Priority setting

Research shows that the public are concerned that patients do not always receive the treatment they should be entitled to, and that the so-called postcode lottery leads to an inequitable system. But the NHS has finite resources and cannot make every treatment available to every patient, and allocating resources is one of the most politically sensitive and complex issues facing today's NHS.

Resource allocation

The Government sets the overall budget for the NHS in England through its Comprehensive Spending Review process and hands over responsibility for 85 per cent of the overall budget to the 152 primary care trusts across the country.

PCTs are allocated money according to the size and age of their local population, their health needs (which often vary, depending on deprivation and mortality levels), and any geographical variations in costs. Each PCT then prioritises which treatments and services to make available for its patients, using guidelines on particular treatments from the National Institute for Health and Clinical Excellence (NICE).

A large amount of resources allocated still reflect historic patterns of provision, the particular approach of local providers or even individual clinicians. High-quality, evidence-based and systematic decision making is needed to support the development of each PCT's commissioning plan.

Briefings for members

Our PCT Network has produced a series of briefings to support the development of decision-making in this difficult area. Written by practitioners in the field, the briefings are primarily aimed at those directly involved in allocating resources. However, the series should also be helpful to a wider audience including providers and policy makers.

The briefings cover:

• An overview
• Managing new treatments
• Managing individual funding requests
• Legal considerations.

Members' views on top-ups

In August 2008 we asked NHS Confederation members for their views on whether or not patients should be allowed to buy additional treatments not offered by the NHS. We asked them to comment on our paper with suggested options for solution. Members were very concerned that top-ups undermine the NHS by creating a strong impression of unfairness. Others expressed concern that the practical difficulties associated with creating a new system would outweigh any benefits.

However, they recognised that the current situation is not sustainable and said that, if top-up payments are to be introduced, they would support the following options:

• allowing top-ups for treatments rejected by the National Institute for Clinical Excellence in Health (NICE) and where administration has to take place simultaneously with other therapies/monitoring
• patients wishing to top up have their care provided by a private sector provider with the NHS component paid for by the NHS at tariff.

Read our letter to Professor Mike Richards, national clinical director for cancer.