Appropriate rationing of access to healthcare is a fundamental part of providing an equitable national health service. In particular, the establishment of the National Institute for Health and Clinical Excellence (NICE) has increased transparency surrounding the basis on which treatments are made available in the NHS. Much less clear, however, are the arrangements for treatments that NICE has not reviewed. How sure can we be that access to these is based on policies that ensure the principle of equity?

The problem is exemplified …