Health
No more, Mr NICE guy!
WHEN New Labour launched the National Institute for Clinical Excellence (NICE) it was promoted as a body that would play a key role in ending the arbitrary system of "rationing by post code" - in which the policies on what types of treatment and drugs the NHS would pay for varied widely from one health authority to the next.
It all sounded reasonable enough - but from the outset campaigners have been concerned that the effect of such rulings by NICE might not be to make treatments more widely available, but rather to impose global rationing and exclusions of controversial or expensive drugs and treatments throughout the whole NHS.
These fears have been exacerbated by the insistence that NICE will base its decisions on so-called "evidence-based medicine" - a system of assessing the effectiveness of drugs and treatments largely by statistical analysis of randomised control trials, without any real reference to the experiences and views of patients, their advocacy groups and the professionals seeking to deliver front-line services.
There as a stark warning of the dangers of this approach last year when the Royal College of Psychiatrists conducted an investigation into the effectiveness of the new generation of anti-psychotic drugs, which are widely recognised to offer fewer harmful side-effects than the established, much cheaper drugs, many of which date back to the 1950s.
The RCP report concluded from its statistical calculations that the benefits of the new, more expensive drugs were not great enough to justify requiring them to be used for all patients.
Unfortunately they had come to this view without asking the views of patients or mental health pressure groups: nor did their report take into account the fact that by generating fewer side-effects the new drugs are more likely to secure voluntary compliance by patients in taking their medication regularly, as opposed to the widespread problems of persuading patients in the community to take the old-fashioned drugs.
The RCP recommendations have been forwarded to NICE, and as yet do not represent government policy, but it was clear that this is no serious way to assess which treatments should be promoted within the NHS.
One-sided
As if to underline the one-sided approach, we now have an equally outrageous report from NICE itself proposing that patients diagnosed as suffering from muscular sclerosis should not in future be prescribed the expensive drug beta-interferon, despite widespread evidence that it can bring dramatic relief to many who take it.
NICE stresses that the drug can cost £10,000 per patient per year, and argues that for some patients it offers no real benefit. But its ruling that no future MS sufferers should receive it on the NHS would impose a brutal penalty on those who might respond to treatment - and is a major step towards a national policy of explicit rationing based on price.
Small numbers of people suffer MS: the total bill to the NHS would not be great if all of them received beta interferon, especially if account is taken of the fact that many would then not have to seek treatment in hospitals or more intensive care in the community.
But of course £10,000 a year is well beyond the means of most MS sufferers and their families to pay privately for treatment, and no private insurer will come up with such cash either. If the NICE plan is endorsed by ministers it effectively condemns MS sufferers to years of possibly avoidable pain and discomfort.
And it is clear that the decision hinges not on the effectiveness but on the cost of the drug: were it to cost £10 rather than £10,000 a year there would have been no debate over whether it should be available to those who might need it.
With Gordon Brown sat on a massive £22 billion windfall from mobile phone franchises and the Treasury bulging with unspent cash, this tight-fisted attempt to decide medical treatment on the criteria of crude accountancy simply reinforces the view that New Labour has no more respect than the Old Tories for the values and collective principles of the NHS.
Health unions, campaigners and the wider labour movement should step up the pressure on Labour MPs to have this recommendation dropped, and demand a fundamental change in NICE's terms of reference to ensure that its brief is to widen and open up access to the best treatment, rather than to ration care and restrict NHS patients to the cheapest - and often nastiest - drugs and treatment.