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Rationing 'already widespread in the NHS for a variety of treatments'

Published 14/09/2016

Seven out of 10 of 1,039 doctors said they had witnessed restrictions to NHS services and treatments in the past year.
Seven out of 10 of 1,039 doctors said they had witnessed restrictions to NHS services and treatments in the past year.

Rationing is rife across the NHS, with patients suffering cutbacks to treatment and expensive drugs, a major survey of doctors has found.

The research, for the Press Association and ITV, found cuts to cancer treatments, costly medicines, mental health services and knee and hip replacements.

Some patients have been left to develop complications before getting the treatment they need, while others are being forced into re-mortgaging to pay for private care.

Seven out of 10 of 1,039 doctors said they had witnessed restrictions to NHS services and treatments in the past year.

Most (84%) said this was happening for financial reasons, while the second most common cause was NHS managers wanting to "manage" patient demand.

Common clampdowns include cutting access to breast reductions, varicose vein removal, IVF, and the removal of benign lumps and bumps.

Almost one in four (23%) doctors said they had witnessed "drug rationing", with some of the most common rationing occurring for cancer drugs, but also for painkillers and arthritis medicines.

Other services have been stopped because they are no longer supported by clinical evidence.

The poll of 672 hospital doctors and 367 GPs in the UK was carried out by Wilmington Healthcare, a healthcare intelligence provider.

Seven out of 10 (71%) said the cuts were increasing anxiety among patients trying to access treatment.

Two-thirds (66%) said restrictions increased the chance a patient would need to go private, while more than a fifth (22%) said patients were more likely to need an emergency admission to hospital if their condition got worse.

Most ( 94%) doctors said more rationing was inevitable, given rising demand and tight finances.

However, eight out of 10 said it was right to ration treatments to ensure the NHS could survive financially.

One doctor told how cancer patients had re-mortgaged their homes to pay for restricted treatments.

They said NHS bosses "tell us there is no rationing, when there clearly is".

Mental health doctors told how patients with dementia or depression have been sectioned when this could have been avoided with more regular care in the community.

Other doctors said patients are being left to get worse, with one giving the example of "large inguinal hernias that are 'not bad enough' to merit treatment, forcing the patient to wait till complications set in before treatment will be considered".

Another said varicose vein surgery was being "deferred until actual ulceration occurs", Another described how "a patient with varicose veins which had ruptured had to attend A&E. As she was not admitted to hospital, the referral was declined even though it was likely they would rupture again".

Another doctor said that while two out of three of Clinical Commissioning Groups (CCGs) - which decide where NHS money is spent - in their area funded outpatient antibiotics intravenously, patients under the care of the other CCG had to be admitted to hospital for care.

"This is not good for bed turnover or for the individual patients' wellbeing," the doctor said. "The CCG has admitted that this service is being withheld for financial reasons."

A girl under 10 also had funding denied to remove a large and growing cyst.

"The cyst is enlarging, so the scar will be bigger when it eventually gets removed," her doctor said.

Gareth Thomas, managing director of Wilmington Healthcare UK, said: "Our research suggests that rationing is already widespread within the NHS for a variety of services and treatments, and with budgets under increasing strain, it is likely that more patients will be subject to restrictions in future.

"One of the key issues that comes across from comments made by doctors who took part in our survey is that currently it can seem like a lottery as to who is eligible for NHS treatment for certain conditions and who is not.

"To make the system clearer and fairer for patients, the NHS at local and national level would benefit from defining and creating a more level playing field on what it will fund in the current economic climate."

Katherine Murphy, chief executive of the Patients Association, said: "NHS rationing is a growing reality of the day-to-day experience of a patient."

Dr Mark Porter, chairman of the BMA, said: "The rationing of vital health care not only causes delay and distress to patients, but can ends up costing the NHS more money in the long run."

An NHS England spokesman said: "The basis on which people receive NHS care - within the funds Parliament makes available - should always reflect the patients' ability to benefit from treatment.

"The NHS strives to ensure maximum value for patients from every penny available, whilst encouraging prevention measures to help people avoid getting ill in the first place.

"The facts are that the amount of planned surgery the NHS is funding grows each year and it will fund more operations this year than it did last."

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