The English National Healh Service and the ‘Transparency Turn’ in Regulation of Healthcare Rationing

In October 2010, NHS Warwickshire, a Primary Care Trust (PCT) which is responsible for commissioning health services for a local population of more than half a million people in the English Midlands, issued a press release in which it specified those clinical procedures which were to be prioritised over the forthcoming winter period, divided into three categories. Those in the „Fast‟ category, which comprised cancer-related referrals, fracture-related referrals, urgent trauma cases and other procedures where a delay would cause deterioration in the patient‟s long-term health, were to be undertaken as normal, with a shorter expected wait time in many cases. Those in the „Slow‟ category were to be deferred until April 2011 except where, following a process of review, it was concluded that treatment should proceed immediately for clinical reasons. Procedures listed in this category included routine elective hip, knee and shoulder surgery, IVF treatment (unless already commenced), referrals for back pain management, oral surgery and orthodontic procedures. Additionally, a third „Stop‟ category designated a number of procedures which would no longer be funded at all by NHS Warwickshire, save for in exceptional circumstances. These included acupuncture, correction of male pattern baldness, hair transplantation, oral vaccines for seasonal rhinitis, penile implants and tattoo removal.