Equity and rationing in the NHS: past to present

Abstract

Aim: This paper explores the historical and political basis of equity and rationing in the British National Health Service (NHS).

Background: Rationing has always featured in the NHS as an implicit, rather than explicit process. Recent healthcare reforms have highlighted the inequity of healthcare provision in the UK and made the rationing debate more explicit.

Origins of information: Information is drawn from a variety of sources which include research studies, review articles and books, policy documents and personal experience of working in the NHS.

Key issues: The search for efficiency in the new NHS is in conflict with the principle of equity and the most vulnerable groups in society are being denied access to healthcare. Decisions about rationing are currently made at a local rather than a national level resulting in variability of health service provision, an inconsistency which will continue with the development of primary care groups.

Conclusions: Rationing of healthcare resources is thought to be inevitable as demands for healthcare increase in a funds-limited service. Rationing of resources is a political problem that requires some form of guidance from central government.