treatments. more later)
2) Interferon for MS
3) Alzheimers drugs
4) Community rehabilitation services (eg community physiotherapy)
5) IVF (Actually I think this is rather controversial, but I'm in the lucky position of having children-I am sure I would want IVF to be available if we didn't)
No:
1) Any cosmetic procedure-including tattoo removal, breast reduction, breast augmentation, botox etc. Not including reconstruction for victims of burns/accidents, and exceptions for disfiguring congenital abnormalities obviously
2) Transport to and from hospital unless for real medical incapacity. I'm sorry but my hospital spends nearly (maybe more than) £500,000 per anum on transport, and I reckon at least half of this is for people who could come under their own steam (if they could find anywhere to park...). If needed for financial reasons, this should be funded, but by social services, not the NHS.
3) GP out of hours services. What I mean by this is that I do think that patients really can suffer through the fact that their GPs no longer cover out of hours work, and god knows what it costs to pay for all the out of hours services
4) European working time directive what are we playing at? the whole system of looking after patients in hospital has completely collapsed due to this directive. and again, what is it costing in junior doctors' pay? Unbelievable
5) Patricia Hewitt's salary £135,337-for what?
OK so I was struggling to find things we shouldn't pay for, but I bet there are plenty I haven't thought of-would be grateful for any views
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5 comments:
There should of course be limits to the amount of treatment available for IVF, but as someone lucky enough to become a father recently due to this, I wish everyone else access to it.
I could probably be talked into paying for most of those exclusions which doesn't mean they are not good candidates for that category.
What would replace the GP OOH services? Is it less costly to encourage people to consult NHS Direct, attend Walk-In Centres (where they exist) or A&E Depts.? Or, perhaps the BBC might run a series on diagnosing minor illnesses and developing stoicism.
Regards - Shinga
I do think that patients really can suffer through the fact that their GPs no longer cover out of hours work but you don't want to pay for GP OOH? I'm confused?
EWTD - yes, it's stupid, but getting rid of it means leaving the EU, which is kind of a big decision.
This sort of rationing approach is going to be necessary sooner rather than later, and seems to me to be fairer than rationing either by the famous "post-code lottery" or by denying health care to those supposedly responsible for their conditions (eg smokers and lung cancer). Doing an Oregon in a country of 66m people is going to be hair-raisingly complicated and expensive though.
Its not that I dont want to pay for GP OOH sevices-I want the GPs to do it within their contract and not pay for expensive regional out of hours covering services which are a) very expensive and b) generally poor for patient continuity especially those with chronic or terminal illness.
You can't have local people deciding what local services should be available without a postcode lottery. I don't know what the solution to that is, but we have a postcode lottery at present despite what you may be told by the government.
I certainly would not deny health care to those "responsible" as you say for their conditions.
Not a bad list. I'd take IVF off the 'always free' part thought; There needs to be a partial charge for 'elective' health services such as these I think - maybe equivalent to what one would pay for a set of crowns.
And elective caeserians for too-posh-to-push mums could be charged for as well (though not caesars for clinical reasons obv)
And what about sports injuries? OK, traumatic damage should be treated free, clearly, but what about follow-up care? Physio and that sort of thing? Scans? A case here for charging, too, I think.
And twenty quid a time without doubt for OOH services. That should cut demand by 90%.
I can see a case developing for insurance for 'NHS +' services; medical services that are not free but are cheaper than private care.
*Every* treatment decision is a rationing decision, and any attempt to impose a homogeneity of medical decision making across the nation is doomed to expensive bureaucratic failure.
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