Tuesday, 2 November 2010

NICE loses power to save Government from hostile headlines?

There has been mixed reaction to the news that NICE is losing its power to reject new drugs that it thinks do not show value for money. The change, announced last week, means that NICE (the National Institute for health and Clinical Excellence) will still exist but its power will be much curtailed - it can provide advice but it will no longer control the NHS drugs purse.

Initial reaction is that this might be a good idea. NICE has long been the ogre of the tabloids as there is a real human cost behind every drug that it says the NHS will not fund. Especially as these drugs have been proven by pharmaceutical companies to have some benefit, it's just that NICE thinks the benefit is minimal compared to the price demanded by its manufacturers.

But although NICE might have been sidelined, there is still no more money for the NHS. In fact despite the coalition honouring its promise to give a real-term increase to the NHS purse, the NHS is actually facing a tightening of its budget as it faces future increases of only 0.8% a year compared to a previous average increase of 4% a year.

So NICE's powers might be gone, but the rationing of drugs is still a reality that the NHS must face. Andrew Lansley, the health secretary, has outlined plans for the responsibility for deciding if a drug is of value to be transferred to local PCTs. This responsibility will then ultimately be handed over to GP consortium']s if Lansley NHS reforms are passed.

The abolition of NICE will clearly exacerbate the problem of the postcode lottery - whereby someone living in one borough will access drugs, and often enjoy a longer life expectancy, than someone in another borough. This may well cause nasty tabloid headlines but local restrictions won't cause quite the hostility towards the Government that a nationwide ban has done in the past. Mike Hobday, the head of policy for MacMillan Cancer Support hints that the negative public portrayal of NICE had a hand in its downfall when he said: "NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers".

And the Government has already hedged its bets when it comes to cancer, the most emotive and political of all health problems, by promising a stand-alone cancer drug fund that patients can apply to if their local NHS won't fund a particular treatment.

Drug rationing is an inevitability of the NHS, as are the hostile headlines it creates, and drug restrictions will continue to be enforced whether NICE controls the purse or 152 local bureaucrats do instead. So the reduction of NICE's powers may well turn out to be a smokes and mirrors exercise to avoid the public recognising the true funding problems the NHS will face over the coming decade.

1 comment:

  1. Hi,

    Drug rationing has been a problem for a long time, in areas other than those that get the Daily Mail worked up.

    I have severe COPD (never smoked - there are other causes) and in the eighties, when I was far less ill than I am now, I had a stock of drugs, prescribed by my GP, to rival a small pharmacy. By the end of the nineties, though I had no more than a few weeks worth of anything (I take 16 prescribed drugs, not all for COPD).

    In the early years of this century, NICES's antibiotic paranoia began to bite, and by 2004 it because impossible - even though both my GP and I knew what I needed - to get antibiotics for my frequent (once a month on average), respiratory infections, without a sputum test. It was foul and toxic, I didn't need to know any more than that!

    The test was supposed to take 24 hours. In reality it took a week - which I spent getting worse. Then I'd get 7 days worth of medication, after which - because the delay meant that wasn't adequate - I'd be back for more - and the whole farce started over again.

    I gave up. Antibiotics have kept me alive** since 1953 (that's when Penicillin was released for public use), and there was little I didn't know about their use - so I bought my own. I still do.

    **I've had severe asthma and bronchiectasis since age 2, when simultaneous whooping cough and measles almost killed me - they did succeed in trashing my lungs.

    Since then (2004), I've been buying my own antibiotics and self medicating, using the GOLD guidelines (http://www.goldcopd.com/index.asp?l1=1&l2=0 ).

    I no longer suffer from COPD exacerbations (infections). I still get them, but I don't suffer because I'm able to treat them as soon as they appear (before they'd be apparent to a GP there are signs which are obvious to the patient), and in 2-3 days, they're gone again. In 6 years I've needed my GP 4 times, and two of them were for serious bouts of flu.

    Do I get through more antibiotics this way? Initially, yes - there was a lot of damage to undo, now, though, when I can see off an infection with as few as 9 or 10 capsules (instead of the usual 21), I believe - though it's difficult to quantify - that I use fewer than I used to.

    There's also the advantage that I'm not hanging around the waiting-room, to come away with bugs I didn't go in with, as my immune system isn’t worth much.

    In that respect, NICE-induced rationing has done me a favour, because I seriously doubt that, if things had continued the way they were going, that I’d be alive now.