Did you hear Ian Gibson, left wing MP for Norwich North, giving Gordon Brown a piece of his mind in the wake of Labour's disastrous performance in the local elections?

"Buck up Gordon, or you'll be out on your ear," was the drift of his message; this from an MP who'd been noisily keen to get rid of that Tony Blair until last 27 June - how long ago it all seems.

As Labour slides towards the abyss, there are plenty of Labour MPs and activists like Mr Gibson. But few are so much fun as troublemakers in the Gwyneth Dunwoody mould, or as scientifically useful and energetic. He may talk lots of nonsense about party politics, but Ian Gibson (69) is a Good Thing.

I thought of this when catching up on Hansard. Not only had the old leftie organised an excellent Westminster Hall debate on what are known as "exceptional cases" in NHS-speak, but Tory MPs turned up to congratulate him on it - and on 10 years' chairmanship of the all-party cancer group.

Quite right too. You may know "exceptional cases" are those whereby primary care trusts decide a patient should receive a particular course of drugs, whether or not it has National Institute for Health and Clinical Excellence approval.

This is a familiar dilemma to patients, medics and managers, but currently topical for two reasons:

  • the health select committee published a report in January which urged NICE to speed up evaluations and is due to be debated any day;

  • the Appeal Court last week ruled against NICE on an Alzheimer's campaign and told it to release the economic model on which it based its rejection of Aricept, Exelon and Reminyl for those with only "mild symptoms".

Everyone agrees that NICE, one of Labour's innovations, is a success story, so much better than the haphazard decision making that preceded it. What puzzles sensible MPs and their distressed constituents - judges too - is that it's not always clear why it reaches its conclusions.

Ditto PCT decisions in exceptional cases, 57 per cent of appeals against which are won. "Every PCT has its own system," Mr Gibson explained, they are almost impossible to understand, interjected brainy Oliver Letwin, Tory MP for West Dorset.

Ian Gibson's case was that the Department of Health should issue fair national guidelines on such procedures, as well as advice on higher-cost rarer treatments using "orphan drugs", that is ones with few takers, their illnesses being rare.

Not everyone, Liberal Democrat John Pugh for instance, agreed with a centrally imposed remedy for postcode lotteries. Nor with Conservative Peter Bone's heartfelt complaint that PCTs should accept "co-payment" from people who offer to pay for drugs the PCT denies them. Instead many say "buy that drug and the NHS will not treat you".

Oddly enough, sensible Ben Bradshaw, the health minister who answered the debate, called that a "subsidy for the private sector" when I would have thought it exactly the opposite.

Wellingborough's Mr Bone reported cases where insurance firms or patients themselves had paid to save their own lives. Mr Letwin pointed out that NICE fails to take into account economic factors, so that letting someone go blind for want of treating age-related macular degeneracy would mean social care far in excess of the drugs denied.

Quite rightly, Southport's Mr Pugh warned against greedy drug companies and careless newspapers campaigning against "NHS parsimony" to promote a doubtful drug at excess cost. All were agreed we can do better.

The bio-scientist Mr Gibson predicted the coming day when we will have drugs customised to work for our individual genes. Ben Bradshaw reported that NICE is reviewing several of its own procedures, including "social value judgements".

PCT compliance with NICE is improving all the time, he told MPs. So is management guidance to NHS bodies reminding them that hiding behind a NICE decision is not sufficient justification for refusing care. Cancer drugs are getting faster appraisal, even those orphan ones are treated with respect.

Plainly there is more to do. Perhaps Gordon Brown should get behind the campaign to be even NICER as he seeks to woo voters.