Public Policy Editor
Rationing is now "sweeping through the NHS" Harriet Harman, Labour's health spokeswoman, claimed yesterday as an independent survey showed that almost one-third of health authorities are now limiting, barring or considering reducing a range of services from treatments for glue ear to routine urine testing of pregnant women and radical treatment for disseminated cancers.
Her claim brought angry denials from Stephen Dorrell, the Secretary of State for Health, who in a sharp Commons clash accused her of lying.
"Her evidence does not remotely justify the charges she is making," he said. Health authorities were consulting doctors on which treatments were good value and latest clinical practice and ensuring the service reflected those developments.
If authorities were "ruling out in every case treatments that doctors wanted to offer their patients, that would indeed be a subject of real concern. That is not what is happening".
Ms Harman backed her claim with evidence from a database of health authorities' purchasing intentions which shows that among the 40 health authorities some are considering excluding or reducing routine ultrasound in low-risk pregnancies and routine screening for brittle bone disease, aortic aneurysms and also colorectal cancer.
"This is the thin end of the wedge." she said. "Yesterday it was grommets, fertility treatment and sterilisation. Today it is varicose veins and osteoporosis screening. Tomorrow it will be hernias and hip replacements". Three health authorities - Bury and Rochdale, Worcester and District, and North and Mid Hampshire - were openly describing their decisions as rationing, she added.
"Ten have targeted varicose veins, 23 have targeted grommets, eight have targeted osteoporosis screening, 21 have targeted D&C [dilation and curettage, or scraping of the lining of the womb] in women under-40, and eight have targeted fertility treatment."
Health care had become "a lottery depending on where you live" and the Government's refusal to admit rationing was taking place was part of its drive towards NHS privatisation.
Alan Milburn, her frontbench colleague and the MP for Darlington, said the data, from Blackwell Masters, an independent health consultancy which has analysed health authorities' purchasing plans, showed "disinvestment from screening for aortic aneurysm in North Birmingham, from ultrasounds for pregnant women in Powys and from cholesterol screening in Wigan and Bolton".
Rationing was not inevitable, he argued. The money was available but swallowed up by the extra pounds 1bn cost of running the NHS internal market.
Doctors said yesterday that the lack of effectiveness of many of the treatments, or their unproven nature, was leading anyway to a fall in how often they were performed.
Treatment policy in 40 districts
7 = Health authorities restricting, barring or considering reductions in provision of treatments
Key to treatments: A: Varicose veins; B: Grommets;
C: Osteoporisis Screening; D: Dilation & Curettage for women under 40; E: Subfertility; F: Other
A B C D E F
Barking and Havering 7
Bedfordshire 7 7
Buckinghamshire 7 7 7
County Durham 7 7 7 7 7
East Dyfed 7 7 7
East Kent 7
East Lancashire 7 7
East Norfolk 7 7 7 7
East Sussex 7 7 7 7
Herefordshire 7 7 7 7
Isle of Wight 7 7 7
Kingston & Richmond 7
Leicestershire 7 7
Merton, Sutton & Wandsworth 7 7
Mid Glamorgan 7 7
Morecambe Bay 7
Newcastle & North Tyneside 7 7
North Birmingham 7 7 7 7
North West Anglia 7 7
North West Surrey 7
Portsmouth & SE Hants 7 7 7 7 7
Powys 7 7
South Glamorgan 7 7 7
South Staffordshire 7 7
South West Surrey 7 7 7 7
Walsall 7 7 7
Warwickshire 7 7
West Glamorgan 7 7 7 7 7
West Kent 7
West Sussex 7 7 7 7
Wigan & Bolton 7 7 7
Wiltshire & Bath 7 7
Wolverhampton 7 7 7 7
Worcester & District 7 7
TOTAL 70 10 23 8 21 8 27
Source: The Blackwell Masters NHS Purchasing Intentions