The changing fortunes of NICE and health secretaries
pharmafile | July 15, 2011 | Feature | Sales and Marketing | NICE
You might not have noticed, but the government has performed a major U-turn. No, I don’t mean the NHS reform bill – but its latest decision on NICE.
You would be forgiven for having missed this announcement, as the government sneaked it out via an almost incidental mention in its response to the Future Forum deliberations on NHS reform.
But there it is – the government will not, after all, strip NICE of its powers to recommend (or not) medicines for use on the NHS.
Back in October, the government had announced NICE would lose it authority to direct the NHS in 2014, coinciding with the introduction of the new Value-Based Pricing system.
The idea to take NICE’s most significant power away originated with health secretary Andrew Lansley, who clearly felt the cost effectiveness body’s recommendations were doing more harm than good, by controversially blocking access to some cancer drugs, for example.
The decision was almost universally descried at the time – not least by GPs. Lansley envisaged them being the key local budget holders and decision-makers, and who would now be ‘liberated’ to override national decisions on access to medicines.
Many GPs have seen this not as a freedom, but as a poisoned chalice, forcing them into making unpopular decisions and becoming the focus of patient group protests in place of NICE.
Even the pharma industry did not truly welcome the humbling of NICE, even after more than a decade of conflict between the two.
One of the reasons for this was of course that no clear – or superior – alternative system had been put forward by the government.
So now NICE will retain its mandate to ‘recommend’ medicines. But why has the government felt forced to make another embarrassing U-turn?
The answer lies in David Cameron wresting control of the reforms away from Lansley, following the ‘listening exercise’. Cameron has re-focused the agenda around a handful of core pledges, in order to restore public confidence in the poorly understood but nevertheless unpopular reforms.
Cameron alighted on the NHS Constitution – established by the previous Labour government in 2008 – as the way to reassure the public that the health service was safe in his hands.
In its formal response to the Future Forum recommendations, the government says:
“We will uphold all of the patient rights in the NHS Constitution. Where necessary we will adapt the way these rights are given legal force, to ensure they have the same legal force under the new legislation. This includes the right to drugs and treatments recommended by NICE, which we will retain after the introduction of Value-Based Pricing for new drugs from January 2014.”
The NHS Constitution says quite clearly that patients “have the right to drugs and treatments that have been recommended by NICE for use on the NHS”. There it is then – in deciding to remove NICE’s authority in October, the wording of the NHS Constitution had been entirely overlooked.
One can only imagine the scene in the Department of Health when they realised the bind they had put themselves in.
But in the end, the choice was easy – NICE must keep its powers. The decision was made easier by the fact that no satisfactory alternative to the current set-up has yet been found.
The government plans for VBP published in January are complex and unproven, and their development has been sidelined by the Department of Health as it struggles to get the main NHS reforms back on track.
True, the Constitution is not truly legally binding, but having signed up to it last year, the coalition government could not be seen to be undermining it.
In fact it is looking to do the opposite, and wants to put this document on a firmer legal footing, meaning it will then be enshrined in law.
Much like the US Constitution, this will bring some clarity, but also some inflexibility.
Trying to amend a Constitution that served previous generations well but no longer matches present needs can be nigh on impossible, as any American will tell you.
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