With millions waiting for specialist care and NHS waiting lists stubbornly high, Britain’s healthcare system is in urgent need of reform. Even Labour acknowledge this, although so far Wes Streeting’s proposals have lacked ambition.
To make the NHS work more effectively, we need to move towards a system where patient demands, not bureaucratic will, are driving improvements. One place where the NHS could immediately start providing more choices for patients is medication.
For far too long, an arbitrary price ceiling on drugs has seen the National Institute for Health and Care Excellence (NICE) reject the authorisation of medication that would have been life-changing for some patients. In June, NICE rejected two medicines that have been proven to slow down Alzheimer’s and stabilise its symptoms. Even though both drugs are approved for use in the UK, NICE claimed the direct cost-benefit ratio was not worth it.
However, NICE’s rules are out of date. For a treatment to qualify under NICE rules, it must deliver one extra year of perfect health, or longer for less ideal health, for no more than £30,000. But this £30,000 figure has been frozen since 1999. If it had increased with inflation, it would be just over £53,000 today.
In other words, every year, as inflation goes up and the £30,000 cost ceiling does not, we are shifting the pharmaceutical playing field, demanding lifesaving drugs become cheaper and cheaper if they are to meet NICE rules. Just as freezing income tax thresholds has dragged millions more into paying higher-rate tax, freezing the NICE benchmark has blocked all kinds of valuable new medicines from reaching those who desperately need them.
By rejecting a drug now, we may also be pushing people towards worse outcomes that cost more later. NICE requires hard evidence of future savings, but often this evidence is hard to quantify in a model. As a result, care home costs, carer burden and lost independence by patients are ignored or undervalued in this decision-making process. How can NICE justify rejecting a drug that prevents future harm, simply because it’s too complex to model? We should give patients the right to choose and enable them to live with dignity.
As ministers review the value-for-money rules governing which drugs the NHS can buy, it is essential to offer patients more choice. As part of the economic agreement made with the USA, the UK agreed to ‘endeavour to improve the overall environment for pharmaceutical companies operating in the UK’. Let’s also not forget Brexit: the UK now has the tools to do things differently and can approve medicines independently of the EU. Indeed, the MHRA, which regulates UK medicines, launched fast-track routes to speed up innovative drug approvals, making the UK more agile and responsive than the European Medicines Agency. We can go further still.
Another potential avenue for reform is allowing patients to access certain medications through private co-insurance or top-up schemes, especially when NICE has rejected a treatment approved elsewhere. Currently, patients in the UK are often left with no alternative if a drug is deemed not cost-effective, even if they are willing to contribute toward the cost. This rigid system disempowers patients, particularly those with progressive or rare conditions, and leaves their care decisions entirely in the hands of bureaucratic gatekeepers. A more flexible approach would be to allow co-funding options, as exists in other health systems, including France, Germany and Australia. This would mean the NHS continues to support core services free at the point of use, while patients who choose to go further are not blocked from doing so.
Reforming NICE’s criteria for drug approval is long overdue. Fixing this overlooked area of health policy must also include options for patient-led funding support, so that the NHS continues to provide universal care, but a one-size-fits-all gatekeeping model no longer traps patients. It is a victory that the Government could achieve swiftly, not just for political reasons, but to give patients better access to medication, and thus better outcomes for them and their loved ones.
Originally published here