MPs demand reform of drug rationing body to end bias against elderly patients


Last updated at 23:19 09 January 2008

The NHS "rationing" watchdog must be overhauled, say MPs.

They accused the National Institute for Health and Clinical Excellence of denying drugs to those with chronic diseases.

The Commons health select committee criticised NICE for making English patients wait longer for treatments than those in Scotland.

Patricia Hewitt

And it said that by not considering the cost of social care when looking at the cost-effectiveness of the drugs, NICE is biased against elderly people with long-term conditions.

Alzheimer's campaigners say the findings of the select committee vindicate their view that NICE has unfairly rejected drugs for dementia sufferers by not taking into account the costs borne by carers.

The select committee found the rationing body was denying potentially life-saving drugs to hundreds of English people by taking much longer to approve them than its Scottish equivalent.

NICE was also criticised for actually turning down life-saving drugs that are available in Scotland.

The committee's report questioned some of the methods NICE used in coming to its decisions, saying some were not based on "hard science".

They said not enough experts in the field were consulted, and recommended the establishment of a further independent body to determine the threshold at which treatments are deemed cost-effective.

Health ministers did not escape censure, with former Health Secretary Patricia Hewitt being singled out for her "interference" in overruling NICE - a supposedly independent body - to say that Herceptin should be used for people with early-stage breast cancer even though it was only licensed for late-stage sufferers.

Committee chairman Kevin Barron said: 'It is essential that NICE is left to do its job without ministerial interference; at the same time, it must have the support of ministers when it makes difficult decisions.

"NICE and the department must work together to ensure the effective rationing of the NHS's limited resources."

The report said all new drugs should be evaluated in future - not just high-profile treatments recommended to the body by ministers, as at present.

And too often, MPs found, NICE did not appraise drugs until "months or years" after they had originally been marketed - deepening the system of medical apartheid in the UK.

They recommended that NICE follow the procedures used by the Scottish Medicines Consortium, the equivalent body north of the border.

To speed up the process, the committee suggested a preliminary four-week evaluation before drugs go on the market - allowing them to be available to NHS patients much earlier.

A more rigorous evaluation could take place later on, and the guidance reviewed if it turns out not to be cost effective.

Committee member Doug Naysmith said: "It is well recognised that the Scottish system isn't as rigorous or as scientifically based as NICE's system.

"However, they regularly come up with the same results as NICE."

He called on NICE to speed up the process by following the Scottish practice of evaluating a batch of similar drugs at the same time.

MPs also criticised the threshold used to decide whether a treatment is cost-effective and should be prescribed on the NHS.

This says that no drug should cost more than £30,000 per extra healthy year of life it gives.

But Mr Barron said the threshold is a cause for "serious concern" because the figure was not based on empirical evidence or "hard science" and had not changed since NICE was set up - even though the NHS budget had massively increased.

The report also found that patients were losing out on treatment because local health bodies were often unsure whether NICE guidance was mandatory.

NICE promised to study the report, in particular the recommendation that all new drugs should be evaluated.