Headlines: January 25th, 2007



National and local politicians should not be involved in decisions about which treatments should be funded by the National Health Service, according to a new poll commissioned by the NHS Confederation. Only 9 per cent of people thought MPs should be part of the process and even fewer wanted local councillors to have a say in the decision making.

The study found that the majority of respondents, 70 per cent, felt clinicians should be the people to decide what treatments were funded. There was also support for the involvement of patient representatives with a third of those participating in the study believing they should play a part. NHS managers were seen as the third most important group, with 23 per cent saying they should be at the decision-making table and 21 per cent voted for general public representatives to be included.

The poll, which is based on almost a thousand face to face interviews, also asked what factors people thought should influence decisions about whether or not treatments should be provided by their local health service. The results show the two most important factors for the public are the probability of the treatment being effective and whether it will be used to treat a life threatening condition. They were backed by 50 per cent and 38 per cent of participants respectively. Just over one in five thought the cost should be taken into consideration, though more than a third thought the availability of cheaper, but equally effective treatments, should be a factor.

Eighteen per cent of people said local trusts should consider whether other treatments would have to be withdrawn from patients as a result of their decision. Eight per cent of people said without prompting that the NHS should fund all treatments.

Dr Gill Morgan, chief executive of the NHS Confederation, said that in the past 18 months decisions by local health service organisations about which treatments to fund had been highly politicised with media attention on drugs such as Herceptin fuelling the public debate. “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,” she said.

The fact that the public were more divided on what factors should be weighed in decisions about funding treatments, she said, highlighted how complex and difficult are the decisions being made by clinicians. Society, she added, needed to grapple with the question of how choices were made in a cash-limited NHS. “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,” Dr Morgan said.