Northerner
Admin (Retired)
- Relationship to Diabetes
- Type 1
Rationing to some extent has existed within the NHS for years now; for instance, for cosmetic procedures, alternative therapies and IVF. This makes financial sense at a time when the burden of ill health continues to rise.
Over recent years, however, increasing financial constraints have been dictating even basic "necessary" treatments. Currently, procedures such as cataract surgery and hip or knee replacements are not performed unless there are significant symptoms. Scorecards used to decide if patients have significant symptoms include immobility, rather than just pain. Eye tests for cataracts would have to confirm that the condition affects quality of life. Yet corrective procedures often significantly improve patients' lives.
Unlike many other countries, GPs in the UK have always acted as gatekeepers to secondary care services. But over-zealous gatekeeping has been socially undesirable, even if there was a sound clinical reasoning behind every decision to refer a patient, or not. The goalposts are changed yearly, so a patient now has to be more disabled for a knee replacement or surgery to relieve carpal tunnel syndrome. Often, arbitrary non-evidence-based thresholds are used and handed down to GPs.
http://www.guardian.co.uk/society/2013/feb/12/nhs-rationing-not-driven-cost
Over recent years, however, increasing financial constraints have been dictating even basic "necessary" treatments. Currently, procedures such as cataract surgery and hip or knee replacements are not performed unless there are significant symptoms. Scorecards used to decide if patients have significant symptoms include immobility, rather than just pain. Eye tests for cataracts would have to confirm that the condition affects quality of life. Yet corrective procedures often significantly improve patients' lives.
Unlike many other countries, GPs in the UK have always acted as gatekeepers to secondary care services. But over-zealous gatekeeping has been socially undesirable, even if there was a sound clinical reasoning behind every decision to refer a patient, or not. The goalposts are changed yearly, so a patient now has to be more disabled for a knee replacement or surgery to relieve carpal tunnel syndrome. Often, arbitrary non-evidence-based thresholds are used and handed down to GPs.
http://www.guardian.co.uk/society/2013/feb/12/nhs-rationing-not-driven-cost