Short cuts

Published: 31/01/2002, Volume II2, No. 5790 Page 10

Expensive drugs are being inappropriately assessed by the National Institute for Clinical Excellence in isolation from other relevant interventions and treatments, and are not necessarily the first choice of patients, the Commons health select committee was told last week.

The second session of the committee's investigation into the work of NICE heard that not only were drugs such as beta interferon being assessed without reference to other measures, but patient care was suffering because of the requirement to fund NICE's recommendations without regard to local circumstances.

Lambeth, Southwark and Lewisham health authority director of public health and health systems Dr Deirdre Cunningham told the committee that local multiple sclerosis patients had a few years ago identified specialist MS nursing care as more important than drugs.

She said: 'We did a study with about 40 people in our HA and asked them what are the gaps in the service, and they said that it was not beta interferon.

'What they wanted us to do was fund the nurses so they didn't have to have beta interferon. If you consider the whole package of care, the drug is not necessarily the most important thing. If we used the drug, it would use up all the money we have in that area.'

Croydon HA deputy director of public health Dr Tim Crayford told the committee: 'As HAs, we have all sorts of other pressures, and NICE doesn't take these things into account.'

He said the HA had spent£120,000 on implantable cardiac defibrillators last year - a sum equivalent to four much-needed nurses. He added: 'The nurses that we could put into accident and emergency very directly stack up against this. It deprives our local residents of very important services. I would like NICE to evaluate the value of the nurses in our A&E department.'

Newcastle and North Tyneside HA director of public health Dr David Walker told the committee that lack of flexibility in funding local priorities was also a problem: 'Patterns of disease are different. There is a funding issue there about how funding is distributed.'

The committee also heard that delays in the appraisal process were causing unnecessary deaths.

In evidence submitted to the committee, the campaign for effective and rational treatment said the appraisal of the drug Herceptin, used in the treatment of breast cancer, had 'been inexplicably delayed by six months'.

Association of the British Pharmaceutical Industry director general Dr Trevor Jones said: 'This is a drug where there is incontrovertible evidence it works.'