One In Five Think The Cost Of The Treatment Should Be A Factor In Deciding What To Fund, UK

MPs and local councillors should not be involved in decisions about which treatments should be funded by the NHS. This is the clear message from a recent public poll commissioned by the NHS Confederation.

The poll of c1,000 members of the public, conducted by Ipsos MORI, asked which groups should make decisions about which medicines are funded by their local NHS. Respondents were given a list of six groups to choose from.

Only one in 11 (9 per cent) think MPs should be part of the decision making process. Even less people (6 per cent) think local councillors should have a say.

On average respondents opted for a combination of two groups to make decisions about the funding of treatments. Unsurprisingly, most people (70 per cent) think that clinicians should be involved. Patient representatives are the second favourite with 33 per cent of participants thinking they should contribute to the process.

NHS managers are the third most important group to be at the decision making table with 23 per cent voting for this group. A smaller proportion (21 per cent) voted for general public representatives.

The poll also asked members of the public what factors they thought should influence decisions about which treatments should or shouldn’t be provided by their local NHS.

The top two most important factors according to respondents are the probability of the treatment being effective (50 per cent) and whether it will be used to treat a life threatening condition (38 per cent).

One in five (22 per cent) respondents think the cost of the treatment should be considered. One in three (34 per cent) think the availability of cheaper, as effective, treatments should be a factor in decision-making and 18 per cent think that local trusts should consider whether or not other treatments will have to be withdrawn from other patients as a result. A small, but significant, minority (8 per cent) said, unprompted, that the NHS should fund all treatments.

Commenting on the role of politicians, Dr Gill Morgan, chief executive of the NHS Confederation which represents more than 90 per cent of NHS organisations, said:

“Over the last 18 months, decisions made by local NHS organisations about which treatments to fund have been highly politicised as media attention on drugs like Herceptin have fuelled the public debate.

“These debates have highlighted the difficult, and often heart-rending, decisions that clinicians and managers in primary care trusts have to make on a regular basis.

“NHS clinicians and managers are working incredibly hard to meet the needs of local patients within a system that has finite resources. It is reassuring to see, therefore, that the public believes it is clinicians, patient representatives and managers who are best equipped to make these tough choices - not national or local politicians.”

Commenting on what factors should be involved in decision making, Dr Gill Morgan said:

“Despite being very clear about who should and shouldn’t be involved in making decisions about the funding and provision of NHS treatments, the public are more divided about what factors should influence those decisions.

“When faced with a number of competing issues - as clinicians and managers often are - it is extremely difficult to reach a consensus that pleases everyone. This highlights just how complex and difficult the decisions made by clinicians and managers truly are.

“There are difficult ethical issues that we need to grapple with as a society about how we make choices in a cash-limited NHS. It’s time to confront the reality and to recognise that if cost is not to be factor in NHS decisions then the public may have to be prepared to pay more in order to have every treatment funded. I think the public is ready for this debate.”

It is because of the competing needs of patients and the public that it is vital we start to have a proper debate about our priorities. Last night the NHS Confederation hosted a debate which aimed to highlight the complexities around decision making in the NHS. Panellists at the debate included Rt Hon Kevin Barron MP, Chair of the Health Select Committee; Polly Toynbee from the Guardian and Harriet Sergeant from Centre for Policy Studies.

Top line results

1. In your opinion, which, if any, factors should influence decisions about whether or not treatments and medicines are provided by your local NHS trust for a particular patient or group of patients?

– the probability of the treatment being effective 50%
– whether or not the treatment is for a life threatening condition 38%
– whether or not there are cheaper treatments/medicines available that are also effective 34%
– whether lifestyle choices have contributed to the illness (e.g smoking, alcohol, obesity) 28%
– whether or not the treatment/medicine is already being used to treat patients in other parts of the country 27%
– the cost of the treatment/medicine 22%
– Personal circumstances of the patients, e.g. age, number of dependents 19%
– whether or not other treatments/medicines will have to be withdrawn from other people to allo
– enough funding for the treatment being discussed18%
– how many other people in the local area are likely to need the treatment 12%

Not on showcard:

– NHS should fund everything/all new medicines and treatments should be available 8%
– No decisions should be made locally - they should all be made nationally 2%
– All of them 2%
– None of them 3%
– Don’t know 7%

2. Which, if any, groups of people should make decisions about which medicines or treatments are funded by your local NHS?

– Clinicians working in the local NHS (e.g doctors and nurses) 70%
– Patient representatives 33%
– Managers working in the local NHS 23%
– General public representatives 21%
– Members of Parliament (MPs) 9%
– Local councillors 6%

Not on showcard:

– Other 1%
– NHS should fund everything/all new medicines and treatments should be available 6%
– No decisions should be made locally - they should all be made nationally 2%
– All of them 1%
– None of them 2%
– Don’t know 5%

Technical note: Ipsos MORI interviewed 969 people aged 15+ living in Great Britain, in-home, face-to-face, between 7 and 12 December 2006.

The NHS Confederation represents more than 90% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.

http://www.nhsconfed.org

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