Report

The doctor might see you now

This report from UK think tank the Adam Smith Institute looks at healthcare rationing in the NHS before and after the Covid-19 pandemic.

Dr Robert Sutton, a junior doctor in Wales and recent graduate of the University of Oxford Medical School, explains how the NHS is failing to meet its central goal: The National Health Service Constitution promises universal access to care, free of charge, based solely on clinical need. This premise is extremely popular with the British public. No major British political party has indicated any intention of changing this promise. This popular goal is a fiction. It is impossible for any healthcare system to provide unlimited care. Rationing, of some description, is inevitable because of limited resources. The NHS hides the extent of rationing by using indirect means, often avoiding the associated difficult ethical questions. Some systems ration healthcare through prices. The NHS rations healthcare through opaque criteria such as waiting times, clinical criteria and administrative hurdles. The end result for patients is near identical to a system that rations through prices. Despite claims that treatments are made based on best-value, there are often arbitrary, political decisions made by politicians and the NHS regarding which diseases and treatments to prioritise. These decisions are made with limited disclosure of reasoning or public involvement. This rewards the loudest and best-connected lobbyists. The rationing of healthcare has grown steadily with an ageing population, increasing treatment costs and limited financial resources. The Covid-19 pandemic has magnified rationing pressures.