NHS drug decisions ‘are flawed’

Researchers claim NHS drug decisions ‘are flawed’

NICE decides which drugs are least expensive at the NHS

The formula utilized by the NHS to recommend which drugs need to be funded is “flawed” and will be scrapped, researchers say.

The European Commission-funded study tested the assumptions of the system utilized by NICE (the National Institute for Health and Clinical Excellence).

Researchers concluded the watchdog’s system failed

to reflect variations in views on illness and disability.

NICE called the study “limited” and said the measure it used was the appropriate.

NICE uses a way called quality-adjusted life years (QALY) for assessing the price of latest drugs in England and Wales. an analogous system is utilized by the Scottish Medicines Consortium (SMC).

The formula looks on the cost of using a drug for a year and weighs it against how much someone’s life could be extended and improved. Generally if a treatment costs greater than £20,000-30,000 per QALY, it might not be recommended as cost-effective by NICE.

The European Consortium in Healthcare Outcomes (ECHOUTCOME) researchers will present their findings at a conference in Brussels on Friday.

Their work has already prompted a backlash by UK-based experts, who defended the present system for making decisions.

The researchers analysed an in depth questionnaire with greater than 1,300 respondents – including 301 within the UK.

Their findings criticised the QALY system for grading different states of health. The researchers said people varied of their views in regards to the impact of alternative levels of illness or disability, and of their way to risk.

They also found that people’s willingness to sacrifice remaining years of life a good way to have better health varied enormously over different periods of time.

The researchers said 71% of the respondents would like to live 15 years in a wheelchair than die after 10 or five years in a wheelchair – however the remaining 29% said they might like to die earlier as opposed to spend 15 years in a wheelchair.

The project leader, Ariel Beresniak, a French doctor and economist who used to work within the drug industry, said: “Important decisions are being made at the basis of QALY, however it produces the inaccurate results.

“This is not a systematic thanks to classify and prioritise the medicine – mathematically, it’s flawed.

“We predict it’s time to open this debate, particularly as one of the vital newer European countries try to organise their health assessment systems and may be considering QALY.

“NICE has made negative recommendations about many major innovative drugs, based only on arbitrary incremental cost per QALY.

“Agencies equivalent to NICE should abandon QALY in favour of different approaches.”

Cost-benefit approach

A similar method is utilized by Canada and Australia for assessing new treatments.

The researchers suggest instead using a value-benefit approach – equivalent to what number cases of remission a drug may give, or what percentage relapses it could prevent.

A NICE representative said: “We have to use a measure that may be applied fairly across all diseases and prerequisites. The QALY is the precise measure anyone has yet devised to enable us to do that.

“It’s developing and improving at all times and the criticisms on this rather limited study haven’t shaken our confidence in its value to NICE in helping make decisions at the best technique to use new and often very expensive drugs and other health technologies.”

John Cairns, professor of health economics on the London School of Hygiene and Tropical Medicine and a member of the NICE’s appraisal committee for 10 years, said: “QALYs are by no means perfect and we should always be searching for better ways of informing decision making.

“But eliminating a less than perfect system without replacing it with a closer one isn’t the way forward.”

Dr Andrew Walker, an economist on the University of Glasgow, with 10 years’ experience of reviewing new medicines on the SMC, said: “i’m amazed it has taken these authors three years and a million euros to determine what we already know, that QALYs aren’t perfect.

“Anyone who makes decisions using QALYs and who cannot think about at the very least three issues with them shouldn’t be thinking hard enough.

“In its place they propose cost per remission in arthritis, but I ask them to inform me how they define remission, how long remission lasts and what kind of we’re willing to pay for one remission.

“If we wish to spend more on cancer medicines, it has to return from somewhere. The researchers speak as if there have been no budget limits.”

Patients face specialist ops wait

Patients in Wales face cross-border specialist ops wait

Under targets in Wales, only 5% of patients should spend greater than 26 weeks on a waiting list

Hospitals in England providing specialist look after Welsh patients was told to delay some operations.

