conference focus

Health authorities considering rationing expensive drug treatments will get little help from the National Institute for Clinical Excellence, a leading public health expert warned.

Oxfordshire public health director Dr Sian Griffiths told the conference she had asked NICE chair Professor Sir Michael Rawlins how far NICE would assist in local decision-making and what values would underlie its guidance.

His reply was that clinicians would have to go on making decisions and NICE would provide 'guidance, not diktat'.

That, said Dr Griffiths, raised more questions. 'I wish NICE good luck - but I still have reservations about how it will work.' She said Oxfordshire heath authority was guilty of 'post-code prescribing' in its use of beta interferon for people with multiple sclerosis. 'For some years we have openly recognised that we have to ration the resources made available to us because there are more things we would like to provide for our local population than we are able.'

There were 300 people with MS in Oxfordshire. Local clinicians and the MS Society opted for improved services rather than more drug spending when consulted in 1997 about how£200,000 available should be spent.

'So we have gone ahead with our local decisions and criteria for rationing, since we can't afford to give all patients with the disease the drug,' Dr Griffiths said, adding: 'We are not purposely providing inequitable poor quality care, but we are struggling to balance the various demands on the NHS - and we would welcome some help.'