The NHS must fund all NICE recommendations in Technology Appraisal within 3 months, except where capacity constraints make it difficult (e.g. the rollout of bariatric surgery some years ago depended on the number of surgeons trained for the job, and the system would not have been able to cope with the NICE recommendations immediately).
NICE recommendations in clinical guidelines and in public health are not mandatory. These latter recommendations cover a much broader set of interventions than the tech appraisals, but are largely unsung. What the public hears about are predominantly the decisions made in tech appraisals. Many of the recommendations in clinical guidelines and public health concern better ways of delivering a product that is already being provided, so do not capture the public interest as much as whether a particular person with an immediate health need is able to get the latest drug for it.
Alastair Fischer
Phone 020 7045 2140 within UK
+44 20 7045 2140 international
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of May Tsung-Mei Cheng
Sent: 28 August 2012 20:34
To: [log in to unmask]
Subject: Re: Score cards for take-up of Nice approvals
Scoring hospitals may be an effective way to reduce the wide geographic variations that has long been observed in the uptake of NICE recommendations by hospitals including the use of cancer drugs. As to who pays, my understanding is that the NHS must fund all NICE recommendations. So NICE recommendations sometimes lead to an increase in NHS spending.
May
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Rudolf Klein
Sent: Tuesday, August 28, 2012 2:58 PM
To: [log in to unmask]
Subject: Re: Score cards for take-up of Nice approvals
Jp-
Not really. There are appeal procedures and GPs would have to give good reason for ignoring NICE recommendations.
GPs prescribing drugs etc. is a relatively straightforward matter and doesn't give much scope for conspiracy theories. Giving greater visibility to what GPs are doing - score cards etc. - is one more attempt to reduce postcode rationing, I reckon.
It's much more difficult to know about the extent to which hospitals follow NICE recommendations because of lack of data. Occasional surveys suggest great variations ( as always in the NHS ) in implementation. So score cards may be a good way of opening this particular can.
Rudolf
-----Original Message-----
From: Joseph White <[log in to unmask]>
To: rudolfklein30 <[log in to unmask]>
Cc: AAHPN <[log in to unmask]>
Sent: Tue, Aug 28, 2012 4:02 pm
Subject: Re: Score cards for take-up of Nice approvals
ah, but if the GPs are in charge, they can decide it's not appropriate regardless of what NICE says, right? Wouldn't that follow?
Not that anything follows any logic in this reform.
cheers,
Joe
On Tue, Aug 28, 2012 at 10:12 AM, Rudolf Klein <[log in to unmask]> wrote:
What's new ? The NHS Constitution - introduced in 2008, reaffirmed by present govt.= states :" You (i.e. the patient) have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says that they are clinically appropriate for you".
Rudolf Klein
-----Original Message-----
From: Tom Foubister <[log in to unmask]>
To: AAHPN <[log in to unmask]>
Sent: Tue, Aug 28, 2012 12:55 pm
Subject: Score cards for take-up of Nice approvals
It is difficult to tell from this story (below) whether there is in fact some concrete compulsion to make available Nice-recommended drugs, or whether the line being pursued is a straightforward 'name and shame'
one. It seems, in spite of the rhetoric, to be the latter.
The focus here is on hospitals (although it's not clear it's just that
- indirectly on purchasers perhaps), but it's hard to see how a hospital can act unilaterally to introduce a new more expensive treatment/technology and not make a loss without the agreement of the purchaser to pay above and beyond the existing tariff - at least until tariffs are reviewed.
Maybe this is how the government intends to 'not interfere' in purchasing decisions. But I'm wondering if it will be particularly effective.
Is there any comparable use of scorecard-type mechanisms for new drugs/technologies provision in any part of the US health system? If so, are there any positive/negative lessons to be drawn? And would US experience even be relevant to the phenomenom of poor areas vs middle class areas (as opposed to United vs Aetna) we have here?
Tom
http://www.guardian.co.uk/society/2012/aug/28/scorecards-nhs-inequality-over-drugs
Scorecards' to end inequality over NHS drugs Measure aims to tackle regional disparity of medicines and treatments
Press Association
The Guardian, Tuesday 28 August 2012
The new rules will allow the public to compare the speed at which NHS hospitals roll out new care methods and drugs.
NHS "scorecards" are to be introduced to tackle the regional disparity of medicines and treatments.
Under the scheme, expected to be launched before autumn, hospitals will have "no excuse not to provide the latest approved drugs and treatments", the Department of Health said.
Hospitals that delay acting on guidance from the health watchdog, the National Institute for Health and Clinical Excellence (Nice), will be forced to explain holdups to patients, it said.
The new rules will allow the public to compare the speed at which NHS hospitals roll out new care methods and drugs.
Currently some primary care trusts delay offering new drugs as recommended by Nice, while other areas use them on patients straight away.
Under the scheme, NHS organisations will be automatically added on to publicly available lists of what drugs are available in local areas.
It is hoped the rules will create a level playing field for treatments such as IVF, for which patients living in different regions have had varying levels of opportunity for the treatment.
Last year, a report found more than 70% of NHS trusts ignored Nice guidance to offer infertile couples three chances at IVF, and some stopped funding treatment.
Some of Nice's most recent guidance, recommending an extended time to administer a clot-busting drug to treat stroke patients, for example, will soon have to be taken on by all hospitals.
The Department of Health said the uptake of new drugs and treatments will also be made quicker by setting up a new group to help local NHS organisations implement the guidelines.
The health minister, Paul Burstow, said: "Patients have a right to drugs and treatments that have been approved by Nice. This new regime will be a catalyst for change – we are determined to eradicate variation and drive up standards for everyone.
"NHS organisations must make sure the latest Nice-approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not.
"Being transparent with data like this is the hallmark of a 21st century NHS. It is a fundamental tool to help healthcare professionals improve patient care."
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