BBC Wales can reveal that health managers have threatened to not pay English trusts in the event that they treat patients too quickly.

As component to a drive to save cash, hospitals had been told to delay some operations, including heart surgery, until the top of March.

The Welsh government said all patients must be treated within set times.

The demand is available in a letter to the bosses of health trusts in England from the Welsh Health Specialised Services Committee (WHSSC), the body liable for planning and commissioning specialised health services on behalf of Welsh health boards.

BBC Wales has obtained a duplicate of the letter which instructs English hospitals to not treat Welsh patients as quickly as they currently do until the top of the financial year.

They also are told to just undertake scheduled procedures if there’s a risk that patients should wait longer than 26 weeks.

Under Welsh government targets, only 5% of patients should spend greater than 26 weeks on a waiting list.

But waiting time performance for Welsh patients being treated in England is usually sooner than the 26-week target. The NHS in England has a waiting time target of 18 weeks.

In the letter, WHSSC says it’s implementing new controls to be able to stay within “available resources”.

“That allows you to ensure equity for Welsh patients we require that each one providers to deliver activity both according to the Welsh waiting times and inside the available resources,” it said.

“Routine elective (scheduled) activity between 17th of January 2013 and 31st of March 2013 should only be undertaken whether it is required to prevent breaching the 26-week target.”

The letter says that if cases are considered “clinically urgent” then English hospitals would have to obtain “prior approval” from WHSSC before proceeding with treatment.

It adds: “This can be a significant initiative for NHS Wales and therefore failure to conform with the above will end in non-payment.”

BBC Wales understands that the verdict will affect quite a lot of operations for Welsh patients undertaken by English hospitals. These could include heart surgery, neurosurgery and cosmetic surgery.

A senior doctor from the north west of britain, who didn’t want to be named, said the verdict could put patients at increased risk.

“i will be prevented from operating on patients that i’d otherwise have operated on,” he said.

“Some patients get further problems and infrequently die while on waiting lists… so there’s always a risk if they’re waiting longer for an operation.”

Conservative health spokesman Darren Millar called on Health Minister Lesley Griffiths to behave.

“This recommendation is absolutely unacceptable and grossly unfair,” said Mr Millar. “Any instruction which puts the health of Welsh patients at the backburner is unjust and will be stopped immediately.

“There isn’t a the reason is, Welsh patients spoke of a hospital over the border could be forced to stay in pain and discomfort at the whim of this committee and that i urge the minister to take decisive action to overrule this recommendation.”

The Welsh government says its position is that every one patients must be treated within set waiting times.

A Welsh government spokesperson said: “The Welsh government expectations are unchanged – that each one patients are to be seen within our waiting time target and so as of clinical importance.

“The minister requires all health boards and WHSSC to work in this basis.”

Marcus Longley, director of the Welsh Institute for Health and Social Care on the University of Glamorgan, said: “People find it offensive with the health system seems to be putting money in front of clinical considerations.

“This is a high profile issue and emotive however it is fair to indicate that the numbers involved are very small,” he told BBC Radio Wales.

A WHSSC spokesperson said: “To confirm equity for all Welsh patients, action was taken to align all elective take care of specialised services that is delivered in England with Welsh waiting times standards.

“Providers of this care have also been informed that if there’s any uncertainty in regards to the urgency of treatment to contact the Welsh Health Specialised Services Committee to acquire prior approval.

Financial pressures

“This affects all inpatient and outpatient appointments for specialized services which can be provided by English organisations.”

The instruction from WHSSC follows moves by Powys Health Board last year to delay treatment for its patients at hospitals around the border.

At the top of November, BBC Wales revealed that Powys Health Board had told English health trusts it might only pay for operations for the county’s patients once they had waited between 32 and 36 weeks.

