"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 23 September 2010

Increasing the Postcode Lottery

NICE is evidenced-based. They evaluate treatments and determine if they are effective clinically and cost effective. There is some controversy over their role, but since there will always be a shortage of money there will always be rationing of some kind. NICE aims to make sure that the rationing is equitable and evidence-based. A totally free-market system is likely to end up in the drug companies charging what the patient will pay, rather than the cost, or value of the treatment. Whatever the Daily Mail say about NICE, we should all be thankful that NICE are calm, sensible and base their decisions on facts.

So we have this bizarre new policy from Commissar Lansley to change to "value-based pricing". I have already said that this is a nonsense policy, and I have pointed out that their example of Lucentis is nonsense since the drug was priced specifically at "what the patient would pay to keep their sight" rather than the actual cost of the treatment.

Now we see that the government is changing the role of NICE (Healthcare Republic). A Department of Health spokeswoman said:
"[NICE's] role will increasingly focus on how to deliver authoritative advice to clinicians on the most effective treatments and on development of quality standards, not acting as an arbiter on the availability of drugs."
This is a serious change. David Willetts says "NICE will continue to offer advice but we will ensure more decisions are taken at GP level". The problem is when there is a ptient sitting in the surgery, will a GP say "there is a drug that you can take, but it is expensive and will only give you a few extra weeks, and may even shorten your life"? This is, in effect, what NICE were saying when they declined to recommend Avastin. It is far better for this decision to be made by a separate, evidence based body.

And then there is another problem. Since NICE is a national body (that is the N in NICE) their decisions affect everyone. The problem with forcing GPs to make the decision is that different GPs will make different decisions based on the same evidence. GPC deputy chairman Dr Richard Vautrey says:

"When it comes to high cost drugs, whether it be NICE or consortia making decisions, the reality is the money is simply not available for everyone to have everything that they want. Patient care will not be improved and the changes risk widening postcode prescribing. It is also likely to be a recipe for chaos if this is implemented at the same time as scrapping practice boundaries. The danger is that patients simply register elsewhere in the country just to get a particular drug and this will cause great problems to those practices who try to offer good quality care to remote patients."
Bizarrely Willetts says that this could result in GPs prescribing quack remedies like homeopathy (Pulse):
"They will have the ability to prescribe things like homeopathy even if they do not meet any NICE requirements. If GPs do detect very strong patient demand, they will be able to respond to that. Under our new role, there will be greater scope for GPs to respond to patient demand."
Any system which allows a patient to demand distilled water treatment from their GP is certainly going backwards. Willetts is supposed to be the Science Minister, so why is he promoting a system that will allow the NHS to pay for quack remedies? That is not science.

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