equity and rationing in the english nhs findings from a survey of bma members july 2013
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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 - PowerPoint PPT PresentationTRANSCRIPT
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Equity and rationing in the English NHS
Findings from a survey of BMA members
July 2013
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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
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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
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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
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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’
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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’
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Universal Equal importance Comprehensive0%
5%
10%
15%
20%
25%
30%
All r
espo
nden
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’
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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)
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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
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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
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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
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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
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Local autonomy Equal importance National uniformity0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
All r
espo
nden
ts11. How much importance do you
attach to local autonomy and freedom vs. national uniformity?
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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’
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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’