I quote in full the editorial in the Morning Star the other day. (Sadly, a point that is missed is the fact NICE only rations drugs in the English NHS, which unlike other health services in the UK, is not controlled by a directly-elected devolved institution.)
Forced to face truth
(Sunday 17 August 2008)
NICE, the National Institute for Health and Clinical Excellence, has been on the back foot for some time.
Everybody, from drug companies indignant that their product hasn’t been approved for purchase and supply by the NHS, to patients angry that their quality of life is being hampered by NICE rejection of drugs or its judgement that they do not supply value for money to the NHS, has launched denunciations of the organisation and, in some cases, court actions to alter its decisions.
Without pontificating on the quality of those various decisions, which cover treatments for diseases ranging from cancer to Alzheimer’s disease, there are still many issues raised by the debate and a variety of conclusions which do not reflect directly on NICE, but rather on its function in our society.
It cannot be purely coincidence, for example, that the spotlight is turning on the institute’s function in determining value for money at precisely the time that privatisation – code-named choice by new Labour – is biting hard and siphoning millions of pounds a year out of the NHS budget.
While granting that, with an increasingly elderly population, the calls on the service will be growing and there must be some limits on expenditure, it is also blatantly obvious that privatisation and its super-profits is doing its share to restrict the options open to prescribing physicians.
And the fragmentation of the NHS into a myriad different budget-holders with different policy-making bodies and objectives can’t be helping, either.
Naturally, patients, their families and friends will have different priorities as to which treatments should be approved and that is certainly never going to change, but there is a great deal that can be done to make things better and the managers and leading lights in the institute are being inexorably pushed into highlighting the actual difficulties which militate against this.
These managers are, in the face of the continuing attacks on the organisation’s judgements, starting to hit back at their critics, and their choice of targets is revealing.
NICE chairman professor Sir Michael Rawlins opened the attack on pharmaceutical companies which, he says, are driving up the price of vital new medicines in order to boost profits and protect executive bonuses
He says that the companies are out to sustain double-digit growth, not least because their senior management’s earnings are related to the share price.
And NICE chief executive Andrew Dillon joins the fray, isolating the postcode lottery which has been generated by the absurdly structured trust system which runs the NHS in the 21st century.
Both these gentlemen are pillars of the Establishment and are not exactly the sort of people you would look to for a radical analysis of the ills of capitalism.
But they are both highlighting precisely those ills.
A profit-motivated, privately owned and unaccountable drugs industry is driving up drugs prices on behalf of managers and sharehoders and doing vast damage to patients in the process.
And a market-oriented cost-cutting NHS structure is resulting in gross inequalities of treatment.
Messrs Rawlins and Dillon are making the clear argument for the nationalisation of the big pharmaceutical companies and a full restructure of the NHS.
Although they may shy away from articulating that conclusion, their arguments back up the case that has been made time and again by health professionals and socialists for many years.