NICE 'will no longer be able to say no'

The National Institute for Health and Clinical Excellence (NICE) is to lose its power to make decisions on whether patients should be given treatments recommended by their doctor, the Government has announced.

While NICE will continue to appraise new treatments and advise doctors on the evidence base for their effectiveness, it will no longer issue NHS-wide guidance on what should or should not be funded.

Since its inception in 1999 NICE has borne the brunt of the blame when patients have not been able to access new drugs on the NHS. However, it has also been highly regarded in international circles as an example of how to make evidence-based judgements on the clinical and cost effectiveness of new drugs, many of which come at a high cost and extend life by a short period of time for small numbers of patients.

The Government claims that a new system of "value-based pricing" will ensure that effective treatments are available to NHS patients. This would see pharmaceutical companies that develop and manufacture drugs paid according to the value that the new medicine delivers.

The charity Macmillan Cancer Support welcomed the decision.

Mike Hobday, head of policy, said: "NICE has performed a really important role for the NHS. Having a body that can say ‘no' to pharmaceutical companies has been crucial in driving the price of drugs down, so that the NHS can afford to support patients more often. But NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers. It has placed insufficient weight on the importance of allowing the NHS to give patients with rare cancers the drugs that their doctors believe will extend or improve the quality of their lives."

However, there remain concerns that giving clinicians the power to make decisions about new drugs, rather than a national independent body, could result in a postcode lottery of access. With the cost of drugs rising - and likely to continue to rise despite the new pricing mechanism - it seems likely that some degree of rationing will still be required, bringing with it the danger that the more vocal patient lobby groups will be most adept at securing funding for new drugs.

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