There is no doubt the NHS is now struggling to cope with increased demand with limited resources. Commissioners and providers have had to face difficult decisions about how to prioritise limited funding and to balance their budgets.
Funding requests are a key marker of treatment rationing. An individual funding request can be made by clinician if they believe that a particular treatment or service that is not routinely offered by the NHS is the best treatment for their patient. As treatments become rationed or unavailable there is a concomitant increase in the number of funding requests.
Normally, the vast majority of treatments and services that patients need are offered routinely by the NHS, but the BMJ investigation shows that the overall number of individual funding requests received by clinical commissioning groups in England increased by 47% in the past four years. Thousands of patients are being turned down for funding each year, while many others are forced to wait for their treatment while their request is considered.
Whatever the government may say about NHS funding, what is clear is that funding per patient has fallen.
NHS Clinical Commissioners recently warned that Commissioning Groups would have £5.72 less to spend per person in 2019-20 than in 2016-17 under current funding from the government.
Clinicians are having to plead for funding for treatment for their patients. There has been a surge in funding requests for hip and knee surgery, cataract removal, and carpal tunnel surgery over the past four years and the consistently high number of mental healthcare requests.
Doctors have warned that rationing is leaving some patients in pain as they wait for treatment.