Does restricting access mean restricting fairness?

PB Account Manager Natasha Silkin writes…

Natasha Silkin

Natasha Silkin

In a report launched this week by the Association Of British Healthcare Industries Orthopedics Industry Group  (ABHI OIG) entitled Hip and Knee Replacement: the Hidden Barriers,the group explore claims that patient access to life changing orthopedic treatments are being limited without clinical evidence to support this policy.

The report finds that of the 141 Clinical Commissioning Groups (CCGs) which have publically published policies (there are 209 CCGs in total), 69% have a BMI threshold, meaning that 47% of all CCGs have a threshold in place. However, these thresholds where not consistent across the board. The report found 8 CCGs put this threshold at a BMI of 25, 20 CCGS put it at 30, 46 at 35 and a further 24 CCGs limiting access at a BMI of 40. The sheer range of these policies portray an uncomfortable picture: one in which commissioning polices are based on arbitrary thresholds and not clinical data.

Encouraging patients to live healthier, more active lives, is sound advice but restricting access to procedures, with no clinical evidence for going so, is both unfair and cruel.

We are all aware of the increasing pressures on the NHS. To put it lightly, an ageing population and an ever tightening budget is dire combination. More people needing treatments and less money for these make it incredibly difficult to balance the scales. But these scales should not be those of fairness.

With charges of a ‘postcode lottery’ resonating louder and louder in recent times, we remind ourselves that rationing has always been a necessary part of the delivery of the NHS. However, in the past this has been delivered through waiting lists, with patients treated in order of medical need and available resources and not by denying treatment based on clinically arbitrary thresholds which reflect the attributes on an individual.

When the NHS was created in 1948 its principles where clear: that healthcare would be available to all and financed entirely from taxation. This means you pay according to your means and everyone can access healthcare. The young, the old, the rich, the poor – all accessing treatment free at the point of delivery.

But what about the overweight?

We are now sending a message that these members of society are no longer included in the contract, despite lacking clinical data to defend this decision. Who’s next? Those who exceed their recommended alcohol allowance or spend too much time in the sun? This is a deeply problematic direction for the NHS take and one which we should fiercely stand up against. Today it might be the overweight turned away, but tomorrow it might be you.