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The body that decides which drugs can be prescribed on the NHS in England and Wales should have a much expanded role looking at a greater breadth of health care and its effect, a parliamentary committee has been told.
Also, giving patients a stronger voice would help repair the reputation of the National Institute for Health and Clinical Excellence (NICE), witnesses told MPs on the parliamentary health select committee as part of their inquiry into NICE.
Tim Crayford, president of the Association of Directors of Public Health, giving evidence, said that NICE had not evaluated a large amount of what the NHS currently provided and considered as “core.”
“I am thinking of very common surgical treatments—common medical treatments which form the bulk of what the NHS does,” said Dr Crayford.
The rates of certain procedures, such as hysterectomy, varied widely regionally, he said, and he added: “In those sorts of situations it would be very helpful if NICE would consider a much greater breadth of treatments and provide primary care trusts with the mechanisms to iron out the variations.”
Dr Crayford said that NICE's integrity had been damaged by political interference from the Department of Health in its decisions, some of which it had overturned.
“It could have been circumvented had there been stronger patient representation in NICE. NICE could go further by giving patients a much stronger voice.”
Richard Taylor, the independent MP for Wyre Forest and a former hospital doctor, asked whether better topic selection of what NICE appraised—something currently chosen only by the Department of Health—could help. Dr Crayford replied, “There's a very strong role for the department, and we wouldn't want to see that role weakened, but it could be enhanced, particularly with a stronger voice within NICE for patient groups, trusts, and other bodies to request for guidance to be produced.”
Gill Morgan, chief executive of the NHS Confederation, which represents most NHS trusts, also gave evidence to the committee. Dr Taylor asked her whether recommending that NICE operate more quickly in the future would be helpful, but she disagreed.
“That will hinder us,” she said. “If something comes in in three months' time because it's been rapidly assessed, it falls in this financial year. Things that come in unexpectedly and very rapidly are difficult to deal with unless you start to establish significant contingency funds sitting at local level.”
Drug company representatives, who also gave evidence at the hearing, said that decisions about which drugs are approved in the United Kingdom should be made more rapidly and more openly.
Howard Stoate, the Labour MP for Dartford, asked the witnesses why drug makers did not sell their drugs more cheaply so that NICE could recommend more of them.
Eddie Gray, general manager and senior vice president of GlaxoSmithKline, said: “We invest an awful lot up front from a research and development point of view. I'm thinking about recouping that cost, providing a profit to shareholders who took the risk, and providing extra money to bring profit to the research pot for the next medicine.”
The committee will publish a report of its inquiry later this year.