Background: In the aftermath of the Coronavirus disease 2019 (Covid-19) pandemic, allocation of non-urgent medical interventions is a persistent ethical challenge as health systems currently face an unprecedented backlog of patients requiring treatment. Difficult decisions must be made that prioritise certain patients over others. Ethical resource allocation requires that the needs of all patients are considered properly, but at present there is no guidance that can help support such decision-making which explicitly considers the needs of children with chronic and complex conditions.
Methods: This paper reviews the NHS guidance for priorities and operational planning and examines how the needs of children with chronic illness are addressed in NHS objectives for restoring services and meeting elective care demands.
Results: The usual criteria for prioritisation featured in the NHS guidance fail to account for the distinct needs of children with chronic illnesses and fail to match more general considerations of what constitutes fair resource allocation decisions. To address this issue, two considerations, namely 'protecting age-related opportunity' and 'recognising complexity of care,' are proposed as additions to the existing approach.
Conclusion: By providing a broader conception of needs, these criteria address inefficiencies of the current guidance and relevant ethical frameworks and help to embed a currently missing children-related ethical approach to healthcare policy making in general.
Keywords: Children; NHS; chronic illness; equality of opportunity; ethical framework; healthcare prioritisation; medical complexities; resource allocation.
This paper addresses an increasingly pressing practical problem of justly allocating healthcare resources between different groups in the aftermath of the pandemic and in the face of significant waiting lists for treatment. Our focus is on children with complex conditions, a vulnerable group that we argue has been systematically disadvantaged in policy considerations. We claim that the current NHS approach does not succeed in capturing their distinct needs. We suggest that two new criteria ‘protecting age-related equality of opportunity’ and ‘acknowledging complexity of care’ should complement the existing ones in order to support decisions-makers to make decisions that are consistent, fair and inclusive to the needs of children with chronic conditions. We also consider broader implications of our suggested framework for health care resource allocation decisions in general. We hope that this work brings a better theoretical understanding closer to the practical changes faced in resource allocation decision making context in the aftermath of the pandemic and beyond.
Copyright: © 2024 Lignou S et al.