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

Year 3 Welsh Teacher vacancy in Penarth

£110 - £120 per day + Travel Scheme and Free training: Randstad Education Card...

Senior Developer - HTML, CSS, PHP, JavaScript, VBA, SQL

£30000 - £35000 per annum + benefits: Ashdown Group: We are working with one o...

Male Behaviour Support Assistant vacancy in Penarth

£55 - £65 per day + Travel Scheme and Free Training: Randstad Education Cardif...

BA/PM,EMIR/Dodd-Frank,London,£450-650P/D

£450 - £650 per day + competitive: Orgtel: My client, a leading bank, is curre...

Day In a Page

Read Next
Prime Minister David Cameron walks on stage to speak at The Confederation of British Industry (CBI) annual conference on November 4, 2013  

Does Cameron really believe in 'British Values'?

Temi Ogunye
The Lada became a symbol of Russia’s failure to keep up with Western economies  

Our sanctions will not cripple Russia. It is doing a lot of the dirty work itself

Hamish McRae
Save the tiger: The animals bred for bones on China’s tiger farms

The animals bred for bones on China’s tiger farms

The big cats kept in captivity to perform for paying audiences and then, when dead, their bodies used to fortify wine
A former custard factory, a Midlands bog and a Leeds cemetery all included in top 50 hidden spots in the UK

A former custard factory, a Midlands bog and a Leeds cemetery

Introducing the top 50 hidden spots in Britain
Ebola epidemic: Plagued by fear

Ebola epidemic: Plagued by fear

How a disease that has claimed fewer than 2,000 victims in its history has earned a place in the darkest corner of the public's imagination
Chris Pratt: From 'Parks and Recreation' to 'Guardians of the Galaxy'

From 'Parks and Recreation' to 'Guardians of the Galaxy'

He was homeless in Hawaii when he got his big break. Now the comic actor Chris Pratt is Hollywood's new favourite action star
How live cinema screenings can boost arts audiences

How live cinema screenings can boost arts audiences

Broadcasting plays and exhibitions to cinemas is a sure-fire box office smash
Shipping container hotels: Pop-up hotels filling a niche

Pop-up hotels filling a niche

Spending the night in a shipping container doesn't sound appealing, but these mobile crash pads are popping up at the summer's biggest events
Native American headdresses are not fashion accessories

Feather dust-up

A Canadian festival has banned Native American headwear. Haven't we been here before?
Boris Johnson's war on diesel

Boris Johnson's war on diesel

11m cars here run on diesel. It's seen as a greener alternative to unleaded petrol. So why is London's mayor on a crusade against the black pump?
5 best waterproof cameras

Splash and flash: 5 best waterproof cameras

Don't let water stop you taking snaps with one of these machines that will take you from the sand to meters deep
Louis van Gaal interview: Manchester United manager discusses tactics and rebuilding after the David Moyes era

Louis van Gaal interview

Manchester United manager discusses tactics and rebuilding after the David Moyes era
Will Gore: The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series

Will Gore: Outside Edge

The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series
The children were playing in the street with toy guns. The air strikes were tragically real

The air strikes were tragically real

The children were playing in the street with toy guns
Boozy, ignorant, intolerant, but very polite – The British, as others see us

Britain as others see us

Boozy, ignorant, intolerant, but very polite
How did our legends really begin?

How did our legends really begin?

Applying the theory of evolution to the world's many mythologies
Watch out: Lambrusco is back on the menu

Lambrusco is back on the menu

Naff Seventies corner-shop staple is this year's Aperol Spritz