Anna Charles

‘NHS spending… back to the 50s’

‘Hip operations banned if you can sleep: NHS bids to save millions with a new pain threshold test as it rules out surgeries on those deemed too fat’

‘Referral centres cause ‘dangerous’ NHS delays’

This is just a tiny sample of the NHS-related headlines in newspapers this winter. The health service is a source of public interest and media scrutiny regardless of the economic and political context, but the spotlight has intensified over recent weeks as pressures have deepened. As part of the work for our forthcoming report on NHS financial pressures, we examined how the media have reported on NHS pressures in recent years by looking at coverage of the controversial and sometimes highly emotive term ‘rationing’.

We undertook a retrospective search for articles mentioning the term rationing in relation to the NHS in eight media sources (BBC News, Daily Mail, The Guardian, The Metro, The Mirror, The Sun, The Times and The Telegraph) between January 2011 and December 2016.

NHS rationing was reported regularly throughout the five-year period, but increased markedly towards the end. A total of 86 stories in 2011 grew to 144 in 2015 and 225 in 2016. There was also a shift in the nature of reporting: in the latter half of 2016, we started to see increasingly hard-hitting stories about rationing due to the severe financial difficulties facing the NHS, with warnings that it is ‘in meltdown’ and ‘on the brink of collapse’.

The results of our search also provide an insight into the sorts of things that are reported as rationing, revealing that the term is usually understood to relate to access. Common subjects include: variations in access between different areas (often described as the ‘postcode lottery’); restrictions in access to drugs, equipment, surgery and other procedures; and rising waiting times for treatment.

We have previously suggested that dilution of quality is an important form of NHS rationing; however it can be extremely difficult to identify. Only a small handful of the articles in our search reported quality issues; this may relate to the search terms used rather than overall reporting on quality, but also suggests that the media tend to associate the sensitive issue of rationing with access rather than quality.

Since we completed our search, there has been a tidal wave of media coverage detailing winter pressures in hospitals and rationing of care. Re-running our search for January 2017, we found more than 30 results in that month alone. The human stories behind these issues have been starkly illustrated in the recent BBC television series ‘Hospital’, which follows staff and patients at Imperial College Healthcare NHS Trust, highlighting the impact of pressures both for patients receiving or waiting to receive care, and for frontline staff managing competing demands as they try to deliver care in an overstretched system.

So how might this impact on policy-making? Jo Maybin’s research exploring how civil servants in the Department of Health learn about health policy issues found that experiences of frontline care – for example through professional visits or personal experience – can have a profound effect on their understanding. Although media coverage may not have the strength or degree of influence that first-hand experience does, the focus on individual patient stories and personal experiences of rationing can help bring the issues to life. Previous research has also observed that media reporting can be influential in shaping the decisions and priorities of policy-makers.

But while media coverage may help to raise the profile of issues among policy-makers and the public, there is a risk that it narrows the focus. In keeping with the tendency to focus on the visible, recent coverage has continued to centre around access issues and hospital care. For example, there has been widespread coverage of A&E waits and decisions by various clinical commissioning groups to limit surgery for smokers and obese patients. This contrasts with limited coverage of changes to public health and community-based services – for example in genito-urinary medicine (GUM) services – despite significant cuts in many areas.

As we highlight in our forthcoming report, some of the most pressing problems in the system are much harder to see, as they relate to risks to the quality of care and problems in community-based services. Care delivered outside hospitals is less visible, and national oversight (including targets, quality metrics and data collection) is limited. As pressures continue, it will be important to ensure a broader focus on issues across the system, even if people aren’t shouting about these as loudly.

• Our forthcoming report explores the impact of financial pressures on patient care, specifically in four service areas: GUM services, district nursing, elective hip replacements and neonatal care. The report is due to be published on 14 March.
• Six ways NHS financial pressures can affect patient care