Further to the article published in the Sunday Telegraph on 15th March 2017 entitled ‘Doctors warn NHS is rationing best drugs to cut costs’, in orderto add clarity to this,it is important to explain the role ofNICE. It stands for The National Institute for Health and Care Excellence and is an independent organisation set up by the Government in 1999. NICE decides which drugs and treatments are available on the NHS in England and Wales. The All Wales Medicines Strategy Group also makes some decisions for the NHS in Wales. Generally they follow NICE decisions. Scotland and Northern Ireland are different in that they have separate organisations to make decisions.
The government first developed NICE to address the pervading health inequalities and the post-code lottery of access to treatment and healthcare. This meant that some drugs and treatments were available in some parts of the country, but not in others.
The remit of NICE is to deliver independent advice about which treatments should be available on the NHS in England and Wales. Importantly, it is committed to ensure that people have the same access to treatment and care irrespective of where they live.
NICE considers whether a treatment
Benefits patients
Will help the NHS meet its targets, for example for cancer by improving survival rates
Is value for money or cost effective
The pharmaceutical industry is by no means a novice in understanding the robust process that NICE uses in deciding if a new drug can be made available for treatment on the NHS. This is not simply based on price alone, but rather the cost-effectiveness of the drug associated with best clinical outcomes. This essentially involves calculating the cost of the drug per Quality Adjusted Life Years known as QALYs.
Putting this into context, means that generally approved treatments should not cost more than £20,000 to £30,000 for each extra year of life in good health gained. However, this is flexible in that it does consider instances where costs can be much higher, as in the case of end-of-life care, as one example.
Once NICE issues its guidance, it is the responsibility of NHS trusts to find the money to make those drugs or treatments available. NICE doesn’t give any extra money, nor does it advise on how to find the money. On that note, it is important to emphasise that restrictions to prescribing can occur at local level with doctors having to be ever-mindful of budgets which are set by local commissioners. Technology Appraisal Guidance recommending a drug is legally binding and patients have a legal right to it if their clinician wants to prescribe it. However, recommendations in clinical guidelines on disease areas for example are not legally binding.
It is also worthwhile pointing out that The NHS Constitution (for nationally approved treatments, drugs and programmes) states:
‘You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.’
It can be justifiably argued that if patients are denied drug treatment by their GP through their CCGs, especially following NICE recommendations, potentially this can lead to worryingly higher hospital admission and readmission rates in some instances, with correspondingly increased costs and greater burden to the NHS.
