Nice drug – if you can get it on the NHS.

NICE has been in the firing line recently. This body which has the duty to decide which drugs the NHS can buy and which are unsuitable on grounds of efficacy and cost has been caught in the crossfire. On one side the pharmaceutical companies have been running effective campaigns to claim NICE was wrong to reject their new drug. On the other side patient groups have started to lobby in ever more media friendly ways for spending on the latest drug that they hope will alleviate or cure their symptoms.

It is what you should expect when you have a near monopoly health service provider controlled by this particular group of politicians who live by the media. Because the NHS has such colossal power in its buying decisions drug companies have to throw everything in to selling to the single purchaser in the English market. They are very disappointed if it does not work.

Similarly, patient groups have come to realise with this government that only media friendly prominent lobbying is likely to get Ministers attention and possibly lead to a change of policy. One of the newer features of an MP’s life is a stream of invitations to attend functions organised by groups whose sole aim is to change the drug purchases and the medical and clinical protocols of the NHS for treating a particular disease. Most diseases now have their action group. They feel forced to behave like this, competing for the attention and money of Ministers in this heavily centralised top down system Labour has devised. Too much rests on the decisions of just a few people at the top, in the Ministry, and in NICE.

The government has invited people to make the NHS the central concern of modern politics. They have shown them how to lobby and use the media, and they have so centralised the NHS that people conclude the only thing that matters is to get to the Minister. They have ended up fashioning a boomerang that is beginning to hurt the very government that designed it as their own political weapon.

Labour believed that if they spent lots more on the NHS most of the problems would go away. If they centralised decisions they could guarantee good standards across the country and claim the credit for all that was going on. Such a strategy means they must also be to blame for things that are not working well, for the hospital infections, the delays and shortages,and to blame when people cannot get access to the drugs they think they need or the treatment that would make them better.

I have been meeting GPs during the summer break from Westminster. They complain to me that too many top down targets are making it far more difficult to serve their patients well. They dislike features of the very expensive centralised computer technology being introduced into their lives. They too are unhappy about the endless fiats from the centre and from too many judgements being made by too few people.

Labour had better be careful. Its attempt to play politics with the health issue, showing itself as the beneficent provider of more cash from the centre, is becoming a cause of angst with patient groups, with drug companies and with GPs. That is a very powerful alliance of interests to turn against you. Never has so much money been spent by so few people with such negative effects.

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17 Comments

  1. Stuart Fairney
    Posted August 18, 2008 at 9:00 am | Permalink

    I've always seen NIHCE as a body whose sole purpose was to delay the uptake of new drugs until their patent nears its end and cheap generic versions become available.

    Hence when you get politicised reports about a drugs alleged lack of effectiveness which contradict genuinely neutral bodies you cannot help but be cynical.

  2. Posted August 18, 2008 at 11:06 am | Permalink

    NICE is a curious body, in the sense that it gets so much stick from the media and the public yet many other countries are desperate to put a body such as NICE in place because it does such a good job of focusing taxpayers' money on cost-effective treatment. This ltimately keeps some sanity on healthcare spending, something which France and the USA can only dream of.
    http://lettersfromatory.wordpress.com

  3. Johnny Norfolk
    Posted August 18, 2008 at 11:14 am | Permalink

    Labour cannt run anything. It set up NICE so it could hide behind it and try avoid direct blame. It is telling the doctors how to do their jobs. What it should be doing is pushing responsibility down to the lowest level possible, instead it is doing the opposite.

    We are being run like some 3rd world old Eastern Bloc country.

  4. Posted August 18, 2008 at 11:57 am | Permalink

    There is a fair bit of "its either illegal or compulsory" to medical drugs. We have just seen a drug called Rimber, which has produced very substantial results in preventing alzheimers.

    Unfortunately so much testing is required that it is unlikely it will be approved in time to save anybody seeing the first symptoms now. I think people should have the free choice to decide whether they wish to try such drugs even if it does take a lot longer before the NMS accept them. I am quite certain that an awful lot of people would take a small risk to prevent alzheimers.

  5. no one
    Posted August 18, 2008 at 1:50 pm | Permalink

    thanks for posting this

    as more people travel they know that the nhs really is the worst health system in the developed world, they see with their own eyes the differences between the UK and the rest of the world, the NHS needs changing into a national medical insurance sheme which does not own or operate providers of care

    and the Mao China style management of the NHS needs to topple as soon as possible for the benefit of all of us
    http://notdrrant.blogspot.com/

  6. adam
    Posted August 18, 2008 at 4:29 pm | Permalink

    I think its unrealistic for the NHS to be expected to provide brand new drugs which cost so much.

    The basics should be in place first and there is still a shortage of beds and understaffing being reported in the press.

    I believe labours investment went mostly on redesigning and remodelling the NHS and for some reason giving GPs ridiculous pay rises (no worries about inflation there!)

