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Equity and rationing in the English NHS Findings from a survey of BMA members July 2013

In July 2012, an online survey was conducted with 2,000 doctors across England to gather their insights on equity and rationing within the NHS. Out of 575 respondents, representing various medical professions, the survey examined concepts of universality and comprehensiveness in healthcare. It explored the importance of access based on clinical need versus the range of available services, decision-making authority on treatment restrictions, and acceptable rationing methods amidst resource shortfalls. The findings contribute to ongoing policy discussions within the NHS.

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Equity and rationing in the English NHS Findings from a survey of BMA members July 2013

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  1. Equity and rationing in the English NHSFindings from a survey of BMA membersJuly 2013

  2. 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

  3. Which of the following most closely aligns with your understanding of the term universal?

  4. 2. Which of the following most closely aligns with your understanding of the term comprehensive? * The percentages do not add up to 100 due to decimal rounding

  5. How universal is the NHS? • Defined as ‘access based on clinical need, not ability to pay’

  6. How comprehensive is the NHS? • Defined as ‘a range of services that meets the needs of everyone’

  7. 5. 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’

  8. 6. At what level of the health system should the following be applied? Regional given as NHS England sectors (4) Sub-regional given as NHS England local area teams (27) Local given as clinical commissioning groups (211)

  9. 7. Which national body should make decisions on restrictions around who can receive certain services/treatments? * Percentage of respondents who answered ‘national’ to question 6

  10. 8. Which national body should make decisions on reductions in what services/treatments are available on the NHS? * Percentage of respondents who answered ‘national’ to question 6

  11. 9. At what level of the health system should the following be applied?

  12. 10. Which national body should make decisions on maximum and minimum waiting times? * Percentage of respondents who answered ‘national’ to question 9

  13. 11. How much importance do you attach to local autonomy and freedom vs. national uniformity?

  14. 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’

  15. 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’

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