Drugs for all
Have the days of drugs being available free to all ﬁnally gone?
A key founding principle of the National Health Service was that it was free at the point of use. Anyone, anywhere, would get the healthcare they needed regardless of their ability to pay. If they were ill, people knew they would get the treatment they needed.
Since the 2000s, there have been growing concerns about the rising NHS drugs bill. The Department of Health reported that prices had been increasing by 5 per cent a year and the bill had reached £12 billion by 2011-12. It was feared that the rising costs could mean it would no longer be possible for everyone to get every available treatment.
In 2013, the UK Government stepped in an attempt to ensure that the NHS would be able to maintain its founding principle. NHS spending on branded drugs has been capped at £12bn from 2014 to 2016.
This deal – agreed with pharma – means that any excess on spending will be paid for by the drugs companies, ensuring that patients will continue to receive necessary drugs regardless of the price tag. Issues of affordability continue to be dealt with by the National Institute for Health and Clinical Excellence (NICE). They provide guidance to care providers in the NHS regarding whether new-to-market drugs offer cost effectiveness. Without NICE approval, care providers in the NHS don’t usually make treatments available.
To make its decisions, NICE calls together expert review groups and commissions assessments of health technologies or products. NICE is, in effect, acting on behalf of taxpayers. As well as medical input, it seeks the opinions of healthcare professionals, patients and carers, and the general public, during consultations and through permanent bodies (a Citizens Council and a Partners Council).
It has been criticised by pharmaceutical companies and patient groups for refusing to sanction certain drugs, such as beta-interferon for multiple sclerosis, trastuzumab (Herceptin) and four drugs for Alzheimer’s disease (except in moderate and severe disease).
NICE faces a difﬁcult task. It can be seen to be denying individual patients potentially beneﬁcial medicines. But if healthcare costs are to be kept in check, it will be necessary to make hard choices about what the NHS will provide. NICE has become the route by which, in effect, rationing has been brought into the health service.