“Sexual health and district nursing services are under particularly severe strain”by Anna Charles / March 23, 2017 / Leave a comment
Read more: Back in the emergency room
There is not a health system in the world where decisions about resource allocation do not have to be made. Where resources are finite—which is the case in all health systems but particularly publicly funded systems such as the NHS—decisions on how to prioritise, allocate or, to use more emotive language, “ration” resources are inevitable. The unprecedented financial and operational pressures facing the NHS mean these decisions are becoming more frequent and more difficult. At The King’s Fund, we have looked at how different services have responded to financial pressures, and found that sexual health and district nursing services are under particularly severe strain.
Sometimes, decisions about the care patients are entitled to are taken explicitly by central government and NHS national bodies. These are often published in policy documents and are usually easy to recognise, for example, decisions taken on the funding of drugs and new technologies by the National Institute for Health and Care Excellence (NICE). But there are also many decisions taken at a local level by NHS organisations and doctors that can be much less explicit and harder to identify.
There are a number of ways NHS organisations can respond when their budgets are not sufficient to cover the cost of the care they are providing. Recently, many NHS trusts have gone into deficit; hospitals and other NHS providers accrued a deficit of £900m at the end of the third quarter of 2016/17. Another way they can respond is to cut spending, and there are several ways they can do this. One is to delay treatment, which we have seen in the recent rise in waiting times for routine operations such as hip and knee replacements. They can also stop offering treatment to certain groups of people—for example, in some areas access to hip and knee replacements has been restricted for people who smoke or are obese—or apply blanket bans (although, in reality, there are very few treatments denied to all patients in all circumstances). Organisations can also respond by cutting spending per patient, which may dilute the quality of the service delivered.
Given the size and complexity of the NHS, it would be very difficult (if not impossible) to detail how financial pressures impact on the availability and quality of care across the…