“POSTCODE LOTTERY”?

In the NHS, access to a proven, effective treatment such as neonatal extracorporeal membrane oxygenation (ECMO) should (in theory) be equitable, especially when there is national provision of the treatment at four designated centres. Furthermore, when these centres are widely separated geographically, access should be reasonable wherever a baby happens to be born. Yet when Tiruvoipati et al examined referral patterns for ECMO they uncovered an extraordinary 4.5-fold difference in referral rates between government regions. Such variation is hard to explain on the basis of intrinsic differences between populations of babies, but until we know more about both the numbers of babies reaching the criteria for referral, and the decision making processes among their neonatologists, we will remain in the dark about how …