Absolutely.

Rationing is what politicians are scared of people seeing limitations as, whereas screening is a public health function with the aim of prevention being better than cure, both for the patient and for the treasury. We are saying the same thing in that regard.

A good example of dilemma can be found in breast screening. There is no clinical evidence to support widening age range or frequency for general public screening via mammography whilst there is every political reason to do so. There is however a need to screen at risk groups and recall screen people with family history and test indicators putting them at high risk. You can't fill the clinic with the riskiest patients because the budget and the physical space is crammed with people arbitrarily sent for based on an ever politically increasing age range.

Screening is one of the best early intervention measures we have, not only for early excision of potential anomalies but also for encouraging healthy lifestyle. Both are good for the patient and the treasury. Increasing anxiety however doesn't help. Breast surgeons and oncologists spend time discussing options with elderly patients for whom the trauma and discomfort of surgery, chemotherapy and radiotherapy is worse than living with something that is so far off being a problem, it will sit there beyond potential life expectancy. Mammography picks these up too..

An interesting less acute example is about fifteen years ago, optometrists were allowed and encouraged to screen for glaucoma, cataracts etc. The cataract "star field" machines are so good they pick up cataracts years before they grow to a level you'd notice. Also difficult to remove properly when so small. People were being referred via their opticians for problems hospitals said weren't yet clinically appropriate to treat.

The best way to explain how a limited budget and rationing mean the same thing is to visit the website for NICE where clinical effectiveness vs cost is used for NHS funding decisions. It isn't about rationing, it's about the best clinical decisions being funded. However, by clinical decision, it's also about patients as opposed to the patient. Giving a drug that costs £500k to add a month of uncomfortable life as opposed to funding three hundred courses of a drug that will extend other lives less far down the line and the quality of them by a couple of years.

Notwithstanding the government's wish to screen more and encourage GPs to refer more (their indemnity insurance encourages that ever more too.) The same government then scratches its head when hospitals are on the verge of bankruptcy and everyone is running round with their hair on fire trying to deal with the workload. Expectation is a wonderful thing and encourages better ways of working but we have reached a genuine point where you can't just throw money at it. Over 19% of clinical posts in The NHS are vacant or short term locum. Over 20% of senior management posts are vacant or with interim. We used to have too many people with clipboards called managers. We now have a huge gap due to not enough management. Paying consultant doctors their time to do what a manager on far less can do better isn't the best way of financing. NHS trusts know this but in case we forget, the piggy bank is controlled centrally by a government ministry.

Still. Over a million clinical episodes every twenty four hours, with approx 97% of them not going wrong. Sounds good but could be better. If the airline industry was at 97%, a jumbo jet would fall out of the sky each and every week.