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Readers' panel: Given the current funding crisis, will rationing become the norm in the NHS?

NHS England recently asked Vale of York clinical commissioning group to review plans to deny routine surgery – such as hip and knee operations – to obese patients and smokers. A spokesman for NHS England said denying operations to a particular group was ‘inconsistent’ with the NHS constitution. Nursing Standard readers panellists have their say. 

NHS England recently asked Vale of York clinical commissioning group to review plans to deny routine surgery – such as hip and knee operations – to obese patients and smokers. A spokesman for NHS England said denying operations to a particular group was ‘inconsistent’ with the NHS constitution. Nursing Standard readers panellists have their say 


Liz Charalambous is staff nurse at Nottingham University Hospitals NHS Trust

Liz Charalambous

Rationing services based on judging a lifestyle choice is not the best use of scarce resources. It will widen existing social inequalities as the poor and disenfranchised on the margins of society become further marginalised.

What other lifestyle choices will service providers deem to be unworthy of healthcare, and why? 

I fear for the future of the NHS. A neoliberal agenda pursues the cost of everything and the value of nothing. In the absence of adequate funding we need to examine the evidence and work together with the public to decide how to provide services for all. 


Grant Byrne (@GGByrne) is a nursing student in Scotland 

Grant Byrne

I have little doubt that rationing services will soon be widespread across England. As a health professional, I balk at the idea of splitting patients into ‘deserving’ and ‘undeserving’ groups but difficult times call for difficult measures. 

If the NHS is to balance the books, bosses have to make these tough calls. But as pressure continues to mount, where will we draw the line? 

Should I ever require medical care, I can only hope that my fondness for a biscuit or two doesn’t make me ineligible.


Stephanie Cumming is a practice nurse in Warwickshire 

Stephanie Cumming

We know obese patients and smokers face higher risks from surgery, and despite the best efforts of many, health promotion messages do not seem to be getting through. 

But individual CCGs rationing or denying surgery to these patients creates a postcode lottery, potentially disadvantaging patients based on where they live. 

On the other hand, given the current financial crisis in the NHS, it is understandable that CCGs are trying to make savings wherever possible. Whatever the outcome, this type of decision must be taken across the whole of the NHS to ensure fair and standardised treatment.


Edwin Chamanga is tissue viability service lead at Hounslow and Richmond Community Health in London 

Edwin Chamanga

Theoretically, this model makes economic and health sense. But is it ethical? And is it in the best interests of the general public or just the clinical commissioning group? 

The phrase ‘balancing the books’ is incongruous with the concept of trying to encourage a healthier nation and should not be used in the same brief.

Although this approach could work in some areas, its sustainability remains unknown. Perhaps the CCG should have invested more in effective health promotion strategies to start with. 


Readers' panel members give their views in a personal capacity and do not represent their organisations

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