Recent controversies over the National Institute for Health and Clinical Excellence (NICE)’s recommendations on access to kidney cancer drugs for National Health Service (NHS) patients have exposed the fact that the UK has held no debate, or dialogue, on the value that society places on life-extending medicines, Members of Parliament (MPs) have heard.

Addressing the House of Commons Health Select Committee this month, the chief executive of NHS North West, Mike Farrar, called for a “really strong discussion” on the value of a product “which might save three years of life for someone at the end of life over and above spending that money somewhere else in the system.” In the absence of “any kind of social construct” on how society values such products, the issue simply becomes “a technical exercise that people can criticize, rather than something that we should all take responsibility for,” said Mr Farrar, and he suggested that such a debate represented “a really powerful opportunity” for the Committee.

Panel member Dr Richard Taylor, Independent MP for Wyre Forest, agreed. A wide, open public debate on health care rationing is necessary “because we have got to get rid of some of the things that are not evidence-based that consume a vast amount of money,” he said, and added: “it is something I think we should, as a Committee, engage with.”

Mr Farrar also welcomed Lord Darzi’s recommendation, in his Next Stage Review of the NHS, that NICE’s processes should be speeded up. At present, Primary Care Trusts (PCTs) are having to make drug access decisions in the absence of a national position so, rather than putting additional pressure on the local NHS, faster NICE approvals would help enormously in reducing nationwide variations in drug access, he said.
However, he added: “I do not think we should blame NICE if there is variable practice …we have got to make sure that clinicians are pursuing best evidence-based practice.”

Margaret Edwards, chief executive for NHS Yorkshire and the Humber, agreed that significant variation in terms of clinical practice still exists even once NICE has approved a drug, and pointed out is that PCTs’ exemption panels are currently having to make access decisions about drugs awaiting NICE approval without the advantage of the Institute’s “thorough and really robust approach.” She told the Committee: “I think we are very lucky to have NICE and it is very useful, but the quicker we can get the results, then the greater consistency we can get.”

Asked what effects faster NICE approvals would have on local NHS expenditure planning, Ms Edwards replied that the Service has to get much better at horizon-scanning, identifying new treatments coming up and agreeing on what NICE should be examining, although she added that no-one knows exactly what is “the next drug that may have fantastic benefits.” However, given that the “vast majority” of treatments used in the NHS have not been examined by NICE and some are not evidence-based, she told the MPs that, if NICE approves a new drug, “then at least we know it is evidence-based and it is cost-effective, so in terms of our priorities for implementation, then clearly that would be a greater priority against something that was unproven.”

- This report is based on an uncorrected transcript which is not yet an approved formal record of the Committee’s evidence session, and neither witnesses nor Members have had the opportunity to correct the record.