Dianthus Medical Blog Archive

The R word

Earlier this week, we learned that NICE is going to lose its powers to decide whether drugs should be funded on the NHS. This is one of the most spectacular triumphs of political fuckwittery over common sense that I've seen for a long time.

Now I'm not going to claim that NICE was perfect in everything it did. But it did some groundbreaking work in assessing whether drugs represented good value for money. Assessing the cost effectiveness of drugs is not an exact science, and not surprisingly some of its judgements were questioned by some, but on the whole, it has been doing a pretty good job.

The trouble is that it hit the headlines in a bad way when it decided that drugs were not cost effective. It would sometimes make decisions that expensive drugs, which had small benefits in treating life-threatening diseases (such as extending lifespan for an average of a few weeks), were not cost effective and therefore shouldn't be funded on the NHS.

Such decisions generally caused outrage in the more tabloid sections of society. Here is a fairly typical article from the Daily Mail.  "You can't put a price on a human life!" is the sort of thing you would hear.

But actually, you can. That is what health economics is all about. And not only can you put a price on a human life, but if you are going to run an organisation like the NHS in a rational way, then you must. The only alternative to putting a price on a human life is to give the NHS an infinite budget. There really is no other way of doing things.

The fact is that the NHS does not have an infinite budget. It never will have. It will always be limited. It will go up and down depending on which party is in government and how much spare cash is lying around, but it will never be infinite. That means that there is only a limited amount of money to spend on treating patients with diseases. So every pound you spend on one treatment means that you have one pound less to spend on another.

And that, in turn, means that treatment has to be rationed. Now that is a word you will never hear politicians using. It seems to be one of the unwritten rules of British politics, along with never answering a question from an interviewer with a "Yes" or "No" answer, that you must never admit that treatment in the NHS is rationed. But in real life, of course it is. If it weren't, we would be back to our infinite NHS budget.

Now if you are a politician, and don't admit that treatment is rationed, then I suppose there is some sort of warped logic in removing NICE's role in rationing treatment. But that doesn't mean that rationing will go away. It just means that rationing will take place by other means. Those means are likely to be considerably less fair, less consistent, and less transparent  than rationing on the basis of cost effectiveness. For example, treatment could be rationed by waiting lists, meaning that only patients who live long enough to get to the front of the queue get treated. Or it could be rationed by local decisions (aka "postcode lottery"), so whether you get treated for a particular disease depends on where you live.

Moving away from rationing on the basis of cost effectiveness to other means seems to be motivated purely by a desire on the basis of fuckwit politicians to play to headlines in the Daily Mail. If it is going to be typical of the decisions our coalition government make, then any claims that the NHS is "safe in their hands" would appear to be wildly exaggerated.

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