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Allocation of scarce resources in health care: An ethical review. The West Glamorgan experiment. / R. C. M Jarvis

Swansea University Author: R. C. M Jarvis

Abstract

The National Health Service (NHS) is seen by many as being at a time of crisis. Demand for care outstrips the human and financial resources available, and the choices that are having to be made with regard to selective funding of treatments are becoming both more public and more tragic. Increasingly...

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Published: 1996
Institution: Swansea University
Degree level: Master of Philosophy
Degree name: M.Phil
URI: https://cronfa.swan.ac.uk/Record/cronfa42682
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Abstract: The National Health Service (NHS) is seen by many as being at a time of crisis. Demand for care outstrips the human and financial resources available, and the choices that are having to be made with regard to selective funding of treatments are becoming both more public and more tragic. Increasingly, there are calls for informed public debate about prioritising treatments, or rationing. This thesis argues that the foundation and various reforms of the NHS have all aimed at one common goal: to make health care provision in Britain more efficient. I argue that underpinning the establishment and reforms of the health service has been the mistaken idea that the scarcity of supply relative to demand (and the consequent need to ration care) can be eliminated with more efficient procedures. Faced with the service's continued failure to align supply with demand, unable to gain clear and consistent advice from central agencies, and unwilling to take the drastic step employed by some health commissioners of decommissioning entire areas of treatment, the health commissioners in West Glamorgan took the initiative and established a Local Ethics Committee (Purchaser Advice) to review and give advice relating to commissioning and purchasing issues within the county. This thesis charts the development of the first three years of that unique committee, giving an insight into the processes and methods by which health care is rationed in West Glamorgan. It discusses the philosophical foundations of the review, examines the workings of the committee from the standpoint of the participant observer, and suggests that, as the problems faced by the West Glamorgan health commissioners are those facing commissioners nationwide, the model of ethical review proposed is one that could profitably be adopted elsewhere in the health service.
Keywords: Health care management., Medical ethics, NHS, National Health Service
College: Faculty of Medicine, Health and Life Sciences

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