The health board insisted nobody could be at greater risk due to the decision.

Plaid Cymru health spokeswoman Elin Jones said it was a “worrying revelation”.

“It shows how the Welsh government’s failure to become familiar with NHS finances is affecting patients,” she said.

“Most worryingly, it reveals that cancelling scheduled treatment is seen as a simple option for cutting costs by the Welsh government. We desperately desire a new method to the NHS in Wales.”

Welsh Liberal Democrat leader Kirsty Williams said: “The Welsh Labour government only sees statistics and waiting times, they do not see the folks suffering behind those statistics.

“i’m really concerned that cash saving ‘initiatives’ like this are happening all around the Welsh NHS to the detriment of Welsh patients.”

All seven health boards in Wales are facing big financial pressures. In November the Wales Audit Office predicted health boards were more likely to be £70m in deficit by the tip of the financial year in March.

Later, Ms Griffiths announced £82m will be provided from the Welsh government to ease the pressure facing the NHS around the country.

The minister fiercely denied suggestions that the cash amounted to a bail out.

Merge NHS and social care – Labour

Merge NHS and social care, says Labour

NHS and social care are entirely separate on the moment

The NHS and social care budgets in England may be combined to create an excellent pot to satisfy the desires of the ageing population, Labour says.

The money – worth £119bn this year – may well be used to offer more joined-up care around the hospital, mental health and care sectors, the party believes.

In a speech on Thursday, shadow health secretary Andy Burnham will say the present arrangements are outdated.

He will claim “dangerous” gaps between services put the vulnerable in danger.

The proposal could see councils get far more fascinated about making decisions concerning the NHS, while the most important hospitals may result expanding into the community, maybe even running care homes.

But government sources suggested this sort of move could emerge as undermining clinical commissioning groups – the recent bodies that are taking control of the health budget under the govt. reforms.

That would mean “taking power faraway from doctors and nurses”, they said.

Combining the budgets may also require changes to the best way money is sent around the system.

And it’d raise an issue mark over the means testing of social care.

Currently people with assets over £23,250 must pay for help, but how that may be enforced in a combined system is unclear.


But Mr Burnham will deny the plan is any kind of reorganisation when he addresses an audience of health professionals in London.

He will dub the proposal, that is being put out to consultation, as “whole-person care”.

“As we are living longer, people’s needs become a blur of physical, mental and social.

“It is only impossible to disaggregate them and meet them through our three separate services.

“But that is what we’re still seeking to do.”

He will say that hospices are vulnerable to becoming “warehouses” for the elderly as social care support is being reduce.

“We’re deciding to buy failure on a grand scale, allowing people to fail at home and drift into expensive hospital beds and from there into expensive care homes.

“The hassle isn’t any-one has the motivation to take a position in prevention.”

Mike Farrar, chief executive of the NHS Confederation, which represents health managers, said: “Mr Burnham is actually right to spotlight the long-term pressures facing the NHS and the will for radical change to deal with them.

“A cocktail of monetary pressure and demographic change suggests that the NHS should adapt to fulfill the wishes of today’s patients.

“We urgently need an all-party debate about these issues, with radical solutions a great deal allowed. The NHS will judge the plans of all politicians on how they assist the service tackle these massive problems.”

Cancer fear raised over horsemeat

Horsemeat cancer fears raised by Labour

Mary Creagh says she has evidence that horses slaughtered in UK abattoirs tested positive for bute

A drug which can potentially cause cancer in humans will have entered the food chain via horses slaughtered in UK abattoirs, Labour claims.

Shadow environment secretary Mary Creagh said “several” UK-slaughtered horses had tested positive for the carcinogen phenylbutazone.

Agriculture minister David Heath said all meat was checked to make certain it was safe to eat.

The news comes after horse and pig DNA was recently present in some burgers.

Some of those were sold in Tesco, Iceland, Lidl and Aldi and Dunnes. Tesco took out adverts in British newspapers apologising for the problem.

