The public’s view of which treatments should be available on the NHS NHS England’s favoured future funding option suggests that nearly three-quarters of the £30 billion funding-needs gap that will exist by 2020/21 is to be filled by increased productivity. Even if the ‘down payment’ pledges of extra money for the NHS from the three main political parties eventually swell to meet the £8 billion NHS England are asking for by 2020/21, the productivity challenge remains substantial.
Being more productive does not just involve producing more of the same for each health care pound to meet growing demands. It also means improving the quality of the product – for example, not just more hip replacements, but hip replacements with reduced recovery times, using hips that last longer and produce bigger improvements in patients’ self-assessed health status.
In short, improving productivity means generating greater value for patients. This, in essence, is at the heart of the difficult task – not only for the new productivity challenge over the next few years, but for NICE too: making better use of the resources it is given means the NHS providing better quality (or more effective) care at the lowest cost.
In practice of course, identifying what’s cost effective is difficult, and requires significant investment in generating the right technical data and, importantly, judgements about what constitutes good value for money. But no matter how tricky it is to amass the evidence needed to identify the costs and benefits of a treatment, it is hard to disagree with the principle that both costs and effects of treatments need to be weighed in order to make decisions about improving value for money and productivity.
Or so you might have thought. For a majority of the public however, this is not a principle they hold.
In the 2012 British Social Attitudes survey we asked the public what treatments should be available on the NHS – asking them to select one of three general criteria that could decide this:
all treatments regardless of cost or whether they provide proven health benefits
only those that provide proven benefits, but regardless of cost
only those that provide proven health benefits and good value for money.
You might ask why people would choose the first or second criteria. But as figure 1 shows, four out of ten of those surveyed stated that while treatments should have proven benefits, cost should not be considered as part of a decision about what treatments the NHS should provide. And (all logically minded individuals look away now) for three out of ten, not only was cost irrelevant, but so too was whether treatments even had any proven benefits.
Figure 1: Which treatments should be available on the NHS? Views from the public
Which treatments should be available on the NHS? Views from the public
Data source: NatCen 2013
The remainder of those surveyed picked the final answer; treatments provided by the NHS should have proven benefits and be good value for money.
Even allowing for some potential misunderstanding about the question and the answer options (though there is extensive testing of BSA questions), these attitudes are pretty surprising. Or are they? As a patient, how sanguine would you be to be told that although a treatment had proven health benefits you couldn’t have it because it cost too much for the benefits it could provide?
Perhaps rather than bemoan the illogicality of the public’s views, these results should remind us of the need to help the public understand about the inevitable need to weigh the costs and benefits of the services and treatments the NHS provides – and not only in times of financial famine. Such evaluations are unavoidable regardless of how health care is funded, whether collectively from taxation or social insurance or from private means. The alternative can be measured, not just in wasted money, but the health benefits that money could have bought.
This may be a hard (and to many, a harsh) message to convey. But as the financial squeeze continues public support (and understanding) of the need for the NHS to tackle increasingly difficult choices about prioritising spending, will become ever more important. The King's Fund
See the topline results and satisfaction trends relating to the NHS and health care issues from the British Social Attitudes survey 2013
Being more productive does not just involve producing more of the same for each health care pound to meet growing demands. It also means improving the quality of the product – for example, not just more hip replacements, but hip replacements with reduced recovery times, using hips that last longer and produce bigger improvements in patients’ self-assessed health status.
In short, improving productivity means generating greater value for patients. This, in essence, is at the heart of the difficult task – not only for the new productivity challenge over the next few years, but for NICE too: making better use of the resources it is given means the NHS providing better quality (or more effective) care at the lowest cost.
In practice of course, identifying what’s cost effective is difficult, and requires significant investment in generating the right technical data and, importantly, judgements about what constitutes good value for money. But no matter how tricky it is to amass the evidence needed to identify the costs and benefits of a treatment, it is hard to disagree with the principle that both costs and effects of treatments need to be weighed in order to make decisions about improving value for money and productivity.
Or so you might have thought. For a majority of the public however, this is not a principle they hold.
In the 2012 British Social Attitudes survey we asked the public what treatments should be available on the NHS – asking them to select one of three general criteria that could decide this:
all treatments regardless of cost or whether they provide proven health benefits
only those that provide proven benefits, but regardless of cost
only those that provide proven health benefits and good value for money.
You might ask why people would choose the first or second criteria. But as figure 1 shows, four out of ten of those surveyed stated that while treatments should have proven benefits, cost should not be considered as part of a decision about what treatments the NHS should provide. And (all logically minded individuals look away now) for three out of ten, not only was cost irrelevant, but so too was whether treatments even had any proven benefits.
Figure 1: Which treatments should be available on the NHS? Views from the public
Which treatments should be available on the NHS? Views from the public
Data source: NatCen 2013
The remainder of those surveyed picked the final answer; treatments provided by the NHS should have proven benefits and be good value for money.
Even allowing for some potential misunderstanding about the question and the answer options (though there is extensive testing of BSA questions), these attitudes are pretty surprising. Or are they? As a patient, how sanguine would you be to be told that although a treatment had proven health benefits you couldn’t have it because it cost too much for the benefits it could provide?
Perhaps rather than bemoan the illogicality of the public’s views, these results should remind us of the need to help the public understand about the inevitable need to weigh the costs and benefits of the services and treatments the NHS provides – and not only in times of financial famine. Such evaluations are unavoidable regardless of how health care is funded, whether collectively from taxation or social insurance or from private means. The alternative can be measured, not just in wasted money, but the health benefits that money could have bought.
This may be a hard (and to many, a harsh) message to convey. But as the financial squeeze continues public support (and understanding) of the need for the NHS to tackle increasingly difficult choices about prioritising spending, will become ever more important. The King's Fund
See the topline results and satisfaction trends relating to the NHS and health care issues from the British Social Attitudes survey 2013
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