There was a discussion about NICE, the National Institute for Clinical Excellence, who decide whether medicines should be licenced for prescription in the UK, based on a cost-per-years-of-life-gained basis. These are the people who decide whether you should get expensive cancer treatments, among other things.
Do they do a good job? I don't know whether they do the best job they could do - I don't have any experience of their work. I think they do a very difficult job...
Billy Bragg argued that what they do is fundamentally wrong - that you cannot put a value on life, that the NHS was set up to fund treatment, and that if you can't fund the treatment people need, you have your priorities wrong and should put more money into the NHS, presumably until you can. He said that if treatment cost £100,000,000 (yes, really, a hundred million) for an extra year, it should be provided.
That's a nice thought to have. But not feasible. We don't have an endless amount of money to spend on the NHS. And there is a near-infinite amount of money required to treat every illness.
NICE is about resource allocation and opportunity cost. If you spend money on one medicine, it isn't just about the cost of that medicine, it's about what you are giving up in order to provide that medicine.
And health goes so much further than just medicine. That £100,000,000 pounds could be spent, for example, to build more houses. Into those houses could go families currently living in overcrowded accommodation, which are damp due to the overcrowding and which make the children ill due to the damp.
No-one is going to stand by and choose to die when they know there's a medicine out there which can help them to live. People are going to fight for the treatment which will keep the people they love alive for longer. Once it's you it's emotive. That's why we need an organisation like NICE to make those decisions rationally. Let's have a discussion about how they do that and the values they apply to make their decisions. But let's not claim that it's wrong to make those decisions.
8 comments:
Thank you. You are correct. ANyone who says just put more money in is not looking at the facts. Because it isn't £100 million. It is bottmoless. There will always be another medicine, another person needing treatment. So it can only come to value for money. Can I treat 1000 people or 1 person. And that is why the decisions have to be made by those who can be dispassionate and decided what is best for society, not what is best for the individual.
Perhaps if we all paid a little bit more in taxes there would be extra cash for expensive drugs... I would be up for this...
Unfortunately asking people to pay more taxes is a sure vote loser amongst the majority of voters (alas those that would happily pay more for a better system are a minority) - so it'll never happen.
What worries me is every time NICE makes a controversial decision a bunch of people start protesting and getting in the newspapers.. so they change their minds, and someone else suffers to pay for it. That's the worst of all systems because you just end up with only those who can shout loudest get the treatment.
It isn't as simple as all pay a bit more taxes. It doesn't matter how much we pay, there will always be more needed. Medicine keeps advancing. And in advancing it gets more and more expensive. When the NHS was set up we couldn't dream of treating, and curing, the conditions we can now. And there will always be another disease to cure. We haven't even started scratching the surface of cancer. Then there are all the age related diseases, as we live longer we get more of those. There is no point where "x" will be enough, because tomorrow it will be "x+1".
back in the dim dark and distant days of my undergrad degreee in social policy, when Ivan illich was considered modern (and I developed rather a penchant for some of his theories, particularly those in 'Medical Nemesis') I was quite keen on the idea of working in some form of healthcare rationing research (most likely working for the Kings fund at the time) but ended up going in other directions instead. It is a completely fascinating but impossible concept to grasp and I too was extraordinarily frustrated by Mr Bragg on any questions. he just didn't seem to get it at all and was making a mockery of the whole arguement.
Now as a solicitor instead I am trying to run a legal arguement as to why the NHS should fund laser treatment for a young, so*mali woman who has very widespread vitiligo lesions *check it out in google. Its not life threatening at all,but the impact of being very dark black skinned, of So8ali Muslim origin, and having prmounced eurasian white patches across her while body, face, hands etc is immense. The NHS say it is too expensive and a waste of resources. I do firmly beleive they are wrong. I SO badly do not want to be the person who decides, but nor do i want to be the person who tells her we lost the argument.
It can never work out for everyone, but next time i reach burn out with work i would very much like to stray back into that field and maybe do a phd in the legal aspects/ ethics of healthcare rationing.
x Caroline
I think it does get more complicated when getting into the realm of treating/helping/supporting non-British people. My current research* is into A8 migrant workers and social housing and I've been reflecting on Margaret Hodge's comments on migrants and social housing - she asked whether economic migrants should expect to be get social housing.
My cop-out answer is they have a right to be here and they have a right to social housing so they have to be allowed it. But... it does raise bigger questions. For the record, I don't think migrant workers are a drain on public funds - at the moment they put in more than they take out. But how far do we go in spending British taxes on people who are not British? What's the rationale? I think we should help people who are less fortunate than us but there is a whole world of less fortunate people. Is there a point at which we say 'enough'?
*Ok, it's an essay...
argh good luck with essay! somewhat strangely in my five years with our firm we have not had a single A8 client for benefits or housing. I think the local communities are very strong and have their own very well organise advice and assistance network but it does seem odd. Admittedly we don't 'go out advertsing' ourselves to A8 nationals, but then we don't advertise to anyone! For our main client group who are EU nationals the restrictions in access to social housing seem utterly draconian (no right to reside - effectively 'no work', no housing), but even this card carrying socialist, anti national boundaries do-gooder can't help but somethimes think, the 'city council aren't going to house you, and why should they? you've told me your story and it's clear that you chose to leave Holland where you had a job and a house, it may not have been great, but hey, you can go back....the kids who grew up here need what's left of the obscenely depleted social housing stock more than you and your six children do if you can't work to provide for them because you're a lone parent. If you go to the social services to say you're homeless, they will offer to pay for you and your children to go back to holland, and you know, I think they are right to do so.'
and I never truely know whether to hate myself or not.
xcaroline
From what I can tell, A8 migrants are eligible for social housing once they've been in continuous employment for a year. But even then they're not necessarily going to get anything as there's such a shortage.
I think it is really important to distinguish between economic migrants who have chosen to come here and refugees who have little or no choice.
Occasionally when I look at the thoughts passing through my head I wonder whether I should hate myself too. I feel in good company now :)
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