The news earlier this week that the National Institute of Clinicial and Health Excellence (NICE) is to lose its powers for deciding which drugs should be made available on the NHS (to be replaced by a new system based around GP commissioning) brought an alternative version of Adam Smith’s remarks about shopkeepers to mind:
“To found a great empire for the sole purpose of meeting people’s health needs may at first sight appear a project fit only for a nation of general practioners. It is, however, a project altogether unfit for a nation of general practitioners; but extremely fit for a nation whose government is influenced by general practitioners.”
Adam Smith’s Health of Nations?
I am beginning to think I might re-train as a GP given that they are one of the few professions in favour with Ministers. In fact, keep going on like this and we may see the dawn of a whole new health aristocracy previously known as GPs – reluctant aristocrats at that I should add, if you believe recent polls (see The Guardian last week).
When the news about NICE broke it sparked a brief flurry of widely differing views (see Emma Baines in the London Review of Books or the Daily Mail) But it is interesting that the NICE story has died a death so very quickly. My sense is that it was probably stamped on pretty quickly by the Department of Health. But also because there is much more to the announcement than has been reported so far. Indeed, there is nothing worse for a Government than having others taste your half-cooked specialty dish. My tuppence worth in summary?
- NICE is a much maligned organisation, but surely we are not intending to lose the skills and expertise that NICE has built up in terms of drug appraisal (plus an international reputation for excellence to boot) for nothing are we?
- If we really are to move to some form of local prescribing then what safeguards will we see in place to stop the same shadow of inequity moving acorss the country much like the Ice Queen managed in Narnia.
- Many of our members seemed to adopt the only sensible response which was one of cautious scepticism but with overriding concern for what it would mean for patients.
But finally….some us can recall the pre-NICE days of real postcode prescribing and healthcare provision. In fact I remember producing a report about the postcode lottery in NHS long-term care beds in 1993. What was staggering was not just the fact that the NHS had abandoned a whole form of care provision, but that health authorities behaved as if completely above the law and wouldn’t even respond to MPs letters asking how many beds had been closed etc.
In terms of further reflection you may wish to read Lord Turnberg’s exchange with the Minister Earl Howe yesterday in the House of Lords. In fact if you want to read an excellent summary of the issues for research raised by the NHS White Paper in general you may wish to read Les Turnberg’s speech in the parliamentary debate on health reforms on 28th October.
Earlier this week AMRC and INVOLVE held a patient and public workshop on the regulation of medical and health research at the invitation of the Academy of Medical Sciences who are in the final stages of their independent review (see previous blogs on the subject). A truly engrossing event. My thanks to the attendees who sent us away with a strong message that we should rebrand the NHS the National Health and Research Service and carve it in stone above every hospital and surgery. We will be producing an independent report of the workshop in due course.
I suppose I am particularly proud of this latter piece of work because if you search for literature on public opinion about regulation there is very little that you can find. It is good to know that we will help to fill that void and I am sure that evidence gathering and data presentation both about research charities and about patients and research will be a strong theme of AMRC’s future.
Richard Smith (former BMJ editor) has written a very thought-provoking blog on the conflcits of interest experienced by journal editors.
For those who have been following the mid-term elections in the United States, Research!America has posted a short piece on its blog summarising the implications for science and research. I do like their pieces.
And finally on the AMRC front again, I am getting very excited about our impending office move (see photo of new office below – it doesn’t show my desk which will rise throne-like from the floor surrounded by dry ice each morning that I arrive for work) and our AGM on 24th November with Earl Howe, John Savill (CEO, MRC) and Nicola Dandridge (CEO, Universities UK) all confirmed speakers.