Just a quick query as a type one for 32 years just wondering why the standard of care is different up and down the country and not the same for everyone. As having various issues from my eyes, kidneys etc at 42 think I've all ready accepted my fate. What I don't get though from losing vision, to kidney problems to feeling rubbish alot. Getting access to consultants or the newer technology ie pumps etc, why is it so hard for some yet others have been on a pump for years. Even the pump manufacturers say please contact your local hospital for availability on the NHS as each one is different. Basically admitting some hospitals do fund things like the pump and others won't. Think all the work diabetes UK and all the other companies bringing out newer technology should make sure it's available to all or at the very least to the people that most need it. I just don't get it at all. The complications etc from diabetes costs alot more in the long run than the initial costs of helping diabetics more in the prevention of complications. In 2022 in the UK it's so hit and miss with the care and funding you receive, we are still living in a time where your place of birth does have an impact on life expectancy. Shame.
Ultimately, the standard of care differs across the country because that is the system of healthcare which 650 members of Parliament (or their predecessors) have allowed to come into effect.
Oh, and because the NHS in England receives a finite amount of money each year. That pot of money is distributed unequally amongst the various health authorities in England (according to a BBC Newsnight programme I saw recently, counterintuitively the more deprived an area, the less NHS funding it receives) who have to prioritise what they consider to be the most important health issues, particularly as the health authorities who commission care are required legally to balance their budgets each year.
I believe cancer care receives more funding than any other disease.
Endless tinkering with the healthcare system since the NHS was established on 5 July 1948. Such tinkering sped up during both New Labour and the coalition government of 2010 to 2015, with the widely regarded as disastrous reorganisation of the NHS into "clinical commissioning groups" (now reorganised further into so called 'integrated care systems") where clinicians who have little or no financial training or experience decide how the money allocated to their health area for which they are responsible will be spent.
The reforms that took place from 2010 to 2015 under the coalition government saw the Secretary of State for Health cease to have legal responsibility for healthcare.
And just like local councils, I understand that integrated care systems (formerly clinical commissioning groups) are required legally to balance their budgets each year.
The National Institute for Health and Care Excellence (NICE) whilst a good idea in principle, has always had an obvious weakness as far as consistency of delivery of patient care across the country is concerned.
NICE does have the power to mandate that particular drugs or treatments must be given to patients as part of its role in assessing "medical technology."
However, NICE also issues "guidance" on the most suitable treatments for a number of diseases, and it is here where the NHS postcode lottery begins.
Most of NICE's pronouncements are issued in the form of disease treatment "guidelines," and as any lawyer will tell you, in England and Wales "guidance" means exactly what it says, and it is not mandatory.
While NHS organisations are required to take NICE guidance into account when making decisions about treatments for patients, those organisations can consider the NICE guidance and choose not to follow it (though there might be consequences legally if they don't follow the guidance).
Which is why so many of the former clinical commissioning groups (now integrated care systems) have a discretion in the health areas they are responsible for not to pay for certain drugs, medical devices or certain treatments that might benefit patients.
If one is a patient living in an integrated care system unwilling (or unable) financially to spend its budget on a drug, medical device or treatment that one believes may be beneficial, and the patient cannot persuade the ICS to spend that money, after exhausting the NHS's own complaints procedures, the only recourse one has is to ask HM courts to make the ICS decide differently. Which is itself never easy (but not impossible) as the NHS retains - at significant expense - some of the leading healthcare lawyers in the country to fight such cases.
But yes, ultimately there is an NHS treatment postcode lottery because that is the way our elected politicians want it and they have structured deliberately the system to work as it does at present.