  7. GeoffH
    Posted August 18, 2008 at 5:33 pm | Permalink

    The whole NICE and NHS approach is the inverse of what is needed.

    If a drug is safe and doctors feel it be effective for their patient, then it should be prescribed and paid for. Cost or cost-effectiveness should not be the issue.

    These expensive treatments are always going to be beyond the reach of most people. That's why we have an NHS and pay taxes for it.

    On the other hand, ordinary everyday treatments that are cheap are well within the means of most people. These should be paid for by the patient. Prescription charges are a feeble attempt at achieving this.

    We should go further. All doctor visits should be charged. hospital stays should attract a contribution charge.

    By charging most people small sums (an insurance excess, if you like) then the expensive, rare treatments for kidney cancer and the like would be attainable.

  8. Matthew Reynolds
    Posted August 18, 2008 at 8:10 pm | Permalink

    Well John as David Cameron wants to match Labour spending levels and just wants a slightly bolder version of Blairite NHS reform how on earth will voting Tory pave the way for the problems that you outline being solved ? Your critique leads one to the view that policies more radical than the Blair style stuff being favoured by messars Cameron , Letwin and Lansley are required . The Lib Dems are of the view that if you cannot be treated within a certain time you can go private if the provider can do it for the same or less as the NHS with the state being the cost . You will only make private healthcare more affordable and the NHS better at healing the sick if market failure is corrected and competition and where needed co-operation is fostered . Why can David Cameron not do us all a favour & read that great Redwood work Healthy Choices ? We need a new NHS policy that will make things better – 11 years of Blairism has not worked ! It is worrying that a Party lead by a ‘joke ‘ has a better idea than the Tories who will be in office by 2010…..

    If the Tories want a decent healthcare policy just get David Laws in for a few chats ! We have EU style spending – why can we not have EU style quality of care ? Mr Laws held a marginal seat in 2001 & 2005 by being a perfect blend on conservatism & liberalism and as such explains why Mr Cameron is basically in a position to see the Tories win office in 2009-10 . That is what the voters want reflected in healthcare policy !

  9. David Gerard
    Posted August 19, 2008 at 10:14 pm | Permalink

    It's a good thing they can approve Viagra instead of cancer drugs. http://notnews.today.com/2008/08/18/drug-firms-de

  10. Derek
    Posted August 19, 2008 at 11:44 pm | Permalink

    John UK:NICE?

    NICE has no jurisdiction in Scotland. The Scottish Medicines Consortium the SMC performs the role of NICE in Scotland.

    So you need to mention England!

  11. T Ritchie (Sr)
    Posted August 20, 2008 at 1:50 am | Permalink

    The article fails to mention that there are three NHSs, and English patients are often denied medications which are available elsewhere in the UK.

    Decisions of NICE, (the National Institute to Curb Expenditure) do not apply in Scotland.

  12. Lee Jakeman
    Posted August 20, 2008 at 7:19 am | Permalink

    "… single purchaser in the UK market." Er – you mean the ENGLISH market, don't you?

  13. gadgie
    Posted August 20, 2008 at 11:40 am | Permalink

    Nice was set up to absolve politiciansand especially Scottish MP’s in ministerial seats from copping flak.Setting up this quango was an attempt in one small way to answer the west lothian question, that’s all. English taxpayers are forced to pay for the parliaments of Wales Scotland Stormont and brussels,but then are refused cancer drugs because of the expense. Incredible, but it does not look like Cameron will do anything to help.

  14. Patrick Harris
    Posted August 20, 2008 at 11:50 am | Permalink

    N.I.C.E. is just another quango that the government uses to shed responsibility, responsibility that we, the electorate expected them to shoulder once they had taken up office in Parliament.
    Whilst MPs pay, allowances and pensions spiral upwards so their responsibilities spiral downwards.
    The problem is, I do not see that it will be any different if the Tories should get lucky and win the next election.
    Incidentally, you omit to mention that the majority of these drugs are availabe in Scotland and are free in Wales. Only in England do patients have to resort to the law courts in order to obtain life enhancing/saving drugs and then, at a cost of £7.20 per item.

  15. Derek
    Posted August 20, 2008 at 11:55 am | Permalink

    NICE to see you, to see you NICE.

  16. Posted August 20, 2008 at 12:02 pm | Permalink

    It’s important to note that the Welsh government can also fund drugs that NICE refuses to fund. Decisions made by NICE are only binding in England.

  17. Mr A.D.Dagger
    Posted August 20, 2008 at 12:03 pm | Permalink

    It's NICE to see you have amended the piece by removing the incorrect reference to the UK and replacing it with ENGLISH.
    Even you can see the adverse affect of assymetrical devolution – at last.

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  1. […] I was disappointed and somewhat amused to notice that John Redwood had engaged in a spot of editing on Wednesday. Originally his NICE article read like so: […]

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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