LETTER : Spending decisions for the NHS

Share
Related Topics
Sir: Polly Toynbee may have got it wrong. She argues (25 March) it would cost pounds 20,000 per patient year to dialyse those 1,000 over 60 years of age who could benefit from dialysis. Let us assume the cost and survival data are correct. Is this the best way to spend pounds 20m?

This question can only be answered with comparative data which answers the question whether there other interventions which, if given an additional pounds 20m, would produce more health gains? By spending pounds 20m on dialysis, 1,000 renal failure patients would each get an additional year of life. By spending money on proven interventions such as improved cardiac services and GP advice to stop smoking, greater levels of health gain would be produced. Spending money on hip replacements and cataract removal would save no lives but would transform the quality of beneficiaries' lives. All spending decisions in the NHS result in less being available for other patients who could benefit from care. With resources scarce the challenge is to target resources at those patients who can benefit most.

The advocacy of sectional interests (eg, those with chronic renal failure) does not ensure that the NHS produces maximum health gains for the UK population from its pounds 40bn budget. Perhaps the NHS has got it right and denies benefits to these patients so it can benefit other patients more with the marginal pounds 20m? Perhaps the NHS should not pursue mere efficiency but give up achievable health gains by spending elsewhere in order to care for needy patients in need of dialysis?

Such questions need to be resolved in a rationing debate which is explicit. Just what weight do we as a society wish to give to efficiency and equity?

Professor Alan Maynard

Secretary

The Nuffield Provincial

Hospitals Trust

London W1

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Physiotherapist / Sports Therapist

£20000 - £50000 per annum: Recruitment Genius: A Physiotherapist / Sports Ther...

Recruitment Genius: Sales Executive / Advisor

£8 - £9 per hour: Recruitment Genius: Sales Executives / Advisors are required...

Recruitment Genius: Warehouse Operative

£14000 - £15000 per annum: Recruitment Genius: An opportunity has arisen for a...

Ashdown Group: Senior .Net Developer - Kingston Upon Thames, Surrey

£70000 - £80000 per annum: Ashdown Group: A long-established, technology rich ...

Day In a Page

Read Next
Women are less likely to become scientists and engineers  

International Women's Day: How much could be achieved if we scrapped the idea of 'male' jobs?

Anne Richards
Dame Maggie Smith stars in Downtown Abbey as Countess Violet  

We need to see Maggie Smith and Michael Gambon on stage again

David Lister
Homeless Veterans campaign: Donations hit record-breaking £1m target after £300,000 gift from Lloyds Bank

Homeless Veterans campaign

Donations hit record-breaking £1m target after huge gift from Lloyds Bank
Flight MH370 a year on: Lost without a trace – but the search goes on

Lost without a trace

But, a year on, the search continues for Flight MH370
Germany's spymasters left red-faced after thieves break into brand new secret service HQ and steal taps

Germany's spy HQ springs a leak

Thieves break into new €1.5bn complex... to steal taps
International Women's Day 2015: Celebrating the whirlwind wit of Simone de Beauvoir

Whirlwind wit of Simone de Beauvoir

Simone de Beauvoir's seminal feminist polemic, 'The Second Sex', has been published in short-form for International Women's Day
Mark Zuckerberg’s hiring policy might suit him – but it wouldn’t work for me

Mark Zuckerberg’s hiring policy might suit him – but it wouldn’t work for me

Why would I want to employ someone I’d be happy to have as my boss, asks Simon Kelner
Confessions of a planespotter: With three Britons under arrest in the UAE, the perils have never been more apparent

Confessions of a planespotter

With three Britons under arrest in the UAE, the perils have never been more apparent. Sam Masters explains the appeal
Russia's gulag museum 'makes no mention' of Stalin's atrocities

Russia's gulag museum

Ministry of Culture-run site 'makes no mention' of Stalin's atrocities
The big fresh food con: Alarming truth behind the chocolate muffin that won't decay

The big fresh food con

Joanna Blythman reveals the alarming truth behind the chocolate muffin that won't decay
Virginia Ironside was my landlady: What is it like to live with an agony aunt on call 24/7?

Virginia Ironside was my landlady

Tim Willis reveals what it's like to live with an agony aunt on call 24/7
Paris Fashion Week 2015: The wit and wisdom of Manish Arora's exercise in high camp

Paris Fashion Week 2015

The wit and wisdom of Manish Arora's exercise in high camp
8 best workout DVDs

8 best workout DVDs

If your 'New Year new you' regime hasn’t lasted beyond February, why not try working out from home?
Paul Scholes column: I don't believe Jonny Evans was spitting at Papiss Cissé. It was a reflex. But what the Newcastle striker did next was horrible

Paul Scholes column

I don't believe Evans was spitting at Cissé. It was a reflex. But what the Newcastle striker did next was horrible
Miguel Layun interview: From the Azteca to Vicarage Road with a million followers

From the Azteca to Vicarage Road with a million followers

Miguel Layun is a star in Mexico where he was criticised for leaving to join Watford. But he says he sees the bigger picture
Frank Warren column: Amir Khan ready to meet winner of Floyd Mayweather v Manny Pacquiao

Khan ready to meet winner of Mayweather v Pacquiao

The Bolton fighter is unlikely to take on Kell Brook with two superstar opponents on the horizon, says Frank Warren
War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

Baghdad fights to win back Tikrit from Isis – but then what?

Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable