Description of the benefit catalogue, England

[FIRST PARAGRAPHS]

The legal framework, within which the National Health Service (NHS) operates, impacts on all six categories of the International Classification for Health Accounts (ICHA). However, duties and powers given by the law are not absolute, but tempered by powers of discretion and by the right to take resource availability into account. For example, the duty to provide services is subject to the Secretary of State’s judgement of what is necessary to meet ‘all reasonable requirements’ (Secretary of State for Health, 1977);(s. 3). Strictly speaking, this means that patients have no entitlement to specific services.

Case law has established that NHS organisations may not operate a ‘blanket ban’ on the provision of services (such as particular health technologies or interventions), with the possible exception of treatments where the clinical evidence of its inefficacy is overwhelming (Newdick, 2005b);(pp 105- 107). R v NW Lancashire Health Authority, ex p A, D and G made it illegal for health authorities to impose a blanket ban on services they consider to be ‘low priorities’. Instead, they must adopt a fair and consistent policy for decision-making that adequately assesses exceptional cases by considering each request for treatment on its individual merits (Newdick, 2005b);(page 101). This means that there are few services that are explicitly excluded from all NHS patients; where exclusions exist, they are principally in the domains of medicines and screening.

The NHS therefore produces a situation where patients have no specific entitlements to services, but also where little is explicitly excluded. This means that the internal quality control mechanisms of the NHS are important to ensure that citizens’ rights to health care under international law are honoured (Montgomery, 2003). National guidelines, decisions by the National Institute for Clinical Excellence and standards employed by regulators in their assessments of NHS performance all contribute to what may be considered as ‘reasonable requirements’ for health care provision. They also help to specify the conditions under which patients may be eligible.