I often write guidance. I often read guidance. But sometimes I’m shocked on the waste of NHS money to provide guidance that is neither required or palatably to the reader. Today is that day!
So the CCG has written guidance – ‘on the cost-effective use’ of medicines approved by NICE within TAGs. 14 pages with flow diagrams sent for consultation throughout the area and updated and reviewed several times. Must have cost tens of thousands of pounds to produce a guideline that the NHS has been expressly told not to produce.
NICE is the organisation that judges whether a medicine is cost-effective. The NHS should introduce all NICE recommended medicines ‘without further assessment’. Put the guidance in your formulary within 3 months and publish on-line. Make the money available to ‘fund and resource’ the implementation of the guidance within three months. Do not introduce ‘barriers’ to uptake and ensure existing barriers are overcome. Monitor uptake in line with the NICE costing template. Surely this is simple enough.
But obviously not. CCGs and CSUs continue to commission further reviews of NICE TAGs at considerable expense. They make recommendations that are clearly not in line with the NICE TAG and does not contain NICE wording. It is shocking that they can also make false claims and cherry pick data. They think that they can get away by saying at the end – ultimately it is the choice of the clinician and the patient – followed in bolt type with – we recommend xxxx over the NICE recommended medicines. So it is the responsibility of the clinician to do the right thing and it will be the clinician in the dock if something goes wrong.
They fail to reference the NHS constitution which talks about patient’s rights to access NICE approved medicines if the clinician and the patient agree it is the right choice for them. But they go right ahead and suggest that clinicians should only offer a single medicine.
The guidelines clearly state that I the patient appear to be well controlled on their existing treatment then the clinician ‘must not consider’ a NICE recommended treatment even though it may be clinically advantageous to the patient or the patient asks about it. That hardly sounds in line with the spirit of openness, transparency and the NHS Constitution.
There are other phrases that I just find insulting and condescending. Whoever uses the phrase ‘wilful non-compliance’ these days – what are they suggesting? Also ‘genuine needle phobia’, suggesting that some needle phobia is not genuine enough. And ‘genuine allergy’ – so what is the definition here. Oh and you need to have a ‘disability that causes difficulty in communication’ – so another judgement on an appropriate level of provable disability. What is the point of inserting the words wilful and genuine in these sentences?
Yes I know –patients will feign non-compliance, needle phobia, allergy and disability just to get access to an appropriate NICE recommended medicine in line with their legal rights under the NHS constitution. Why can’t they just ask?
What I can’t understand are the people who have been involved in the process – Consultants, GPs, Pharmacists, Commissioners, Managers and Patients. Not one of them have stood up and said ‘we should not be doing this’ or ‘don’t you think it is a little insulting to patients’ or shouldn’t we be supporting NICE and the NHS Constitution’. Even just shouldn’t we be open and transparent and explain why we are doing this to our population.
You should be ashamed of this guidance!
And NHS England should get off their butts and stamp it out.
Let’s support NICE and the NHS constitution and let’s trust well informed clinicians to do the right thing. Now there is a radical suggestion.