Not the way to run the NHS
This week the national media have once again gone to town on preliminary approval given by the National Institute for Health and Clinical Excellence, this time for aromatase inhibitors to be available for women with early breast cancer. In theory this decision is open to consultation and will not be given formal approval until later in the year. (This, incidentally,
is why the The Journal is not covering the story in the news pages;
we decided some years ago that we would only cover final decisions
made by NICE and not the different stages of the approval process.)
A lack of appreciation of the finer points of the NICE process has not
stopped sections of the national press (often egged on by PR and medical
education agencies acting on behalf of the pharmaceutical company producing
the drug) finding any excuse to demand that patients should be prescribed
a particular product in advance of the final decision. The pressure seems
to work. If the drug is given enough publicity, and especially if a patient
is found who would benefit from the therapy, the local procedures carefully
established to deal with NICE decisions may be thrown out of the window.
The workings of NICE are complicated and this short leading article can
only
scratch at the surface — other aspects are covered in the current
issue of the BMJ (27 May, pp1266–71).
NICE was established as a special health authority in 1999 to make decisions
about whether certain drugs should be funded through the NHS in England
and Wales and to stamp out postcode prescribing.
The process for deciding whether or not a drug should be made available
through the NHS has one major flaw, however. Most medicines are not considered
by NICE until they are given their marketing authorisation. The result
is that a manufacturer has a short window of opportunity during which
to make a song and dance about its product, get it fixed in the public
consciousness before it is “NICEd” and, with luck, made available
courtesy of the public purse. (The Association of the British Pharmaceutical
Industry has a slightly different take on this [p616] but the outcome
is the same.)
With some exceptions the national media do not seem to care whether or
not they are being used in this process — all they want is to sell
copies of their papers or for their programmes to be watched or heard.
Since 1997 there has been no effective parliamentary opposition, so the
media have become more influential in setting the political agenda. If
enough fuss is made, it seems, the Government will act. It is probably
not the way to run the country or the NHS but it is the way things are
now done. Learning to manage patients’ expectations as a result
of this pressure is the challenge for local health managers.
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