NHS ‘Postcode Lottery’: Consistent Care or Financial Dilemma?
August 8, 2012
The Fresh Outlook
Can we always expect treatment to be consistent and always accessible across the UK when numerous factors contribute towards decision-making?
Various NHS trusts around the UK have come under pressure this week for seemingly denying access to certain treatments in order to save money. This will undoubtedly reignite debates which have surrounded the NHS in recent years; issues such as whether or not the ‘postcode lottery’ is more than a myth in practice, and whether or not NHS trusts should bear the brunt of criticism angled at how resources and treatments are allocated in the health service.
The issue of NHS funding and the budget will always be contentious. Due to the current economic situation, the NHS is experiencing increasing pressure from all angles to provide a consistent and effective service, which is very difficult to provide within its tight budget.
The issue of denial of treatment has sparked responses from organisations such as the National Institute for Health and Clinical Excellence (NICE), which provides the framework for quality standards in the NHS, and also makes decisions on which particular treatments and drugs are available to patients. Sir Michael Rawlins, chair of the non-executive directors at NICE, has stated that there were examples of NHS trusts using “delaying tactics in order to circumvent the legal obligations they have to provide treatment and drugs recommended by NICE within three months”.
On the other hand, other individuals and organisations believe that just because a particular drug or treatment has been approved by NICE, it doesn’t necessarily mean that it is the most effective method. For example, a particular drug might be just as effective for a patient’s needs, and may be more cost-effective than the NICE-recommended drug, when all the various factors are taken into consideration. These factors are based on each patient’s individual needs and requirements.
The chairman of the NHS Alliance, Michael Dixon, has taken a pragmatic view of the current situation in the eyes of those who disagree with NICE. He stated: “No one is trying to save money for the sake of it,” but, he conceded: “sometimes there are more cost effective ways of treating patients, rather than cures advocated by NICE.”
This view may be considered negative; however, it has been argued that there will always be an element of prioritisation with regards to the way in which resources and drugs are budgeted across the UK.
Another issue related to the denial of services and treatment is the ‘postcode lottery’. This phrase refers to the inconsistency and imbalance of treatments available, with some people being denied access to treatments which could be available elsewhere. NHS trusts have attracted criticism over the past few years for this disparity.
The Fresh Outlook spoke to Andy and Yvonne, two medical and surgical outpatients, who have received their care in the NHS South Central and South West Strategic Health Authorities, as well as receiving care in other NHS trust areas in the UK.
Andy, 38, talked about his personal experiences during the outpatient process. He said: “The care I receive at my consultant appointments has always been consistent and personal [in the NHS South Central trust area]. At my GP I do not always receive the same treatment but this is to be expected as GPs have to have such a wide range of expertise; this is why I am referred to a consultant.”
Andy has moved around the UK and received care at a number of different NHS trusts. He continued: “On the other hand, I have been to appointments where the consultants do not seem as clued up about my progress. I am supposed to have a range of routine exams and tests to check my progress but these are not always carried out. Doctors who specialise in my condition should be aware of these checks but this isn’t always the case.”
Yvonne, 41, has also mainly had positive experiences from her NHS appointments. She talked about the availability of medication at her bi-annual appointments and shared her views about communication in the health service:
“During my time in the south and south east of England, my care was very good on the whole. The communication between my GP and the hospital was efficient, which made the process much easier for me. I did have problems when I moved to the west of England, as my new doctor didn’t have all my relevant information which meant that it delayed the process and that slowed my progress down too. I was told that all the information would be passed over but this wasn’t the case and it meant that it took a while for my new doctors to get a detailed picture of what was happening.”
Talking about medication, she said: “I have always had access to the medication that I have wanted or needed, but in some cases I have not been made aware of newer treatments. I have never been denied access to treatment, however.”
From Andy and Yvonne’s experiences, it seems the case that treatment across the NHS is fragmented and there are obvious disparities and different standards of care depending on which area the patient lives in. On the other hand, they have both had positive experiences, and for the parts of the care that are the most important, the NHS has delivered.
Many, including Yvonne, are aware that there will be differences between what care is available in one area of the UK and what is available in another. From their experiences as part of an outpatient support group, it seemed the case that patients in general have received consistent care, but have sometimes been faced with cost-effective measures. Most of these individuals would agree, however, that these measures have not adversely affected their treatment.
Conversely, there have been frequent reports of people who have fallen victim of the ‘postcode lottery’ in the UK. In 2011 a government analysis body, the NHS Atlas of Variation, revealed the extent of the problem, and found that there was an “unwarranted inequality” that had to be ironed out.
However, it appears that where a patient lives may not be the only factor which influences their potential treatment. The Guardian recently reported on a survey published on doctors.net.uk which discussed the argument for the withholding of treatment for clinical reasons for those who smoke or are severely overweight. The practice, which is informally known as ‘lifestyle rationing’, is becoming more frequent in the everyday functioning of the NHS.
The medical networking website found that 54% of the registered doctors who returned a verdict replied ‘yes’ to the question: ‘Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?’ This survey opens up another debate which could see patients being refused treatment if, in the clinical circumstances, it would not be practical or efficient to do so. Dr Tim Ringrose, chair of the website, believes that the findings of the survey show a “significant shift in doctors’ thinking brought on by the need to save £20bn by 2015”.
The debate surrounding NHS funding and how NICE approves and budgets for treatments will always be at the forefront in the media. It would appear that in some cases, the NHS can easily provide patient-specific treatment which is not compromised by cost. However, there are obviously times, where very specialist and uncommon treatments are concerned, when patients can lose out. Factors such as where a patient lives should not contribute to a denial of treatment, but there have been cases where this seems to be the situation.
Few would argue against the existence of a ‘postcode lottery’; and while many patients do receive the treatment they want and need, the question remains as to how the NHS can ensure that all patients get what they need and don’t have to rely on the ‘luck of the draw’.
By Stephen Jennings
[Image courtesy of hang_in_there]