Madsen Pirie

Yet another story has appeared about the so-called “postcode lottery” in the NHS.  If there is any kind of local decision-making, it follows that different policies will be followed, and different treatments will be available.  It is thought by many to be a good thing that NHS people in an area can take decisions they think appropriate for that area, but the result will be a postcode lottery.

“The number of patients undergoing common surgical procedures varies widely across England because of funding restrictions, figures show. Local NHS rationing of hernia repair, hip and knee replacements, cataracts and varicose vein surgeries has led to a ‘postcode lottery,’ say researchers.

And while there had been much debate about the “clinical value” of some elective surgical procedures, there was poor consensus on which treatments should be restricted to save costs, the Imperial College London team said.

The study’s author, Steve Beales, describes variation as “a bad thing” and calls for national guidance.  What the report does not point out is that procedures have to be limited because the resources needed for each – time, finance, personnel, space – cannot simultaneously be used for another.  This means that there have to be priorities as NHS managers decide on the priorities for each.  Money spent on keeping a premature baby alive cannot simultaneously be spent on keeping several kidney patients alive.  Resources used on varicose veins cannot be simultaneously allocated to hip replacements.

The NHS has turned health into a zero sum game in which spending resources on one person means that resources must be denied to another.  Within a fixed budget that caters for everyone, this is an inevitable result.  Access to NHS treatment is therefore competitive.  To campaign for more to be spent in one area of treatment means that less can be spent in another.  To demand an expensive drug for one treatment means denying drugs to other people.  This will happen whatever the size of the NHS budget.  The latest story exposes yet another failing of the entire structure of the NHS.  There will be no end of such stories because the NHS is a fatally flawed concept.  It is time for it to be wound up and replaced by a better system that allows more weight to the opinions of patients than it does to management decisions by so-called ‘experts.’

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