This will no longer wash , according to " Rationing and Rights in Health Care " , a study published on November 20th by the Institute for Public Policy Research ( IPPR ) .

FOR the past 50 years decisions about who would live and who would die were mostly taken behind closed doors by consultants . In theory , access to treatment was determined solely on the basis of clinical need . In practice , it was often determined by age , geography , marital status and the personal prejudices of the consultants making the decisions .

This will no longer wash , according to " Rationing and Rights in Health Care " , a study published on November 20th by the Institute for Public Policy Research ( IPPR ) . There are several reasons why . The purchaser - provider split , central to the government 's health reforms , has made purchasing decisions more transparent . The Patients ' Charter , which lays down maximum waiting times for operations , has also focused public attention on lack of resources . Many health authorities have had to make drastic changes to their priorities to reduce queues for operations . One in six authorities now excludes certain treatments such as cosmetic surgery , sex change and tattoo removal . Berkshire Health Authority has specifically excluded 12 treatments from NHS provision , among them treatment of varicose veins , snoring , and the removal of wisdom teeth .

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Access to the most expensive care , such as fertility treatment , depends largely on geography . In some parts of Britain , in vitro fertilisation is provided free of charge . In others , such as Somerset , couples have to pay 500 - 1,500 per treatment . Different places have different age thresholds . In Liverpool , treatment is restricted to women under the age of 35, in Humberside to those under the age of 40. Care for terminally - ill patients varies widely . Ealing and Hammersmith , for instance , provide in - hospital care for all patients who are diagnosed as likely to die within a year ; in Bromley , by contrast , the threshold is two weeks .

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The more sensitive the rationing decisions , the more covert they tend to be . In some health authorities , if your kidneys fail and you are over 65, you will quietly be allowed to die . Only 8% of patients receiving renal dialysis in Britain in the mid - 1980s were aged over 65, compared with a quarter in Germany , France and Italy . There is no clinical justification for such ageism . The five - year survival rate for pensioners on renal dialysis is 62% compared with 44% for those aged 55 - 64, according to a study published in the British Medical Journal . Similar unjustified discrimination on age grounds can be seen in treatments for certain types of cancer and heart disease .

There is a strong case , as the IPPR study argues , for bringing such decisions out into the open . " Priority setting " , as the politicians prefer to call rationing , involves many , often ad hoc , decisions taken by ministers , health authorities , hospital consultants and doctors . The NHS spends 100m every day . Those who pay for it have a right to know rather more than they do about how this money is being spent , and why .

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