11th August 2014

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HealthChat - CNO Jane Cummings in conversation with Roy Lilley - 10th November 5.30pm King's Fund London Book Here.  Come and chat, network and enjoy a glass of wine. Some tickets left at �39.95

Heading in the same direction     
News and Comment from Roy Lilley

NICE have been in business for 15 years and I still don't know; do I take a Statin or not, a daily aspirin or not? Is it five a day or more, can I drink white wine not red, red not white. No wine? Sugar, good or bad, natural fat, saturated fat, no fat? No idea. Prostate screening, good or bad? Health checks, yes or no? NICE confuses me.


There is a welter of NICE guidance on everything from osteoporosis to obesity, diabetes to depression. How much of it is needed, heeded or shredded I guess we'll never know.


I do try and read NICE guidance. I'm not sure I understand it. Mostly it looks to me like a Google collection of other people's work (that is assumed to be correct), aggregated and distilled into something with a NICE logo on it... then presented as gospel. The bits I do understand look like common-sense and why we need an organisation the size of a small town to tell us I'm not sure?


I do understand vice-chair, Gillian Leng's, half-baked guidance on nurse:patient ratios. It is ridiculous. Up-sum in-a-sentence; "...staff the wards at the minimum and be prepared for someone to tell you things are going wrong... and have spare nurses on stand-by".  This simple graph (Doing the rounds on Twitter) explains the stupidity of 1:8 and the daftness of the NICE conclusions.  


In an NHS that sacks whistle-blowers and destroys their careers and obfuscates, complicates and muddies the water of complaints Leng's guidance is as useful as a chocolate-tea-pot, as realistic as a fairy tale and about as academic as the Beano.


NICE have become a remote industry. Participation discouraged (nurses were not allowed to contribute to the nurse-patient ratio guidance) and as the regulator of what we can and can't have, are neither democratic, nor elected. Not content with telling us in England how to live they are now telling the world... NICE International.


Under all normal circumstances I would have sided with NICE over their latest spat with Roche and Kadcyla, an end stage breast cancer drug, that doesn't fit NICE's value for money template But now I'm not so sure.


It is not credible for NICE to repeat, for 15 years, this or that treatment doesn't give enough of a return on investment. I know big-pharma is unpopular but aside from nationalising them we have to accept they make profits, to invest in research, to innovate drugs, to sell, make profits and pay dividends for our pensions. You may not think it a virtuous circle but it is a circle and reality.


Despite doing everything wrong Roche are winning the Kadcyla argument. They have a spokesperson; a brittle, hard-as-nails American woman who personifies big-pharma, profit and gimme. She says because other countries have bought Kadcyla the NHS should too.  


Different countries have different reimbursement systems so it's a stupid argument... or is it? Countries hit just as hard with austerity are using it. They seem prepared to value end-stage life differently. NICE look flat-foot, complacent and behave like this just the latest row in a long line of rows. It is not. It is a defining row for NICE.


Complex, new drugs that provide new hope, will get more expensive and NICE can't keep saying 'no'. It is not credible. The Cancer Drugs Fund is an additional layer of bureaucracy that ignores NICE guidance and will make Kadcyla available anyway. If NICE says 'no' and the CDF says 'yes' what's the point of NICE?


NICE can't keep peddling 15 year old answers to today's problems. They need a better story, some fresh ideas and a new approach. They have to decide; are they the security at the back door of the Treasury or the concierge at the front door into people's hopes and lives.


Sophisticated drugs take +14years to fineness and a 20yr patent life is not long enough to recoup +�bn's investment. Hence the rush to amortise R&D investment over the 3 or 4 years tale end of the patent and horribly expensive drugs. Bear in mind; a popular song can be copyright for 50yrs... why not a lifesaving drug. Pharma and NICE should be working together to extend EU patent law to ease the price of drugs.


NICE is yawning when it should be shouting.  NICE is shag-pile carpet in a wood-floor era. Born in 1999, NICE are stuck in the time when Charles Kennedy won the Lib-Dem leadership... now the LIB-Dems have lost credibility and face extinction...  


It looks to me like NICE is heading in the same direction.

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CNO England 
Jane Cummings
in conversation with
Roy Lilley
10th November
King's Fund
Mark Britnell
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