Lecture 1 The Allocation of Health Care Resources Part I Rationing Strategies

Lecture Overview

  • Lecture Title: The Allocation of Health Care Resources Part I: Rationing Strategies

  • Institution: Sussex Law School

  • Instructor: Dr. Kenneth Veitch

Aims of Lecture 1

  • Overview of allocation strategies for scarce resources in the NHS.

  • Identification of benefits and drawbacks of various rationing strategies.

  • Reflection on decision-makers for allocating scarce health care resources.

Context

  • The NHS: Overview and principles guiding the health service.

  • Recent Developments:

    • Health and Social Care Act 2012.

    • NHS Constitution 2023 (latest version).

NHS Resources: The Problem

  • Key Issue: Limited resources vs. infinite demand.

  • Investment: Heavy investment in the NHS since 1997.

  • Current Budget (2024-25): Approximately £177 billion (around 9% of GDP).

Reasons for Resource Problems

  • Technological Developments: Increased healthcare technology raising costs.

  • Higher Expectations: Growing public expectations on healthcare services.

  • Clinical Negligence Claims:

    • E.g., 2020/21 recorded 12,629 claims, with costs reaching nearly £2.209 billion in damages and legal fees.

  • Other Spending Commitments: Competing financial demands impact NHS funding.

Potential Solutions to Resource Issues

  • Increased Funding: Pros and cons of simply spending more on NHS.

  • Free Market System: Options for individuals to pay for their own healthcare.

  • Preventative Measures: Emphasis on preventive health strategies to reduce demand.

Possible Criteria for Allocating/Rationing Resources

  • Objective: Achieve justice in resource allocation.

  • Criteria:

    • A) Equality.

    • B) Need:

      • Issues in defining need, e.g., comparing clinical needs.

    • C) Maximisation of Health Gains:

      • Utilitarian justification: Focus on cost-effectiveness to maximize quality years of life.

      • Tool for measurement: Quality-Adjusted Life Year (QALY).

    • D) Age:

      • Rationale for age-based allocation; debates on discrimination and population aging.

    • E) Individual Responsibility:

      • Examines lifestyle's role in health; discussion on patient responsibilities per NHS Constitution.

    • F) Miscellaneous Methods: Rationing through denial, delay, dilution, and termination.

Who Should Allocate NHS Resources?

  • Options for Allocation:

    • A. Government:

      • Must promote comprehensive health service (NHS Act 2006).

    • B. Clinical Commissioning Groups (CCGs):

      • Transition to Integrated Care Boards under the Health and Care Act 2022.

    • C. NICE:

      • Role in resource allocation and healthcare evaluations.

    • D. Health Care Professionals:

      • Importance of clinical decisions and flexibility in allocation processes.

    • E. The Public:

      • Potential role of public input in resource allocation decisions.

    • F. The Judiciary:

      • Discusses judicial involvement in ensuring legitimacy in public power decisions regarding healthcare.

References & Further Reading

  • Key References:

    • Department of Health, The NHS Constitution for England (2023).

    • Health and Social Care Act 2012, Part 1 focusing on the NHS in England.

  • Further Reading:

    • Jackson, E. (2022), Medical Law: Text, Cases, and Materials.

    • Syrett, K. (2007), Law, Legitimacy and the Rationing of Health Care.

    • Newdick, C. (2005), Who Should we Treat? Rights, Rationing and Resources in the NHS.

    • Morgan, D. (2001), Issues in Medical Law and Ethics.