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Penny pinchers or NICE people? Why someone’s got to choose which treatments get funded

Whatever you think about the UK’s National Institute of Health and Care Excellence (NICE), there’s no way around it – we need someone to make tough decisions about which health treatments get funded, says Claire Beecroft, educator on The University of Sheffield’s free online Health Technology Assessment course.

Claire Beecroft, educator on The University of Sheffield's free online Health Technology Assessment course.
Claire Beecroft, educator on The University of Sheffield’s free online Health Technology Assessment course.

It seems that barely a week goes by without a newspaper headline telling us about the latest “wonder drug” that NICE has refused to make available to patients on the NHS.

Such headlines are inevitably accompanied by stories about specific patients and their families, giving a profound picture of the emotional impact of such decisions on the lives of individuals. The decision-makers themselves are inevitably cast as “penny-pinching, “bureaucrats” and even simply “stupid.

NICE is a political hot potato

Most political parties accept that its role and function is necessary, but it’s very difficult to spin the work of NICE in a way that wins votes.

When the Conservative-Lib Dem coalition came to power in 2010, headlines about their plans to dismantle NICE and their “rationing” of healthcare abounded, but over five years on, little has changed. Indeed NICE itself has since taken on the remits of both health and social care services, widening rather than diminishing the scope and impact of its work.

Why? Because, as all the political parties know, the reality is that the NHS has a finite budget – funding every treatment that is shown to be safe and have a positive impact on health is simply impossible, even with cost-savings and efficiency drives elsewhere in the NHS.

So, decisions must be made in order to allocate these resources fairly and in a manner that uses the best available evidence about both the benefits and costs each treatment presents.

No additional funding is available for the treatments NICE approves

In media reports about the decisions made by NICE, there is relatively little discussion of the fact that no additional funding is made available to accompany a decision to fund a new treatment that has made it through NICE’s approval process.

Instead, as a consequence of the decision to make a treatment available, new and often tough decisions need to be made about what health benefits for other patients will need to be forgone in order to fund the new treatment.

Sometimes this means the withdrawal of other treatments and services or the cancellation of operationsThis can lead to significant negative impacts on the health of other patients – with some research suggesting the impacts could include reduced length of life.

To truly understand and appreciate how these decisions are made requires an understanding of not just the emotional impact on the lives of individuals when NICE rejects a new treatment, but also the wider impact on those whose care or treatment will be adversely affected when NICE does say “yes” to an innovative, but often very expensive, new therapy.

Only this, coupled with a wider awareness of the exhaustive approach that NICE takes in its consideration of the evidence around a new treatment, will enable us all to understand how its role is essential to the delivery of modern healthcare.

If you want to understand more, join the free online course Health Technology Assessment: Choosing Which Treatments Get Funded.

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