The Nuffield Trust questions whether it is time to set out more clearly what is funded by the NHS?

The Nuffield Trust, in a series of debates and reports questions whether NHS services could be further restricted or whether those services should be defined.

The National Health Service in England currently faces the challenge of deriving, by 2015, an estimated £15-20 billion more value from the overall budget in order to meet rising demand but without a corresponding increase in funding.

At the same time, political debates over the Secretary of State’s duty to provide ‘a comprehensive health service’ have thrown a spotlight on how the NHS interprets national guidance at a local level. The drive to devolve greater responsibility for decision-making to local clinicians is expected to result in wider variations in funding and purchasing decisions, and some fear this could result in greater inequities in access to care.

The report outlines the current system in which decisions for determining which treatments are funded by the NHS are arrived at implicitly. It makes several recommendations for how the system could be improved. These include:

  • Establishing a set of principles that would shape how public money is spent in the NHS;
  • Producing a national list of the treatments that public money should not be spent on in the NHS (unless there are exceptional circumstances);
  • Ensuring that decision-making by clinical commissioning groups is transparent.

Guardian Healthcare Network

Nuffield Trust report