NHS Resources and Patient Rights Flashcards
What was the original aim of the NHS upon its foundation ? What is the problem with this aim ?
- The aim had been to improve the health of the nation, and thus decrease the demand for healthcare (i.e. based on the premise that there is a finite amount of ill health, which, once removed, would result in the maintenance of health and the provision of healthcare becoming cheaper as the need for it dropped off)
- Problem: This^ is a fallacy. Success in healthcare has resulted in people living longer potentially to be ill more often and therefore consume more resources
Explain some of the reasons why the NHS has become overstretched, year on year.
♥ Increase in life expectancy ♥ Increasing costs of treatments ♥ Patients’ expectations increase ♥ Increased cost of admin & salaries ♥ Free means less constraints on demand ♥ Increase in negligence cases
What is rationing on the NHS?
- Rationing does NOT mean that everyone gets the same fixed amount of resource
- Rationing instead refers to the discretionary allocation of scarce resources
Explain different strategies that could be used in NHS resource allocation.
- Equal access to treatment (i.e. equivalent health needs have equivalent access to care)
- Rationing according to clinical need (dealing with worst cases over rest, or other way around)
- Maximising health gains (QALY, i.e. cost-effectiveness)
- Discriminating according to age (treat elderly ? children ? economically active people ?)
- Taking individual responsibility for ill health into account (smokers ? parachutists ? what about people who do important jobs like policemen ?)
- Rationing according to ability to pay
- Singling out certain types of excluded treatment (e.g. assisted reproduction not provided for everywhere)
- Dilution of care (i.e. enough to keep you alive)
- Random allocation (i.e. lottery system)
What are cons of rationing according to clinical need ?
CONS
How do we determine hierarchy ?
How do we define normal human functioning ?
What about exceptions ?
What are the cons of taking individual responsibility for ill health into account ?
CONS
Does behaviour even matter?
Is it a choice?
What are the cons of rationing according to ability to pay ?
CONS
Poor will not be able to afford it
What are the cons of dilution of care ?
CONS
Delays
Undersupply of time/staff
Define QALY. Which ethical theory does QALY follow ?
Quality adjusted life year (i.e. It takes a year of healthy life expectancy to be worth 1, but regards a year of unhealthy life expectancy as worth less than 1. Its precise value is lower the worse the quality of life of the unhealthy person)
Consequentialism
How do you calculate QALY ?
(Quality of life X life expectancy after treatment) - (Quality of life X life expectancy before treatment)
Then cost it
E.g.
• Before treatment: 0.5 X 2 years = 1 year §
• After treatment: 1 X 6 = 6 years
• Hence QALY value of treatment = 5
• If cost of treatment is £5000, then cost per QALY is £1000
What is beneficial healthcare activity in terms of QALY?
Positive # of QALYs
What is efficient healthcare activity in terms of QALY?
Cost per QALY is low
What is the welfare of the patient in terms of QALY?
Quantity + Quality
What are the main cons of QALY ?
PROS
– Health can be described as changes in life expectancy and quality of life
– Comparisons possible over a wide range of clinical outcomes
CONS
– Unclear relation to individual and social preferences for health
– May not totally capture the value of a new medicine
– If you start applying basic numbers to human life, you are not acting ethically
Outline the role of NICE.
Produce evidence-based guidance and advice for health, public health and social care practitioners. E.g. guidance given: •Clinical guidelines •Technology appraisals •Public health •Interventional procedures
What does NICE stand for ?
National Institute for Health and Care Excellence
Describe the work of NICE in their technology appraisals.
Four technology appraisal recommendations possible (i.e. recommendations on the use of new and existing medicines and treatments within the NHS):
- Recommended for use in NHS
- Restricted use to certain categories of patients
- Use confined to clinical trials
- Should not be used in NHS
Decision-making process is open & transparent
Identify some criticisms of the work of NHS.
- Status of guidelines ambiguous •Implementation is variable (i.e. no way of enforcing them)
- Topic selection is not random (leaves questions as to how decisions are made)
Outline the role of SMC.
The remit of the Scottish Medicines Consortium (SMC) is to provide advice to NHS Boards and their Area Drug and Therapeutics Committees (ADTCs) across Scotland about the clinical and cost-effectiveness of all newly licensed medicines, all new formulations of existing medicines and new indications for established product
(Less likely to restrict a drug than NHS in ENgland)
What does SMC stand for ? Who are its members ?
SMC = Scottish Medicines Consortium
Lead clinicians, pharmacists, health economists, representatives of health boards, pharmaceutical industry and the public
Identify some current rationing issues with the NHS in the news.
- Obese patients ‘surgery ban’ in York to be reviewed
- NHS groups consider vasectomy funding cuts
Identify areas for which there is debate as to whether or not they should be funded from the healthcare budget ?
- Treatments to assist reproduction
- Cosmetic surgery
- Long-term nursing for elderly
- Health education in schools
- Provision of traffic-calming measures
- Reversal of sterilisation
Identify examples of incentives used in healthcare.
- New mums ‘paid’ to breastfeed
- Incentives in weight loss and smoking cessation (e.g. free gum to help stop smoking)
- Incentives for patients with schizophrenia (to adhere with treatment)
Identify cons of using incentives in healthcare.
- Decrease the autonomy of the patient
- Contaminate doctors’ relationship with them
- Not necessarily best use of resources
