Just 9% of UK adults believe that Members of Parliament should be involved in deciding which treatments should be funded by the National Health Service, and only 6% think that local councillors should have a say, a new opinion poll has found.

70% of those polled said they believe clinicians should be involved in such decisions, while 33% and 23% say that patient representatives and NHS managers, respectively, should contribute to the process, according to the survey, which was conducted for the NHS Confederation.

Asked which are the most important factors to influence the treatments which should - and should not - be provided by their local NHS, 50% of people polled said the most important was the probability of the treatment being effective, while 38% cited use of the product to treat a life-threatening condition.

22% of respondents said the treatment’s cost should be considered in decision-making, while 34% felt the availability of cheaper but equally effective treatments should be a factor. 18% said local trusts should consider whether or not other treatments will have to be withdrawn from other patients as a result, while a small but significant minority (8%) said that the NHS should fund all treatments.

Commenting on the findings, Gill Morgan, chief executive of the NHS Confederation, said: “over the last 18 months, decisions made by local NHS organisations about which treatments to fund have been highly politicised as media attention on drugs like Herceptin have fuelled the public debate.”

Time for a public debate

It was “reassuring,” she said, that the public believes it is clinicians, patient representatives and managers who are best equipped to make these tough choices, not national or local politicians. However, Dr Morgan also noted the poll revealed that people are more divided about what factors should influence those decisions. “There are difficult ethical issues that we need to grapple with as a society about how we make choices in a cash-limited NHS,” she said, and added: “it’s time to confront the reality and to recognise that, if cost is not to be factor in NHS decisions, then the public may have to be prepared to pay more in order to have every treatment funded. I think the public is ready for this debate."

Patient groups have also signalled this need. Last week, the charity Cancer Research UK – which has condemned the National Institute for Health and Clinical Excellence’s (NICE) recent rejection of an appeal against its decision last August that Merck KGaA’s bowel cancer drug Erbitux (cetuximab) should not be available on the NHS – said that it did not understand the cost framework used by NICE to come to its decision. “We feel there needs to be a public debate on how much the NHS ought to be spending on any individual cancer patient,” said chief executive Alex Markham. A debate is also needed about how pharmaceutical companies agree pricing with the Department of Health, he added.