“No decisions about us without us”? Individual healthcare rationing in a fiscal ice age

Healthcare rationing is high on the political and public agenda in the United Kingdom. The English National Health Service (NHS) is undergoing major restructuring aimed at improving efficiency. From 2013, responsibility for commissioning NHS services look set to shift from primary care trusts (PCTs) to general practitioner (GP) commissioning consortiums, which will also take over funding decisions on new clinical interventions from the National Institute for Health and Clinical Excellence (NICE). The coalition government’s comprehensive spending review (which demands savings of £20bn (€23bn; $32bn) over four years will take the NHS into a “fiscal ice age.”1 Patient and public involvement in decision making remains a central part of the NHS mission and is a statutory responsibility for commissioners of NHS care.2 However, although patient and public participation in national and local decisions is widely accepted, there is a lack of consensus on whether and how they should be involved in rationing decisions at the individual level,3 and uncertainty about what involvement means in practice.