health service politics

A deaf toddler has been offered an operation in one ear - but not the other - in an age-old debate over the best use of NHS resources.
Little Aminah Kashif, from Manchester, is to get one coclear implant on the health service - but if her parents want the other ear done they have to do so privately.
Manchester Primary Care Trust believe it is better to give two people some hearing than one person the op in both ears. They say they are following national guidelines - but it seems the rules will not in fact be set down until next year.
It is a tough one. When does treatment for a condition like this become a right?
A former consultant in this field told me one coclear implant would make a huge difference to a deaf child's life, and that some learn to compensate for the ear without the need for a second implant.
No specialist would fit two implants at once - instead they would do one, assess how the patient adapted and then fit the other one later.
"In the old days, people would be grateful for any help they could get - but now people expect to get everything. Cochlear implants are highly specialised and expensive procedures. Unfortunately, in a health service with limited budgets and competing priorities, you have to make judgements about what is possible," he said.
So, once again it comes down to making a choice between giving a little girl the gift of hearing - and normal development - and equally pressing cases for cancer drugs and hip replacements.
Sadly, all to often these kind of decisions tend to get lost in the politics of the situation. Take Herceptin for example.

A 2003 piece for the Royal Society of Medicine puts it like this:
"Hard choices have to be made about how the National Health Service spends its limited budget. The Government established the National Institute for Clinical Excellence (NICE) to examine interventions and advise on whether and to what extent they should be made available. The approach is explicitly technical with the recommendation depending on health gain, measured where possible as the number of quality adjusted life years (QALYs), in relation to the cost...."
Quoting from a Court of Appeal ruling:
"'It accepted that, while assessment of QALYs may assist in determining which treatments are cost-effective—showing, for example, whether a treatment for a particular condition that has a higher price is actually more cost-effective than a cheaper treatment because it is more efficacious—QALYs cannot ‘assist the Secretary of State in deciding which diseases or conditions should be regarded as the higher priorities in the NHS’."
Their verdict?
"This is very important because the court has reiterated the point (noted by the House of Commons Health Committee) that what should be paid for by the NHS is a political rather than a technical matter."