Decision on prescribing leaves me feeling sick - Herald Scotland | Comment | Anne Johnstone

It’s not nice.

English Health Secretary Andrew Lansley is cock-a-hoop after plunging his dagger into the National Institute for Health and Clinical Excellence (Nice, to you). This much-maligned body is to lose its power to reject new drugs. The decision was greeted with rapture by the Daily Mail, which has conducted a hate campaign against Nice for years, based on emotive stories from small groups of mostly cancer patients, often egged on by the pharmaceutical industry. “The scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end,” declared the Mail triumphantly.

The Scottish Medicines Consortium (SMC), the equivalent body here, has never attracted the same flak, partly because it seems, well, nicer and quicker to approve new drugs. It has accepted some drugs rejected by Nice. RoActemra for hard-to-treat rheumatoid arthritis patients is a recent example. Yet the SMC, too, is a rationing body.

Who, other than opposition politicians before an election, pretends there is no rationing in the NHS? That being so, the best way to ration drugs is to take difficult decisions away from politicians and give them to clinicians qualified to make national, rational, transparent, evidence-based judgments. Many of these drugs offer little or no improvement over other, cheaper, products. Putting a limit of around £30,000 on a “quality adjusted life year” is not heartless: it is sensible. There is no immediate threat to the SMC but it is going to be exposed to some ferocious pressure by the emasculation of Nice.

In place of Nice, we are promised “value-based pricing” negotiated by government officials. What does this mean if Nice can no longer dictate the terms of reference? Mr Lansley says prices will come down. If so, why is Big Pharma ecstatic? To say the Department of Health doesn’t have a great record on securing value for the taxpayer would be to flatter it. Remember GP contracts and the NHS supercomputer? Expect drug costs to rise.

Secondly, deciding which drugs are prescribed is being delegated to “a system of discretionary funding from locally-held budgets”. This used to be called postcode prescribing. Another name is “those who shout the loudest get the most”. What’s worse, as one GP consortium crumbles under pressure from a vocal group of patients, backed by drugs industry money, others will feel obliged to follow or risk being labelled heartless. And, though the worst excesses of five-star junketing of GPs by drugs companies have been curbed, doctors are still vulnerable to the manipulation of medical reps desperate to flog the latest “miracle cure”.

The knock-on impact on Scotland is going to be hard to resist. Drug prices are negotiated nationally, so the SMC is going to be offered new products on a take it or leave it basis. And if English GPs are to be given the freedom to prescribe what they like, how will Scottish doctors respond if, as at present, new drugs are often given limited approval? For example, it is common for an expensive new drug to be prescribed only in cases where cheaper ones have not worked. The Tories’ election bribe of a £200m new cancer drugs fund in England also risks undermining Scottish “patient access schemes” that secure such products at introductory prices before SMC approval.

The drugs bill already swallows 15% of Scotland’s £11bn a year health budget. The most obvious way to cope with rising demand is cutting prescribing. The alternative is more painful cuts elsewhere: fewer nurses and doctors, longer waits for diagnosis and treatment, even less for the mentally ill and dementia care.

Cancer charities (and the Daily Mail) claim “20,000 patients die early needlessly every year because of Nice decisions”. But it is cancer, not Nice (or the SMC), that kills patients. If funding a drug that saves 10 lives costs twice as much as another that would have saved 20, that decision costs lives when budgets are finite. Cancer survival rates are up because of earlier diagnosis and treatment, not expensive drugs. If Big Pharma tries to pick off our SMC, we mustn’t let them.

via heraldscotland.com

Posted via email from Jack's posterous