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.

NHS funding overhaul will create conflict of interest between public health and private enterprise

Ok so it's taken me a couple of days to respond to Monday's news that the NHS is in for a dramatic shake-up (blame it on the weather, the heatwave wiped me out completely - it's weird to think of myself in the 'vulnerable' group when it comes to things like that).
 
But anyway while we were all busy eating lollies and loving the recent weather, the Government was preparing to launch a white paper called 'Liberating the NHS' that plans to radically alter the way the NHS is funded. It wants to give £80 BILLION directly to GPs to decide how best to spend it on patients, scrapping Patient Care Trusts (PCT) along with it.


I'm not a big fan of PCTs, they have a habit of implementing localised policy that goes against the decisions of NICE, the body governing what drugs and treatment should be available to patients nationwide. Last November I was told by my PCT that I was no longer allowed to be given a nebulised antibiotic called Colomycin as according to old medical guidelines it should only be given in a hospital environment. Except I, along with countless other people with lung conditions, have been taking it at home for two decades. So clearly this sudden decision was one based on saving money.

My GP called the PCT to protest: "Sharon needs easy access to her medicines to be able to concentrate on resting and staying well, not worrying about receiving the drugs she needs". Despite this call, the PCT still said no. (I still get this drug, via hospital, so the NHS has saved no money, the patient has merely been inconvenienced.)

So given that scenario the new plans in principle are an interesting idea. GPs know their patients well and can best decide what treatment they need. However the truth of the matter is that the NHS is still cash-strapped and always will be so my concern is that GPs will instead be faced with a conflict of interest - a patient needs a drug he knows he cannot afford to prescribe. What happens in that scenario? He keeps quiet and offers a cheaper alternative that he knows is less likely to do the job?

The new plans also include a patient being able to choose where to visit a GP, meaning they no longer need to live in their GP's catchment area. But in practice will this be allowed to work in reverse? Perhaps GPs will balance the books by limiting the number of 'expensive' patients they look after, and it's exactly these patients who will be too ill or too busy with time-intensive medical regimes to be able to travel far. It's long been documented how people struggle to find an NHS dentist, will the same soon be said of GPs?

The Government has said hospitals will be encouraged to move outside the NHS to become a "vibrant" industry of social enterprises. Effectively meaning they will need to 'pitch' for money from GPs and that their cap on how much private work they can do will be removed.

The idea is that hospitals will have to become very good at care to ensure they survive, as otherwise GPs won't refer their patients there. But instead they could feasibly cut their prices to lure in patients - meaning those hospitals that achieve less good results could ensure survival by offering services to GPs at prices that reflect this lower quality, in a similar way that lower-rated Universities can offer cheaper tuition fees to attract less well-off students. In addition, waiting lists for NHS patients could soar as hospitals prioritise private patients, who will be unlimited in number. Notably, the health secretary Andrew Lansley already abolished hospital waiting lists.

And there will be no "bail-outs" if a hospital overspends and goes bust. This is completely unacceptable. Social services are provided in a local area to provide access to the care that local people need. If a hospital is failing it should be helped to improve not just be allowed to fail and close down with no thought for the needs of the local community.

And what about patients like me? I never see my GP except for prescription renewals and a common cold. Instead I visit my hospital doctors at least once a month, they decide on my care plan and drug regime and tell the GP what I need. I have no idea how this scenario will be dealt with when GPs are meant to commission hospitals, not the other way round. But it adds to the overall concern towards the Government's plan: it's untested, unpiloted and is meant to be implemented in just 24 months time.

This blog raises a lot of questions I don't know the answer to, but I'm not sure if the Government does either.

Local variances in diabetes treatment challenges the use of 'National' in NHS

A recent national diabetes audit examining differences in patient care across the UK has revealed that almost 60 per cent of those with diabetes are NOT receiving effective care - despite the fact that 90 per cent of diabetic patients are now meeting healthcare teams at least once a year. Of nine recommended care processes that each diabetic patient should be offered, routine urine tests to detect early stage kidney failure is still the least used test - over a third of patients were NOT offered one. Statistics might seem dry but the fact that there has been a 20 per cent increase since 2003 of diabetics needing kidney dialysis or transplant demonstrates how serious these patient care 'oversights' can be.

These variances in health care across the UK are simply unacceptable. If there is a routine list of tests that should be done on diabetic patients, then a GP should simply print it off and tick them off as he or shes goes along. It doesn't have to be any more complicated than that.

It's interesting to note that the data was compiled by statistics offered by Patient Care Trusts (PCT). For those of you who don't know, a PCT is a local body operating within or across a few boroughs that decide how its local 'money pot' should be spent. I've had enough dealings with my PCT to think of a more appropriate four letter word to represent the 'C' in the acronym. No doubt I'll mention the PCT again in my blog, but in my opinion they have more power then they should have and make random monetary decisions about treatment which is never based on what is best for a patient. And often their money saving initiatives are short sighted: it's more economical to keep a patients diabetes under control then deal with the costly consequences such as dialysis and complicated operations.

So, if you have diabetes or any long term illness then do your research. Get in touch with the charity that represents your illness, talk to other patients on health forums and go to your GP armed with facts. If it was me I'd print out the nine key tests that I need, ask for them to be done and insist on a referral to a hospital specialist team if my GP wasn't able to do them.

Until changes are made in the NHS to provide truly universal care, then knowledge really is power when it comes to managing your long-term health.