NICE Chief Blames Primary Care Trusts For Postcode Lottery

The “postcode lottery” that means cancer patients miss out on new drugs is the fault of local health trusts, the head of Nice, the NHS drug watchdog, has said.

Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence, warned primary care trusts they needed to be more consistent when deciding whether to pay for drugs the watchdog rules are too expensive for the NHS.

His claims are bound to anger patients, who blame Nice for denying them potentially lifesaving drugs because they are not “cost effective”.

Mr Dillon’s comments came as his colleague Sir Michael Rawlins, the chairman of Nice, launched a separate attack on the drugs industry for hiking up the price of medicines.

The double intervention is seen as a fight-back by Nice, which has been heavily criticised in recent weeks over a series of controversial decisions, including the “barbaric” ruling that new kidney cancer drugs are too expensive for NHS patients.

Local health trusts are allowed to pay for drugs for patients even if Nice has ruled they are took expensive in ‘exceptional’ cases.

This has led to a so-called “postcode lottery” where some patients receive new treatments while elsewhere others are denied depending on where they live.

Speaking on the BBC’s Panorama programme, to be shown this evening,[mon] Mr Dillon said that if Nice ruled that a drug was too expensive, then it was wrong for individual PCTs to agree to pay for treatment if it was not available to patients elsewhere.

He said: “An almost limitless amount of money could be spent in this case on the health system.

“When you limit it then you set up the need to make choices and sometimes those choices are very difficult and very painful

“It is crushingly disappointing for anybody for whatever reason who has pinned their hopes on a new treatment, and so we don’t take these decisions lightly and it’s why we take great care and sometimes why we take longer than people would like to make those decisions.

“It shouldn’t make any difference where you live. There ought to be a common basis for making decisions about exceptional circumstances and I think anybody who uses the NHS for their care is entitled to expect that.

“What they need to do is to find out from those who are making the decision what the basis of that decision is, and if they don’t think it’s reasonable, if they don’t think it compares appropriately with decisions that are taken elsewhere, ask why not.”

Nice came under fresh attack last week when it refused to approve new drugs for kidney cancer for NHS use on the grounds that the £30,000 price tag brought suffers only a few extra months.

Sir Michael countered the criticism by saying that the drugs could be produced at a tenth of the costs, accusing the pharmaceutical industry of seeking to inflate prices in order to boost executive salaries, which he said were linked to share prices.

He told The Observer: “Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because their senior management’s earnings are related to the share price.

“It’s not in their interests to take less profits, personally as well as from the point of view of the business. All these incentives drive the price up.”

His claims were yesterday denied by drugs companies.

Andrew Lansley, the shadow secretary for health, called on the Government to address the high cost of drugs.

He said: “The problem lies less with the fact of Nice having to undertake cost effectiveness evaluations and more with the failure of the Government to ensure that the price paid for new cancer drugs reflects their clinical value.

“It is really for the government to explain why new cancer drugs are far more available elsewhere in Europe and America than they are through the NHS in this country.”

In the Panorama programme, Mr Dillon also warns that Nice may be unable to meet the recent pledge by Alan Johnson, the Health Secretary, to reduce the time taken to approve new drugs from three to two years.