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Constructing ‘exceptionality’: a neglected aspect of NHS rationing / David, Hughes

Sociology of Health & Illness

Swansea University Author: David, Hughes

  • Accepted Manuscript under embargo until: 20th June 2020

Abstract

The principle of exceptionality involves assessing whether a patient is sufficiently different from the generality of patients to justify providing a treatment, such as an expensive cancer drug, not approved for routine funding. In England, individual requests for certain high-cost treatments are co...

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Published in: Sociology of Health & Illness
ISSN: 01419889
Published: Wiley 2019
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa50556
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Abstract: The principle of exceptionality involves assessing whether a patient is sufficiently different from the generality of patients to justify providing a treatment, such as an expensive cancer drug, not approved for routine funding. In England, individual requests for certain high-cost treatments are considered by funding request panels that examine exceptionality alongside treatment efficacy and cost as the main criteria for funding. This was also the case in Wales until September 2017. Our paper draws on audio recordings of panel meetings and interviews in a Welsh Health Board to investigate how exceptionality was constructed in discussions. It focuses on the combination of different decision criteria in meeting talk, particularly regarding the discourses associated with efficacy and exceptionality. Exceptionality is a malleable category that raised questions about the evidence-based nature of panel decision making. For example, the paper discusses the use of subgroup data from trials and the difficulty of deciding how small a subgroup of patients should be before it is deemed exceptional. Determining exceptionality has been a key mechanism for deciding that a minority of NHS patients can still receive high-cost treatments not routinely provided for all. As a neglected rationing mechanism.
Keywords: rationing; individual patient funding requests; evidence-based medicine; exceptionality; clinical effectiveness
College: College of Human and Health Sciences