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Stephen  Bevan

New remit for NICE offers hope for workers with chronic ill-health

Authors: Stephen Bevan Steve Bevan

25 June 2013

The Work Foundation has been warning for a while that the burden of chronic ill-health in the working age population threatens both long-term competitiveness and productivity of the UK workforce. We have identified some of the policy barriers to dealing with this problem. One is that the new Clinical Commissioning Groups (CCGs) – the consortia of GPs which now control the majority of NHS spending – are not required to consider work outcomes for patients in the treatment they recommend or commission. The Work Foundation’s submission to the Health Select Committee summarises the core arguments. Another barrier is slightly more technical but no less significant. Health Technology Assessment (HTA) is a process that informs decisions on allocation of spending on medical devices, drugs and other interventions across health care systems. HTA is now widely practiced around the world, however, the approach taken, and the influence of HTA within policy-making differs both across and within countries.

In the UK, the National Institute for Health and Clinical Excellence (NICE) is the agency which conducts evidence-based evaluations of clinical interventions and is assesses the cost-effectiveness of new treatments or devices to establish whether they represent value for money for the NHS and for the taxpayer. NICE is highly regarded internationally and has a well-deserved reputation for excellence and rigor. However, it has been given a limited remit when it comes to assessing whether spending money on a new treatment or medical device will have an impact of a patient’s ability to continue working (and paying tax). Through our Fit for Work projects, we have been concerned to urge a rethink of the ‘perspective’ which NICE is allowed to take in making recommendations on cost-effectiveness, especially if it means that patients who could continue to work are denied access to treatments on the basis of this narrower remit.

We reviewed international practice in this area in a discussion paper a few months ago, and presented our arguments at the prestigious Health Technology Assessment International conference in Seoul last week. We found that many gvernments across Europe and around the world aim to take this wider societal perspective – which includes consideration of the impact of a healthcare intervention on the patient’s ability to work and the wider economic effects of improved productivity and reduced welfare costs. By contrast, England has tended to take a health care system perspective is taken – covering only those costs and benefits of immediate relevance to the NHS.

There are some ethical concerns about widening the remit which NICE is given by government. For example, if the ‘productive capacity’ of patients were to be considered when considering whether they should be given a new drug, a hip replacement or an insulin pump, does this mean that a young child or an elderly person might be denied treatment because they are not part of the working age population? These are genuine issues where safeguards are needed, yet we still feel that change would be more broadly beneficial.

Following an announcement last week, the government has finally asked NICE to go beyond this traditional healthcare system perspective to take more of a societal perspective. As Health Minister Lord Howe said:

“We cannot simply spend more and more on drugs – this would mean spending less and less elsewhere. That’s why we have asked NICE to look at the impact that drugs can have on people’s ability to work or contribute to the economy and society. A drug that brings a lot of extra benefits may justify the NHS paying more, but equally the NHS might pay less for a drug that does not deliver wider benefits.”

While the precise details of the methods which NICE will use to broaden the perspective it takes, we welcome this change as it now opens up the possibility that work might more routinely regarded as a clinical outcome of treatment for patients who wish to work and for whom staying in work might also have therapeutic benefits.