Unaccountable Delegation

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It is important that necessary medical attention and treatment should be an entitlement throughout the national health service.  People who are dangerously ill or injured, in severe pain or incapacitated by injuries must receive and be confident they will receive prompt and adequate treatment complying with any national standards.  Shortage of financial resources should not excuse or permit any deviation from this requirement.  Nor should Government targets for waiting times for non-urgent treatment divert resources away from treatments necessary to protect life and limb and other conditions of similar urgency.

If a patient has two or more medical conditions that make treatment unusually dangerous or less likely to be effective, the implications must be fully discussed with the patient or carers, who must be able to influence the chosen treatment.  If, for example, it is necessary to correct one condition (that might not otherwise be urgent) before treatment for another urgent condition becomes sufficiently safe, any available treatment for the first condition must be offered.

It is unacceptable to have a blanket ban on groups of people from urgent treatment because of moral judgments on lifestyle even if the patient's lifestyle may add to the risk of treatment. Likewise people should be treated regardless of whether they are in the UK legally.

The only exception to this principle is where there are resource constraints other than money.  Organs for transplant may be in short supply in the long term, and should go to the people most likely to benefit from them. 

Major epidemics or disasters may necessitate short-term prioritisation, again of the people most likely to benefit from attention.  But this type of prioritisation should follow the greatest possible diversion of resources into the most urgent work.

Two trends in Government policy interfere with the principle that some treatments are necessary and should be an entitlement and an absolute priority.

  1. Autonomy of NHS bodies allows ministers to shelter behind "clinical judgment" when an NHS body makes an outrageous decision to comply with ministers' directives.  This applies even for NHS bodies that do not have Foundation Trust status, and is unacceptable.  When East Suffolk primary care trusts said patients will no longer be considered for hip and knee replacements at Ipswich hospital if they have a body mass index of more than 30 (Wednesday November 23, 2005 The Guardian ), Patricia Hewitt, the secretary of state for health, did just that on Channel 4 News.
  2. Contracts with specialist units (diagnostic and treatment centres), often in the private sector, to reduce waiting times for non-urgent elective surgery, may reduce the capacity of the NHS to respond to large scale emergencies, when it may be appropriate to prioritise the work of all trained staff and facilities such as wards and operating theatres.  If surgeons, nurses and other staff are tied to an employer performing only non-urgent operations, they may not be available for an emergency. Contracts should enable the diversion of staff and facilities in an emergency so that facilities that are needed are staffed with the right number of people with the right skill mix.  For example an operating theatre normally used only for cataract operations might be used for people sustaining eye injuries in a terrorist incident.  Specialist units should be included and involved in emergency planning.  In the medium term staff in specialist units might lose more general skills, so specialist units should be phased out and their work returned to general hospitals.

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Sheila Porter-Williams
Campaign for Health Service Democracy
Green Haven, Halfway Lane
Dunchurch
Rugby, Warwickshire CV22 6RD
sheilaCHSD@porter-williams.freeserve.co.uk