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Rationing in child health services: a personal view
  1. AIDAN MACFARLANE, Consultant in Public Health and Health Policy
  1. Oxfordshire Health Authority
  2. Old Road, Headington
  3. Oxford OX3 7LG, UK

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    Rationing in the UK National Health Service comes in many forms: there is choosing not to see something as a relative health problem in the first place; there are simple straight decisions not to fund treatments, investigations, preventive measures, etc because of lack of resources at that particular time; there is rationing by reasonable methods of priority setting at national and district level. There are also more insidious methods of delaying the implementation of treatments of proved efficacy that, on balance of evidence, should be used. Such delays are done by reassessing, demanding more information, claiming that it is someone else’s responsibility, etc. There is also rationing by waiting lists and rationing by illogical resource allocation on the grounds of political expediency.

    As a commissioner, while I am aware of these facts I am also aware that the NHS, compared with other health delivery systems used around the world, supplies an excellent “value for money” service that is “free at the time of delivery”. It is just that we still, within the NHS and outside (particularly in political spheres) hate owning up to the fact in public that rationing has always been and will always be a necessity.

    Where has there been rationing in child health services?

    This will vary from one district to another. A quick look over the past four or five years of my own work in commissioning would include: rationing of all the treatment services for handicapped children; rationing the availability of medical services to severely disabled children placed “out of county”; lack of funding for triple testing pregnant mothers for Down’s syndrome, which …

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