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Think pink!

Shouldn't the NHS have the discretion to buy what it wants?

Imagine you are at home, slumped on the sofa, exhausted after a day's shopping. It's a Saturday. You always do the shopping on a Saturday. You galvanised yourself and got up early to fill your trolley with all the basics required to get the family through a calorie-fuelled week.

After throwing it all into the back of the car, you headed for Marks and Sparks for a bit of therapy - buying the little 'nicky-nacky-noo' bits that make life bearable.

Once home, you bunged all the frozen stuff into the freezer and slumped. A period of quiet reflection. The credit cards are manageable, the holiday is planned and paid for and the car tax isn't due to be renewed for another nine months. You are just about hanging on. There is the issue of what happens when the fixed-rate mortgage runs out and there is the prospect of private school fees, but, for now, it's a white wine and chocolate moment. You are on top of your own affairs.

Unexpectedly the door bell rings. A man is standing there looking serious, with gold rimmed glasses and a clipboard. He is the inspector of socks. Armed with the full power of the courts, the law and the European Union, he has stopped by to look in your sock drawer.

Argument is futile. He marches into the hall, up the stairs and into your bedroom. He makes notes, accompanied by the occasional sharp intake of breath. He is not long about his business and, marching back downstairs, he gives you a piece of paper. You have 24 hours to get back to the shops and buy six pairs of pink socks.

I know. You don't want pink socks. You haven't budgeted for them, nor do you see a use for them. Nevertheless, Marks and Sparks have a new line of pink socks and you must buy them and that is the end of it. So get up off the sofa, get into the car, get back to the shops. Marks and Sparks have profits to make, staff to employ and dividends to distribute. Go and buy the socks. You have no choice.

Does this sound stupid? Are you thinking I have lost my last marble? I haven't. I am talking perfect sense. I am talking the perfect sense that the NHS has to put up with.

The National Institute for Health and Clinical Excellence (NICE) has just been made to buy pink socks. NICE accepts that pink socks are just the thing for some people. They agree that a lot of people want pink socks. It's just that NICE doesn't want them. It doesn't think they are great value for money and it can't afford them.

I recognise that it is not a perfect world and NICE does not do a perfect job, but it does the best it can. NICE does the job no one else wants to do. And now, its job is being made even more difficult. NICE makes the moral and ethical decisions about clinical cost effectiveness that no one else wants to make. The NHS cannot fill its medicine cabinet with everything that pharma companies make - however good the products may be. And so it is up to NICE to decide and it has to be left alone to do it.

The recent High Court decision that forces NICE to share its financial model (in simple terms - an Excel spread-sheet) with peeved pharma makes no sense. Pharma will simply use different numbers, more numbers and other numbers, until they conjure the results they want. In essence, they will tell the NHS to buy pink socks and plenty of them. If you happen to be in the business of selling blue socks you may be in trouble; if your interests are in yellow socks, you may very well go out of business soon. NICE has to buy pink.

The issue is simple. Shouldn't the NHS be allowed the discretion to buy the pills and potions it thinks it wants?

No doubt its decisions will create disappointment, displeasure, annoyance, frustration and protest. NICE's processes are painfully slow because they are painstaking. They are as transparent as a bay window. Patients all have an equal claim on NHS cash and so can create a case, tug at our heartstrings, embarrass us, lobby and protest. Pharma can use its money to recruit lawyers, advisors and lobbyists. They can appeal against, argue with, write about and, it seems, force NICE to spend goodness knows how much tax-payers' money fighting over a spread-sheet. At the end of the day, where does this leave us? In the jungle it is the big beasts who survive; in the NHS it is the loudest voice.

This is not good government, this is not what the courts are for. This is bullying, hectoring and browbeating. This is pharma living out the fantasy of its worst image.

To the patients who long for a cure, relief, treatment and help I say: the NHS is designed to do the greatest good for the greatest number, nothing more. You may not get what you want but someone else might.

To pharma I say: you have brought shame on your industry and once again smeared its good name.

To NICE I say: I have no idea why you sweat and persist in trying to put a rationale behind the use of resources. Ministers should strengthen your hand.

To you, dear reader, I say: go and look in your sock drawer and tell me who should be responsible for filling it?

The Author
Roy Lilley
is a (sometimes controversial) healthcare author and broadcaster

4th June 2008

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