Dai Havard

Labour Party | Merthyr Tydfil & Rhymney

NICE work if you can get it!

To a Labour MP, the political attractions of NICE were: getting a tool in the battle to end ‘postcode prescribing’, a consistent, not uniform, application of best practice and an engine of change to tackle inequity of treatment. I hoped NICE would also act to discipline any ‘maverick’ or ‘vested interests’ in the ‘rationing’ processes involved in introducing the best technologies and treatments. NICE is more about reforming NHS outcomes than Foundation Hospitals and other such ‘ideological’ experiments in provision!

My recent experience of trying to get better use of erythropoietin (EPO) and other alternatives to blood transfusion, especially for cancer patients, has been revealing. I believe more frequent use of alternatives such as EPO would help to protect the valuable and problematic supply of blood, give a better quality of life to many patients, and be efficient!

These alternatives are not ‘new’ and therefore don’t require any licensing. What they do require are, ‘total cost’, and net positive value accounting, that the DoH seem unable to do, and a settled will about their use. After 18 months of campaigning, the DoH agreed to consider referring these issues to NICE’s ninth wave work programme. Interestingly, even when the Treasury agrees there are gains and ‘savings’ to be made, all it can do is submit a referral to NICE so that it can implement the change. It’s the only effective reform process in town!

What’s wrong with that? Pragmatically, nothing if it’s quick! It may be the only way to get consistent ‘incremental’ change. But what of a more immediate ‘step change’?

NICE is a world class organisation with credibility among its peers and political backing from the government; this has given it the ‘clout’ to become the arbitrator of best practice and efficiency it is now. The process by which the Institute formulates its work programmes is of crucial importance when campaigning for the wider use of treatments such as EPO - such as I am!

The appraisal procedure is currently being reviewed by both NICE itself and the World Health Organisation. The first thing that should be looked at is the number of issues it can assess and re-assess. I understand there may be some additional capacity being given so NICE can take on 3 rather than 2 appraisals a year. But I could not get confirmation of that from the Minister in my recent debate in then House.

As a Welsh MP working in a devolved environment I see the All Wales Medicines Strategy Group and the Scottish Medicines Consortium doing similar things to NICE, but completing assessments within three months. This disparity in the speed at which applications are processed in different parts of the United Kingdom also needs to be considered.

I believe there may well be some reforms on the way that will allow for more collaborative working between similar standard setting organisations and that should help with the speed of appraisals. I hope this will be taken further in subsequent reviews. NICE already has a lot to offer but with some extra help then it can do more, more quickly!

It‘s not just the number and speed of assessments. The issues of ‘step change’ advice on better use of already licensed technologies and re-appraisals of classes of technologies with interim guidance should be included in any reviews. The power of any NICE appraisal is the three month requirement that the recommendations be implemented by the NHS. I note the recent reaffirmation of that but also note with a little disappointment the immediate declaration of two ‘exceptions’ to this rule.

NICE is a vital tool in the real reform of treatment, procedures, technology, and financial practices of the NHS. If MPs will change we must will means, especially to one of the best engines of such change and reform! My immediate litmus test for the DoH, Treasury, NICE, and others is to see how they help NICE deal with an issue that effects so many of my constituents.