The National Health Service in England currently faces the challenge of deriving, by 2015, an estimated £15-20 billion more value from the overall budget in order to meet rising demand but without a corresponding increase in funding.

At the same time, political debates over the Secretary of State’s duty to provide ‘a comprehensive health service’ have thrown a spotlight on how the NHS interprets national guidance at a local level. The drive to devolve greater responsibility for decision-making to local clinicians is expected to result in wider variations in funding and purchasing decisions, and some fear this could result in greater inequities in access to care.

The NHS Commissioning Board should work closely with CCGs to ensure that they make decisions within an agreed set of principles and guidance, and that any decisions made locally are subject to proper public scrutiny

Dr Judith Smith, Head of Policy, Nuffield Trust

Against this backdrop, Rationing health care: is it time to set out clearly what is funded by the NHS? by Dr Benedict Rumbold, Vidhya Alakeson and Professor Peter Smith, examines both the feasibility, and the advantages and disadvantages, of setting out explicitly the care patients are entitled to, in the form of a nationally specified NHS ‘benefits package’.

It draws on the experience of countries that have sought to explicitly define the health care benefits that their publicly-funded health systems will pay for.

The report outlines the current system in which decisions for determining which treatments are funded by the NHS are arrived at implicitly. It makes several recommendations for how the system could be improved. These include:

  • Establishing a set of principles that would shape how public money is spent in the NHS;
  • Producing a national list of the treatments that public money should not be spent on in the NHS (unless there are exceptional circumstances);
  • Ensuring that decision-making by clinical commissioning groups is transparent.

This report forms part of the Nuffield Trust’s wider programme of work on efficiency. It will be of interest to policy-makers, commissioners, managers and academics with an interest in health system efficiency and equity.