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Wednesday 23rd May 2018

NICEly done: Still a Healthcare Lottery

1st December 2006

01122006_postcode1.jpgThe great-and-the-good in evidence based healthcare from both the UK and around the world will converge in Birmingham on the 6th of December for two days. It's the National Institute for Health and Clinical Excellence (NICE) 6th Annual Conference.

There will be the usual offerings from the Chair of NICE Professor Sir Michael Rawlings and Chief Executive Andrew Dillon which will, no doubt, be dressed liberally with presentations from recently published guidance. Almost 6 years and with 48 clinical, 188 interventional procedure, 10 cancer service and 2 public health intervention guidelines under its belt, NICE really has got something to celebrate this Christmas.

It is also pleasing to see a central place for the dissemination of NICE work included in the guideline development process. The Head of Dissemination and former Director of Guideline Commissioning Gillian Leng will take questions covering a number of key dissemination issues including the expansion of NICE into the regions. Measuring the effectiveness of NICE guidance and its impact on the NHS will be central to the talks this year.

But has NICE done anything to help reduce the postcode lottery of care - one of the key reasons for its formation? If you watched this weeks ‘Dispatches’ (Channel 4, Monday 27 November, 8pm) then the answer would clearly be no. It would appear that two people living in the same area but getting their healthcare services provided by a different PCT, will still be able to access different services. This all sounds well and good – local services for local people. But is this right for everyone and does this enhance the concept of a National Health Service?

Dispatches highlighted the case of two women, practically neighbours, both with the same disease and both receiving different treatments despite clear guidance from NICE. An isolated incident? Not according to the media as similar cases are reported almost every day.

There appears to be a complete paradox; NICE was established to ensure that the postcode lottery of care became a thing of the past; everyone should be able to get the most effective treatment regardless of where they live. Yet at the same time there is a drive to develop locally commissioned services which are decided, theoretically, by local people. As a result some NHS patients will be denied life saving drugs despite NICE recommendations that they should be given. This is not due to any clinical rationale; it is purely because of where they live.

Those in Whitehall, sharing the same building but working in different departments, clearly have differing visions of how healthcare should be provided, however someone forgot to tell NICE. Either NICE has a job to do or it doesn’t. Each piece of NICE guidance costs hundreds of thousands of pounds to produce, calling on the time and expertise of key specialists in the field.

If we still have the situation where your postcode determines treatment and not robust clinical guidance, then what precisely is the point of NICE?


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