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Letters to the Editor
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NICE: National Institute for Clinical Excellence
Ending “postcode prescribing” a bad idea
From Mr B. T. Brown, MRPharmS
In her article (PJ, 27 August, p254 PDF (230K)), Sarah Garner
reminds us that the National Institute for Health and Clinical Excellence
(NICE)
was established
in part to eliminate “postcode prescribing” and develop an
environment of equal access to medicines and health care. Surely, however,
that was always disingenuous. The NICE concept, however sensible it appears,
was flawed from its inception.
The British Medical Association’s Consultants’ Committee
has recently written to the Health Secretary warning that some hospitals
are in deep financial crises and that jobs, services and hospitals are
at risk. On top of that, in some areas, consultants are apparently feeling
the stress and receiving psychiatric care. Thus, despite politicians’ attempts
to manage the NHS centrally and ensure equal access, local difficulties
mean local priority setting. By definition there will always be “postcode
prescribing”.
Until recently the NHS’s drug expenditure has been but a small
proportion of the whole but there are some exciting and hugely expensive
gene therapies coming over the horizon. These new therapies will have
potential to unhinge drug budgets. It will be interesting to see how
NICE approaches them. Rationally, politicians will leave the matter to
be resolved at a local level and let local NHS managers engage directly
with their own constituencies. After all, if a local population supports
the widespread use of very expensive therapies it may have to forgo other
treatment and services. Apparent inequalities attributed to “postcode
prescribing” may be intensified but this is “choice” — what
sacrifices will people accept in order to ensure access to the best possible
health care?
Perhaps I have been overly political here but I do fear that the NHS
is heading for an implosion. Patients, apparently, are beginning to see
benefits from the huge increase in NHS expenditure but at what cost?
Health care professionals may be meeting political targets but at what
cost to their personal health? At some point many patients will recognise
that they too have incurred a huge financial cost, the demise of the
final salary pension scheme.Pensions, and similar savings, were subject
to a tax worth about £5bn in 1999 and much of that has been used
to fund the increase in health spending. That tax effectively created
a £100bn pension under-funding overnight. Companies cannot easily
plug this under-funding without compromising the very dividend payments
that underpinned annual inflationary increases in private pensions. Many
final salary pension schemes have been closed to new members.
NICE has a number of positive goals but ending “postcode prescribing” is
not one of them and we really ought to debunk the belief that it is.
Bruce T. Brown
Birmingham
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The
Pharmaceutical Journal