NICE and the Franchising of the NHS

It was with great dismay that I read that NICE is to be divested of its power to act as regulator for drugs for the NHS. This is to be handed to GPs as part of the commissioning deal and will leave NICE as a pretty toothless organisation, ready to be thrown on the quango bonfire.

Those who read me regularly will know that I have a chequered attitude to NICE. On the one hand, I was furious about the blatantly political attempt to remove all dementia medicines from prescriptions. At the same time, I do recognise its value as a negotiator with pharmaceutical companies about the price of their drugs. Drugs in America can cost five or six times what they cost here, because there is not a national regulator between the companies and the patients. Removing this guard dog is going to make the price of drugs in Britain shoot up and place GPs in the invidious position where they might reject one drug, but the GP next to them might prescribe it.

But there is another element to this move. Some time ago I did an post on the European Cross Border Directive and the dangers inherent in this for the NHS. One of its proposals was for prescriptions written in one country to be recognised in another. I wondered aloud how this would work given that NICE did not permit the same drugs under prescription that other countries did. I think we have just been given our answer. The removal of a national regulator to be replaced with local ones, is turning the NHS into a group of health care organisations along the lines of the American HMO. Many GP practices are run by the likes of United Health and Atos; they also have their favourite drugs companies who pay them big bucks to promote their brands. This move is more dangerous than it looks.

Europe marches on. The franchising of the NHS marches on. The vultures are gathering..

Time For the Grey Revolution

The National Institute for Clinical Excellence (NICE, and it's not nice, I can assure you) won its case today to allow them to limit the prescription of dementia drugs, to the later stages of the disease. This is not really surprising; there is a considerable amount of controversy over what drugs should be on prescription, especially when they are expensive, but this is a real blow for the elderly and flies in the face of evidence about these drugs. The way that NICE carried out its 'research' about the effectiveness of these drugs, was highly questionable.

My mother is on Aricept for Alzheimers. Aricept, like the other dementia drugs, does not improve cognition. What it does do, is it holds back deterioration of the mind for a while. It also helps to reduce the more distressing effects of dementia such as aggression, depression and hallucinations. This is very important for the patients quality of life and also the carers quality of life. It's the difference between someone staying in their own house and going into a home. What did NICE ask questions about? Whether or not the drug had an effect on cognition. We all bloody know it doesn't have an effect on cognition and the people at NICE know that, or else they're not fit for their job, so why ask? Why make that the parameter for the effectiveness of the drug?

Then they say that they'll allow prescription of the drugs in the later stages of dementia. Again, they know damn fine that Aricept really has to be prescribed in the early stages of dementia to be effective. If it's prescribed later, it isn't any use. So you might as well not prescribe it.

Then there's the cost. Now, Aricept ain't cheap. It costs £1000 a year. Then we have the ominous statement that is becoming more common 'We have a growing elderly population, so it's getting more expensive, so...' and then they leave the sentence dangling. So what? So, we need to think about providing more care for elderly people? More help? More medicines? Or was your thinking going another way? Why is it, when it involves old people that we whine about cost? Someone receiving £70 per week from the Social, costs £3500. Do we moan about that? It costs £5000 to send a child to state school. Do we moan about that? So what's the problem with the oldies? Do we just wish they would do the decent thing and die when they're 65, so that we don't have to pay out their pension?

Join the dots. Three nursing homes are shutting per week. Dementia medicinces are being restricted. Continuing care beds are being reduced. Old people have to sell their home to pay for care. Lord Joffe is trying to introduce a euthanasia bill. Where is this going? You work it out. In the meantime, I think it's time to get mad, like the granny above..