Editor's blog 18th August - Rawlins and Dillon show attack is the best form of defence

While blogging last night, I didn't yet know that NICE chair Professor Sir Michael Rawlins would be writing a piece for the Health Service Journal website today, and merely went from what was in The Observer's interview / feature.

Nor had I then seen NICE chief executive Andrew Dillon's comments to BBC's Panorama, trailled in today's Independent.

The best form of defence
These two have clearly decided that the best form of defence is to attack. With charateristic dry wit but some considerable anger, Rawlins points out in his HSJ piece that oncologist Johnathan Waxman's intervention in The Times and the Daily Mail last week contained a plethora of factual inaccuracies.

Rawlins writes that "NICE has assessed 56 cancer drugs since 1999 and not the 407 that he alleged ... contrary to his claim, ... no NICE guidance has ever been "overruled by ministers". And his allegation that much guidance has been "stomped on by judicial review" is equally wide of the mark".

Meanwhile, Dillon has rightly pointed out that a postcode lottery in healthcare remains - and it is the responsibility not of NICE, but of primary care trusts, whose interpretations and implementation of NICE guidance differs widely.

Tonight, BBC1's Panorama has the magnificently naff title 'The NHS postcode lottery: it could be you'. Practically the whole of the programme's content is given away on the above web page.

At just 30 minutes, Panorama is a bit of a sad remain of a once-great investigative TV programme.  While the subject is of course topical thanks to all the recent silly season debate, it looks likely that this will shed much heat but little enlightenment onto the vexed issue of health inequalities in access to care and of equity in the modern NHS.

It might even be as bad as the BBC's previous Gerry Robinson programmes.

RIP equity?
Dillon's point about PCT's varying willingness and / or ability to fund NICE-approved therapies is at the heart of the Darzi review's constitutional right for patients to have NICE-approved treatments.

However, the Darzi review's announcements that PCTs must fund NICE-approved drugs without undue delay (now defined as three months), and mustn’t refuse to fund a drug because of the lack of a NICE appraisal were already, in theory, national policy.

However, this was a national policy that people just didn't follow if they didn't want to and thought they could get away with doing so.

The more substantial point is that we should not be bounced into a top-up insurance scheme for drugs of slight utility and high cost by PR default.

Equally, we now need to think hard about what equity means in an NHS which is reconsidering its traditional funding allocation formulae, in a society whose economy is clearly slowing, and in a context of commissioning being at the centre of the policy world (class).

Some PCTs and PBC consortia are going to be better commissioners than others, or to buy better commissioning support than others. That will increase health inequalities. The BBC and national press will not notice this very fast, but answers will be needed when they do.