A Labour government could reduce variation in access to drugs and procedures by making it mandatory for commissioners to follow national clinical guidelines, Andy Burnham has revealed.

In an exclusive interview with HSJ, the shadow health secretary also gave his most detailed account of how he would deliver his ambitious NHS and social care reform proposals.

He revealed new details of his plans on staff pay, NHS funding, his “NHS preferred provider” policy, and changed roles for health and wellbeing boards and clinical commissioning groups.

Andy Burnham

Andy Burnham said ‘people hate the idea of postcode lottery’ for treatments

Mr Burnham said decisions about which treatments were “effective… affordable and everyone is entitled to” should be taken at a national level by the National Institute for Health and Care Excellence.

Such a move would be a dramatic upheaval of the current system, under which NICE’s clinical guidelines are not mandatory.

Mr Burnham said he wanted to “strengthen” NICE’s role. Asked if he would consider making its guidelines mandatory rather than advisory, he said: “I wouldn’t rule that out.”

Mr Burnham added: “We can’t just have national entitlements broken up… We need to look at how you strengthen NICE. Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody? I’m not comfortable with that. I don’t support that.

“Strengthening NICE is important because what I am seeing at the moment is CCGs beginning to take quite drastic decisions with respect to rationing. Some of this is veering into the judgmental.” He gave the example of decisions not to give access to treatments based on whether someone is a smoker or their body mass index.

The former health secretary said Labour had found evidence of “CCGs increasingly opting out” of NICE guidelines.

“People hate the idea of postcode lottery. They can’t understand it when they can see someone else in the next place get something, like IVF, when they can’t,” he added.

Mr Burnham acknowledged making all NICE guidance “nationally binding” would be a major step with significant implications, and said he had not taken a final decision on the policy.

At present NICE produces clinical guidelines for commissioners, which are advisory, and technology appraisals, which are mandatory.

Mike Birtwistle, health policy expert and founding partner of consultancy Incisive Health, warned there would be “potentially significant implications” to making guidelines mandatory.

Mr Birtwistle said: “Technology appraisals are a largely binary decision for NICE, either the technology is accepted or not. Clinical guidelines are often long, complex documents covering entire patient pathways, such as for rheumatoid arthritis, which makes them far more open to interpretation. 

“If guidelines became mandatory they would be subject to far more scrutiny from commissioners who would be worried about cost and might demand more robust evidence.

“It would be difficult to make some clinical guidelines mandatory and some just advisory because there would be considerable debate about which guidelines were given mandatory status.”