Why the NHS has to ration care

The NHS budget is effectively frozen for the next few years

Extending fertility treatment to older women sounds good in theory.

But the reality of it in a cash-strapped NHS in another matter.

NICE - the NHS body which recommends what should and should not be done - has suggested the age limit at which IVF is offered is increased from 39 to 42 in England and Wales.

But already those working in the health service are raising concerns about how likely this is given that the majority of trusts are struggling to meet the current recommendations.

Dr Mike Dixon, of the NHS Alliance, which represents doctors, nurses and managers on the front line, perhaps summed it up best in his interview with the BBC's Today programme.

He said: "The problem with them [the recommendations] is that NICE does not pay the bill."

He then went on to add that if the NHS did everything NICE said it would be "bankrupt".

Rationing

This was not an attack on NICE, which is the envy of health systems across the world as it has brought a solid evidence base to health care spending, but rather an acknowledgement that the NHS cannot keep up with expectations.

The cost of providing health services is growing - by about 3% a year because of factors like the ageing population, cost of new drugs and lifestyle issues like obesity.

But the problem is that the budget is not keeping pace with demand. Funding is effectively frozen - and could be for a considerable length of time.

It means the NHS is having to increasingly ration what it does.

This does not just affect fertility treatment.

In the past year, evidence has been gathered about how a growing number of areas are placing restrictions on everything form access to cataract operations to correct eyesight problems to hip and knee surgery.

This is natural for a system with finite resources.

Care has to be prioritised and, understandably, emergency and life-saving treatments come first.