Equity and rationing in the English NHS

Findings from a survey of BMA members

July 2013

Background

• Online survey sent to 2,000 doctors working in England in July 2012, via the BMA’s Intouch Research Panel

• Doctors surveyed were a broadly representative sample of consultants, junior doctors, GPs, staff grade, specialty doctors and associate specialists

• 575 doctors completed the survey, giving a response rate of 29 per cent

• Three BMA discussion papers provide a fuller analysis of the findings and the implications for policy. See www.bma.org.uk

1. Which of the following most closely aligns with your understanding of the term universal? Percentage

Everyone has access to the same range of services 44.0

Everyone has access to the same quality of services 20.0

Access to services is based on need 15.0

NHS offers a range of services that meets the needs of everyone 11.0

NHS offers a range of services that it is feasible to offer 9.0

Every possible service is available on the NHS 1.0

2. Which of the following most closely aligns with your understanding of the term comprehensive?

Percentage*

NHS offers a range of services that meets the needs of everyone 37.0

NHS offers a range of services that it is feasible to offer

34.0

Access to services is based on need 9.0

Everyone has access to the same range of services

9.0

Every possible service is available on the NHS

7.0

Everyone has access to the same quality of services

5.0* The percentages do not add up to 100 due to decimal rounding

1 = Not at all

2 3 4 5 6 7 8 9 10 = Fully0%

5%

10%

15%

20%

25%

30%

35%

Today 5 years ago In 10 years time

All r

espo

nden

ts3. How universal is the NHS?

Defined as ‘access based on clinical need, not ability to pay’

1 = Not at all

2 3 4 5 6 7 8 9 10 = Fully 0%

5%

10%

15%

20%

25%

30%

Today 5 years ago In 10 years time

All r

espo

nden

ts4. How comprehensive is the NHS?

Defined as ‘a range of services that meets the needs of everyone’

Universal Equal importance Comprehensive0%

5%

10%

15%

20%

25%

30%

All r

espo

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ts5. How much importance do you attach to

universality vs. comprehensiveness?

Universality defined as ‘access based on clinical need, not ability to pay’Comprehensive defined as ‘a range of services that meet the needs of everyone’

6.At what level of the health system should the following be applied?

Percentage (all respondents)

National Regional Sub-regional

Local

Restrictions around who can receive certain services/treatments

85.0 6.0 3.0 6.0

Reductions in what services/treatments are available on the NHS

83.0 8.0 4.0 6.0Regional given as NHS England sectors (4)Sub-regional given as NHS England local area teams (27) Local given as clinical commissioning groups (211)

7.Which national body should make decisions on restrictions around who can receive certain services/treatments? National body Percentage*

All Respondents GP Commissioners

NICE 32.0 31.2

Department of Health

27.0 21.9

NHS England 27.0 37.5

Elected officials/Parliament

14.0 9.4

* Percentage of respondents who answered ‘national’ to question 6

8.Which national body should make decisions on reductions in what services/treatments are available on the NHS? National body Percentage

All respondents GP commissioners

Department of Health

30.0 23.3

NICE 26.0 16.7

NHS England 26.0 36.7

Elected officials/Parliament

18.0 23.3

* Percentage of respondents who answered ‘national’ to question 6

9.At what level of the health system should the following be applied?

Percentage (all respondents)

National Regional Sub-regional

Local

Maximum waiting times 75.0 11.0 5.0 10.0

Decisions around access to newdrugs/technologies

67.0 24.0 4.0 5.0

Minimum waiting times 60.0 10.0 7.0 23.0

10. Which national body should make decisions on maximum and minimum waiting times?

National body Percentage* (all respondents)

Maximum waiting times

Minimum waiting times

Department of Health

28.0 31.0

Elected officials/Parliament

10.0 11.0

NHS England 33.0 32.0

NICE 28.0 26.0* Percentage of respondents who answered ‘national’ to question 9

Local autonomy Equal importance National uniformity0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

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ts11. How much importance do you

attach to local autonomy and freedom vs. national uniformity?

Rationing by delay Rationing by denial Rationing by selection

15%

26%

56%

16%

28%

41%

GP Commissioners All respondents

12. Assuming there will always be a shortfall between demand and available resources in a given year, which of the following are most acceptable to you?

Rationing by selection phrased as ‘tighter restrictions around who can receive certain treatments/services’

Rationing by denial phrased as ‘reduction in the range of treatments/services that are available’

Rationing by delay phrased as ‘patients wait longer for treatments/services’

Rationing by delay

Rationing by denial

Tighter cost criteria for new drugs/technologies

Co-payments

Increase in taxation

Rationing by selection

15%

26%

51%

23%

18%

56%

16%

28%

32%

32%

34%

41%

All respondents GP Commissioners

13. Assuming there will always be a shortfall between demand and available resources in a given year, which two of the following are most acceptable to you?

Rationing by selection phrased as ‘tighter restrictions around who can receive certain treatments/services’

Rationing by denial phrased as ‘reduction in the range of treatments/services that are available’

Rationing by delay phrased as ‘patients wait longer for treatments/services’