End of life care: Resource constraints

1. 37. Decisions about what treatment options can be offered may be complicated by resource constraints – such as funding restrictions on certain treatments in the NHS, or lack of availability of intensive care beds. In such circumstances, you must provide as good a standard of care as you can for the patient, while balancing sometimes competing duties towards the wider population, funding bodies and employers.²¹ There will often be no simple solution. Ideally, decisions about access to treatments should be made on the basis of an agreed local or national policy^iv that takes account of the human rights implications. Decisions made on a case by-case basis, without reference to agreed policy, risk introducing elements of unfair discrimination or failure to consider properly the patient’s legal rights (see paragraphs 7-9).
2. 38. If resource constraints are a factor, you must:

1. (a) provide the best service possible within the resources available
2. (b) be familiar with any local and national policies that set out agreed criteria for access to the particular treatment (such as national service frameworks and NICE and SIGN guidelines)
3. (c) make sure that decisions about prioritising patients are fair and based on clinical need and the patient’s capacity to benefit, and not simply on grounds of age, race, social status or other factors that may introduce discriminatory access to care
4. (d) be open and honest with the patient (if they have capacity), or those close to them, and the rest of the healthcare team about the decision-making process and the criteria for prioritising patients in individual cases.

1. 39. You should not withdraw or decide not to start treatment if doing so would involve significant risk for the patient and the only justification is resource constraints. If you have good reason to think that patient safety is being compromised by inadequate resources, and it is not within your power to put the matter right, you should draw the situation to the attention of the appropriate individual or organisation, following our guidance on Raising concerns about patient safety (2006).