NHS Resources and Patient Rights

Question 1

What are some reasons for the NHS being over-stretched?

Answer 1

• people are living longer, potentially to be ill more often especially more towards the end of their lives and therefore consume more resources
• not enough money is going into the NHS funding and there are not enough workers for the NHS

Question 2

What are the different strategies to resource allocation?

Answer 2

• equal access to treatment
• rationing according to clinical need
• maximising health gains (QALY)
• discriminating according to age
• taking individual responsibility for ill health into account
• singling out certain types of excluded treatment
• dilution of care

Question 3

What does rationing mean in the NHS?

Answer 3

• rationing does not mean that everyone gets the same fixed amount of resource (unequal)
• discretionary allocation: resources allocated based on need (equity rather than equality)

Question 4

What are negative aspects of QALY?

Answer 4

• quality of life is subjective between each patient
• what defines a healthy/unhealthy life? It can mean different things for different people
• it might be dangerous to quantify what they consider to be a ‘healthy life’

Question 5

What is the role of NICE?

Answer 5

• produce evidence-based guidance and advice for health, public health and social care practitioners for:
• clinical guidelines
• technology appraisals
• public health
• interventional procedures

Question 6

What are NICE’s recommendations for technology appraisal?

Answer 6

• recommendations on use of new and existing medicines and treatments within NHS:
  1. recommend for use in NHS
  2. restricted use to certain categories of patients
  3. use confined to clinical trials
  4. should not be used in NHS

Question 7

What are some criticisms of NICE’s recommendations for technology appraisal?

Answer 7

• status of guidelines ambiguous
• implementation is variable
• topic selection is not random

Question 8

Outline the role of SMC

Answer 8

• national source of advice on clinical and cost-effectiveness of all new medicines for NHS Scotland
• ensure people in Scotland have timely access to medicines that provide most benefit based on best available evidence

Question 9

What is the SMC’s role in NHS rationing?

Answer 9

• evaluates whether the benefits for patients may be considered an acceptable use of NHS resources

possible decisions:

• accepted
• accepted with restrictions
• not recommended
• if approved, NHS boards are expected to make it, or an equivalent SMC-accepted medicine available

Question 10

What is QALY?

Answer 10

• quality adjusted life year
• theory is consequentialism (utilitarianism)
• a year of healthy life expectancy is worth 1
• unhealthy life expectancy is worth less than 1 (lower the worse the quality of life is)
• QOL X life expectancy (before and after) then cost it

Question 11

Give examples of controversial uses of the healthcare budget

Answer 11

• incentives
• ‘New mums paid to breastfeed’
• paid £200 in vouchers to breastfeed for 6 months
• targeted deprived areas