Introduction
The National Health Service (NHS) was established on the 5th July 1948 by the then Labour Health Secretary Aneurin Bevan, being the first health system in any Western society to offer free medial care to the entire population (Klein, 2013: p. 1). It was founded from the principle ideal of the Welfare State that good healthcare should be available to all, thus forming the core purpose of the NHS (National Health Service, 2015). The foundation of the NHS is based upon three core principles; that it meets the needs of everyone, that it be free of charge at the point of delivery and that it is based on clinical need and not the ability to pay (National Health Service, 2015). Healthcare funding is theoretically provided for the entire population whom reside in UK, currently at a figure of 65 million, based on their imminent need for healthcare, rather than their means and ability to pay for it.
The NHS has changed and developed dramatically over the time that it has been in existence to the point today where the principles of NHS healthcare delivery can only realistically be maintained by an element of rationing to ensure that the sizeable but finite resources are used as appropriately and effectively as possible in a modern day NHS, with Klein (2013) arguing that the transformation of society and the changes in dominant public philosophy being essential elements in the analysis of health care policy.
NHS Budget
Funding for the NHS is predominantly derived from general taxation and National Insurance contributions, with small amounts coming from patient charges for certain services such as optical care, prescriptions and dental care along with additional elements such as hospital car park charges. The private healthcare sector paid for by personal or private insurance reduces the burden on the NHS although this is only marginally and is only viable for those who are able to afford insurance costs. The initial budget for the NHS at the point of its launch was an approximate figure of ''15billion, now however as stated in The Government'''s Mandate to NHS England for 2016-2017 the indicative budget for NHS England 2017-18 is at a capital figure of ''310billion (2016). However, although this may seem like a large budget it is not suffice in providing the necessary funding for NHS services. A briefing composed by the Kings Fund states that '''NHS providers and commissioners ended 2015/2016 with an aggregate deficit of ''1.85 billion, a threefold increase on the previous year''', with them arguing that the principle cause of the foreseen deficit is due to funding not keeping up pace with the increasing demand for services (Dunn, P. et al. 2016.).
Lack of fundng article/report''''''
Lead to why nhs should be limited
Why the NHS should be limited
As a result of people generally living longer and a rapidly expanding population, public spending on healthcare is likely to be restricted, limiting access to NHS services would provide a pragmatic approach in improving the NHS by preserving funding that would provide ineffective services.
It is not uncommon knowledge that idle lifestyle choices lead to an increasing financial burden on the NHS, with Action Smoking on Health (ASH) estimating that smoking costs the NHS ''2bn a year for treating the diseases instigated by smoking, this figure including the cost of hospital admissions, GP consultations and prescriptions.
Limiting the NHS to a certain extent based on age and lifestyle is not just backed by the government as a way to cut costs and reduce the budget but is also supported by doctors, with an article published by Denis Campbell, health correspondent for The Guardian arguing that '''the majority of doctors support measures to deny treatment to smokers and the obese''' with '''some medics believing that unhealthy behavior can make procedures less likely to work'''. A survey carried out by Doctors.net.uk, observed that of 1,096 doctors who took park 54% responded with yes when asked '''should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?''' (2016).
Why the NHS should not be limited
An article published by The Week Magazine argues that limiting the services offered by the NHS would essentially be eroding the core foundations upon which the NHS was established.
Furthermore, with the establishment of Local Clinical Commissioning groups who have sole choice on additional lifestyle criteria that need to be met in order to access funding, it is believed that a varying standard of healthcare will be given throughout the UK. A recent report published by The Royal College of Surgeons states that one in three Clinical Commissioning Groups are already denying or delaying hospital-based services such as routine surgery to patients until they stop smoking or lose weight, as a way for local GP-run CCGs to cut-costs and preserve their budget. However there is some justification of this as smoking and obesity are said to be a causative factor in post-operative complications with a retrospective cohort study of 3,309 carried out by The Journal of Bone and Joint Surgery finding that of those who had a hip replacement, the risk of post-operative complications were greatly increased by a figure of 121% in heavy smokers and 58% in those in the obese category.
Restrictions already in place
Presently, the NHS demonstrates numeral restrictions that restrict an individual'''s access to a service, based upon distinct age and lifestyle factors. A prime example of this is the limited access to In-Vitro Fertilization (IVF) services that the NHS funds. In order to be considered for IVF on the NHS it is necessary for the individual to meet definitive criteria, which incorporates features such as age, smoking and weight. IVF is not restricted by the NHS as a whole, but rather by Local Clinical Commissioning groups who decide whether to fund the treatment, with being of a health weight – specifically a BMI range between 19-30 – and being a non-smoker forming the basis of additional criteria that influence access to NHS funded IVF treatment (NHS Choices 2015).
Although many believe rationing of IVF by limiting the number of cycles or outright denying smokers and those with a BMI outside of the healthy range is ethically wrong and incorporates an element of discrimination,
Conclusion
Founding NHS principles are no longer sustainable in the current situation with limited and finite funding unable to cope with the increasing and almost infinite demand on the system, with people living longer and the evolvement of better diagnostic and treatment options. A form of rationing is inevitable in order to ensure that the NHS remains a predominantly free provision and patients taking an element of responsibility for their health status, by means of losing weight, stopping smoking or drinking, appears ethically and morally an important consideration as it is not based on where they live or their financial status. With studies showing that patients who take an element of responsibility for their health may provide for better outcomes as they are more likely to adhere with instructions and be more motivated to overcome their health problems. Conversely however, I do believe that limiting NHS services based on age is ethically unacceptable and is a form of discrimination as not everyone who is the same age experiences the same health difficulties.
References
Can I get IVF treatment on the NHS? 2016 Department of Health. Available at: http://www.nhs.uk/chq/Pages/889.aspx?CategoryID=54 [Accessed: 25 January 2017].
Department of Health. 2016. The government'''s mandate to NHS England for 2016-17. (s.l.): gov.uk. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/494485/NHSE_mandate_16-17_22_Jan.pdf [Accessed: 25 January 2017]. pp.11.
Klein, R. 2013. The new politics of the NHS: From creation to reinvention. 7th ed. London, United Kingdom: Radcliffe Publishing.
In-text citations: (Klein 2013, preface, p. 1)
Dunn, P. et al. 2016. Deficits in the NHS 2016. (s.l.): (s.n.). Available at: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf [Accessed: 27 January 2017].