The original founders of the NHS envisaged a first class health service for all. The service was to be funded out of direct taxation in order that the better off classes contributed more towards its costs, while the poor (it was assumed) would benefit the most. The NHS was founded on a principle of equity, and it was assumed that it would improve the health of the nation and more specifically of the poorer classes, who had previously had access to less comprehensive health care than the more advantaged classes who had been able to pay. It was said that everyone should have access to a comprehensive range of services – primary, secondary and tertiary care. Basically the NHS nationalised the existing provision, which resulted in considerable inequalities in spending on health care and the provision of services in different regions.
There has always been inequalities in health care between regions and people denied treatment on the basis of lifestyle or age and it has always remained possible for people to pay privately for treatment in order to avoid waiting and/or to have treatment that isn’t really considered medically necessary. It is certainly the case that the overall health of the population has improved since the NHS was introduced, although to what extent this is directly attributable to the service is hard to determine. Part of the general improvement in health is the result of improved living standards in Britain after the Second World War and other elements of welfare provision other than the NHS itself. Jones (1994) suggested that ‘Good Health Services do not produce a fit and healthy population overall, they produce an aging population with a higher proportion of handicapped and infirm’.
Despite increased spending on health care, there always seems to be demands for more, partly because of the increasing elderly population (which by 2010 will have greatly increased due to the post second world war baby boom population reaching 65 or thereabouts), because of advances in medical science and high tech medicine and because wage inflation/staffing costs have been higher than the general growth in the economy. Also there has been a need to replace older hospital buildings and provide services where existing provision has been inadequate. Personally I feel that we will never be able to resolve the rationing dilemma because whatever funding method is used and however much money you spend on healthcare you are always going to reach a point at which the cost of treatment begins to outweigh the benefits. The most overt form of rationing is the use of waiting lists to delay demand for treatment, but a doctor’s receptionist who screens calls to the doctor is also effectively using an indirect form of rationing. There is, and always will be, a gap between supply and demand where health services are concerned – the more we have the more we want, our expectations increase in line with the quality and availability of medical interventions. The UK spends twice as much on health care as it did 50 years ago, but even if health service budgets were doubled again we would still need some form of rationing. Spending more money on the NHS could alleviate some rationing decisions, but evidence suggests that no amount of money will fully satisfy all demands, so rationing is inevitable.
Rationing does not eliminate the need for difficult allocation decisions i.e. who gets what treatment and when. Rationing occurs at various levels in the NHS: • at parliamentary or government level,
• by individual health authorities
• at a clinical level by health care professionals :- rationing between patients i.e. if there is only one intensive care bed and two patients, who gets it? People can be denied treatment on the basis of age and/or lifestyle. • Nurses ration time between patients and rationing occurs between specialists i.e. should a hospital provide more intensive care beds or orthopaedic beds? At the...
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