Editorial: Take the politics out of healthcare? Impossible

Taking the politics out of healthcare and the NHS is an ideal that many subscribe to, but is it something that can be made a reality?

Take NICE as an example. The body was set up to end the postcode lottery affecting prescribing and treatment, which was at root the result of the 'politics' of health budgets and targets. The idea was that an independent expert body would remove this political element by concentrating on the science and cost-effectiveness of treatments.

But, of course, in the real world things were not quite that simple, as the latest House of Commons health select committee report on NICE reveals. It discusses the effects of 'NICE blight' - the fact that it can take upwards of two years from a drug's launch for NICE to produce a final appraisal. That's two years when it is effectively up to primary care organisations (PCOs) to decide whether or not it will fund the treatment.

The 'Herceptin scandal' ((c) Daily Mail) was a case in point. The drug was available and being promoted, but PCOs had no guidance on which to base their decisions, leaving different local areas with different policies.

But there is also a more direct political aspect to NICE in that it is the DoH that decides what new treatments the body will appraise - which is hardly leaving things up to the independent experts.

The health select committee is advocating wholesale change in an effort to depoliticise these decisions. It calls for NICE to be given the remit to appraise all new treatments regardless of DoH priorities.

And to end the NICE blight, the committee would like to see 'rough and ready' appraisals on all new treatments as they become available, based on an agreed cost-effectiveness measure.

At face value this certainly looks a more independent approach, however on closer inspection politics still rears its head.

What, for example, happens if the initial NICE appraisal recommends a new drug, but more detailed appraisal suggests it is not as cost-effective as initially thought? Imagine what would have happened with Herceptin; there is no way that ministers would have avoided entering the ensuing row over a 'wonder-drug' being withdrawn.

Then there is the question of who will set the cost-effectiveness threshold for new treatments. The report mentions the need for more evidence for these cut-offs, but this cannot be anything other than a political decision because, however much we try to avoid discussing the 'R word', it is rationing.

The aims here are to reduce the political influence on NICE and the report's ideas would be a move in that direction, but no-one must be naive enough to think that this issue can ever be politics-free.

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