Sue NHS to ensure access to drugs, says NICE chief
pharmafile | August 6, 2012 | News story | | Lucentis, NICE, Ozurdex, judicial review, market access, ophthamology
The chairman of NICE is advising campaigners to sue NHS bodies that block a treatment recommended by the watchdog.
In a opinion piece on the Health Service Journal’s website, Sir Michael Rawlins revealed that he told blindness charity the RNIB that it should seek a Judicial Review against NHS trusts not supplying an ophthamology drug.
The drug in question was Allergan’s Ozurdex for retinal vein occlusion, a common eye condition. Ozurdex was recommended by NICE last year, but the RNIB has found that the treatment has been restricted or blocked by 37 NHS trusts.
To stop this behaviour, he said that taking the trusts to court would be the best answer. “The court would unquestionably uphold the claim,” he said, adding that “not that any case would ever reach the courts,” implying that the trusts would back down under legal pressure.
Sir Michael said: “Although they [NHS trusts] know they are required to make NICE-approved products available, they introduce delaying tactics.”
This is happening, he said, because the NHS is under large financial pressure, but added that this was no reason to deny patients drugs they are entitled to under the NHS Constitution.
Sir Michael also said he wants people to whistle-blow when their trusts fail to pay for NICE recommended drugs and inform the chair of the trust board involved.
“If NHS managers wish to avoid this they should arrange for NICE’s forward agenda to be examined, with care, by their formulary committees.
“These committees could then advise their trust boards on what innovative products are likely to become available in the coming 12 to 18 months and which of them might be particularly relevant for their own patient population.”
He said that trust boards could then make plans, with their PCTs – or soon, the clinical commissioning groups – for appropriate financial arrangements to be put in place for these drugs.
“That would be a much better use of the time of formulary committees than trying to pretend they have the knowledge and skills of a NICE appraisal committee,” he concluded.
NHS managers hit out at Rawlins
Sir Michael’s views have not gone down well with the NHS Confederation, which represents NHS trust and PCT managers.
David Stout, deputy chief executive of the NHS Confederation, said he agreed that the NHS should be providing patients with the treatments they are legally entitled to, but argued that the NHS cannot always do this given its financial problems.
Stout said: “We must remember the reality is that every NHS organisation has a finite amount of money available. Every new treatment covered and funded under a NICE technology appraisal means fewer resources for other treatments.
“The issue raised by Sir Michael Rawlins leads us on to the wider debate that we need to have about the fact that the NHS is facing an unprecedented financial challenge.”
Stout added: “We need to be open and honest with the public about what the consequences of this financial challenge are, and the fact that trade-offs will be required if we are to improve standards of care while keeping the NHS affordable.”
The NHS must save around £5 billion a year from 2009 to 2015, and could even need to repeat this feat again until 2020, according to new estimates.
The NHS is supposed to be making these savings from its QIPP agenda, but many PCTs are simply blocking high-cost drugs in order to make short-term savings.
This debate comes just several months after Novartis was granted a Judicial Review against a PCT Cluster in south England.
This was after the SHIP Cluster decided to recommend using Roche’s cheaper, unlicensed Avastin ahead of Novartis’ Lucentis for patient with wet AMD.
The Cluster reversed its policy last month after Novartis offered a price cut for its drug, making it more affordable.
Ben Adams
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