Tuesday, 29 January 2013

The Great NHS Free-For-All

Today, an important but understandably touchy angle on the seemingly perpetual divide between the realists and the fantasists. Yesterday, the Labour MP, Dave Anderson had a letter published in the Torygraph bemoaning Nice - the National Institute for Health and Clinical Excellence. As you know, it is the job of this unfortunate set of souls to decide what we can afford to cure 'free'.

By this I mean they look at treatments and medicines, work out how much they cost and what benefit they deliver. They use necessary but harsh sounding units called "cost per quality-adjusted life year". They take all this into account and work out if the NHS should add this treatment to the sanctioned list that John Q Taxpayer can undergo or be prescribed free at the point of delivery.

It must be a desperately depressing job. When they rubber stamp something that helps people out, they are unthanked (naturally, one might think - it's their job). However in the absence of the smooth, they certainly get their 'fair' share of rough; when we do hear about them, it is not normally in a story showing them in the greatest light. You can probably recall at least half a dozen articles along the lines of 'Nice refuse to fund cancer drug condemning little girl to death' or other such monocular representations of the very complex situation.

Now the thrust of Anderson's letter was a criticism of the decision to place under Nice's remit the assessment of viability of "high-cost, low-volume drugs for very rare conditions." Sadly it appears he has previous experience with one such condition having lost two family members to myotonic dystrophy. However, in his concluding paragraph he exposed the ultimately flawed opinion which characterises his party.

He stated "people affected by rare diseases should not be faced with the uncertainty of knowing whether Nice would deny them treatment on the grounds of cost." Whilst I can empathise with someone who has experienced the terminal illness of a loved one, I cannot agree with this statement. We should strip out the "rare" part and analyse what he says - essentially "diseases should all be treated free of charge by the NHS regardless of cost".

This is one of the reasons why we have a cyclical political cycle. The Tories piss everyone off / stab their leader in the back / erupt into civil war and Labour get in. Labour then bankrupt the country because they subscribe to the economics school of Ocean Finance. Cue Tory return. Ad infinitum.

As I blogged about in part here, referencing this excellent comedy sketch (here), there is a finite amount of money to be apportioned to varying competing demands (and the same goes in all areas of Government, not just health). What Anderson is essentially saying is there should be no Nice. Drug companies should simply create procedures, treatments and drugs and the Government should pay whatever price those companies choose to charge, because everything should be free. Nothing's too good for our loved ones, surely? NHS means 'Free For All', right?

Anyone suggesting otherwise surely wants people to die? Painfully. What total Tory bastards.

Or of course, they know that there is only a certain amount of money and lots of ill people. So you have to take a utilitarian sort of view and try to do the most good and the least bad. Now those closest to illness are naturally biased. I would have been a terrible Chancellor or Health Secretary whilst my father was ill. I suppose I might have sold all the eye units, pawned off the heart disease research centres and put the maternity wards on eBay. I might have traded it all in for as much anti-cancer stuff as I could get my hands on. Luckily I wasn't in charge, so that didn't happen.

Like Dave Anderson's brother and sister, my father didn't make it. Unfortunately, that's life, and indeed death. It comes for us all, and there is likely not a family in the country who have not had somebody succumb to one illness or other. Many of them no doubt feel very strongly about funding for research into the disease or condition in question. But that's why we have Government to make impartial, unemotional decisions. MPs are part of that and should be able to speak as a representative of their constituency, not just of their family.

At the end of the day there isn't enough money (even if we had not been left in such a parlous state by the last Government) to treat everyone to the highest levels. Those lucky enough to afford private healthcare can mitigate this to some extent. Those lower down the economic scale cannot. So we have a system that tries to make sure the money goes as far as it can. Often this means refusing to fund medicine that would help some sick people quite a lot. It is not out of spite. It is because they have decided they can spend the same money elsewhere and make a few more people better.

It is very sad for the unfunded group, but we should not let Nice become a punching bag. Perhaps the equation they use could do with tweaking, perhaps it does not take all of the right things into account? But it has to be there in one form or other. It has to exist. It is as necessary as a medic on a battlefield deciding which soldier to treat - given the time he has and the equipment with him, where is his help best put to use? We should all feel sorry for the man left to bleed out as the medic moves to help the man lying next to him and then the next and the next, all in the time the medic would have taken to treat the first man and still perhaps not save him. We can make a song and a dance about it if we wish, but we should not question the medic's motives nor forget the greater good he did by not treating the first man.

This is Government; trying to do the most good for the most people but being realistic about the fact that we will never please everyone. Unfortunately, there are too many people commenting disingenuously about decisions on where we can afford to spend and where we cannot. We know there isn't enough money to go round. Yet we still hear bleating of evil cuts as if there was no need to budget.

This is the fallacy Labour would have us believe - that the cuts are for shits and giggles; some kind of old-Etonian 'screw the poor' party where all the spare money is spent on champagne and fox hunting or just burnt in great bonfires for fun. Because if they pretend the choice to fund a drug or not is not an economic one but a moral one and anyone who disagrees is just punishing the ill, they hope you'll forget the reason why so many of these decisions do actually have to be made from an economic point of view - because they screwed the economy of this country for likely decades to come.

We must feel great sadness for those who are struck down by illness and even more so for those whose treatment is not economically viable. It would be lovely for those falling ill to not have to worry about treatment costs, but to pretend their having to is the whim of a malicious, uncaring Government is poor form. They rightly do have to worry because there isn't enough to go around and objectively the money might be better put to use elsewhere. It is the fantasy of the centre and left, of Labour and Lib Dems, that all decisions should be made on principle and not economics. It is what got us into this mess in the first place. If they are let back in, they will cause chaos again in the economy - then the NHS really will be a free-for-all.

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