There is not any suggestion that these burgers contained phenylbutazone.

‘Right to know’

Phenylbutazone is an anti-inflammatory drug that’s given to horses for the treatment of lameness, pain and fever.

It is banned from entering the human food chain inside the EU and horses which have been administered the drug must have the guidelines recorded on their passport.

But Labour claim the issuing of horse passports within the UK is fragmented, as there are 75 approved issuing organisations within the UK, and not using a national database to trace the info.

Ms Creagh told Mr Heath within the Commons: “i’m in receipt of evidence showing that several horses slaughtered in UK abattoirs last year tested positive for phenylbutazone, or bute, a drug which causes cancer in humans and is banned from the human food chain.

“It’s far possible that those animals entered the human food chain.”

When she asked if Mr Heath was acquainted with the cases, the minister replied: “The Food Standards Agency perform checks in slaughterhouses with the intention that equine animals presented for slaughter are edible inside the same way as they do for cattle, sheep and other animals.

“Additionally, the FSA perform subsequent testing for phenylbutazone and other veterinary medicines in meat from horses slaughtered during this country.

“Where positive results for phenylbutazone are found, the FSA investigates and takes follow-up action to track the beef.”

‘Very serious’

Ms Creagh then asked if that meant Mr Heath was aware about the problem.

“I’m astonished that you’ve got not raised this and that i think the general public have a right to grasp,” she said.

She also said the inside track was a “very serious development” and demanded action in order for “illegal and carcinogenic horsemeat stops entering the human food chain”.

And she called at the government to reverse a “reckless” decision to finish the National Equine Database.

But Mr Heath replied: “There isn’t any difficulty in tracing using a horse passport. To indicate the National Equine Database was required to do this is solely erroneous.”

Female smoking risk ‘has soared’

Female smoking death risk ‘has soared’

Women smoking nowadays are rather more more likely to die thanks to their habit than they were within the 1960s, in line with a brand new study.

Changing habits reminiscent of starting earlier and smoking more cigarettes had been blamed on dramatically increased risks of lung cancer.

The trends, reported within the New England Journal of medication, show death rates in women have caught up with men.

The study checked out data from greater than two million women inside the US.

The first generation of ladies smokers started in the course of the 1950s and 60s. In those early years, women who smoked were nearly thrice likely to die from lung cancer as individuals who had never smoked.

Looking at medical records from women between 2000-2010 showed they were 25 times likely to die from lung cancer than their non-smoking friends.

It follows an identical pattern in men, who reached an analogous level inside the 1980s.

Lead researcher Dr Michael Thun said: “The steep increase in risk among female smokers has continued for many years after the intense health risks from smoking were well established, and nevertheless women predominantly smoked cigarette brands marketed as lower in ‘tar’ and nicotine.

“So not just did using cigarette brands marketed as ‘Light’ and ‘Mild’ fail to stop a giant increase in risk in women, it also can have exacerbated the rise in deaths from chronic obstructive lung disease in male smokers, because the diluted smoke from these cigarettes is inhaled more deeply into the lungs of smokers to preserve the accustomed absorption of nicotine.”

Research published last year suggested that lifelong female smokers died a decade sooner than folks that never started.

However, people who gave up by the age of 30 almost completely avoided the dangers of dying early from tobacco-related diseases with those stopping by 40 died a year younger.

Speaking after that study, Prof Sir Richard Peto, at Oxford University, said “If women smoke like men, they die like men.”

Antibiotic ‘apocalypse’ warning

Antibiotic ‘apocalypse’ warning

Drug resistance is a controversy in tuberculosis

The rise in drug resistant infections is analogous to the specter of global warming, in response to the manager medical officer for England.

Prof Dame Sally Davies said bacteria were becoming proof against current drugs and there have been few antibiotics to switch them.

She told a committee of MPs that going for a routine operation could become deadly as a result of threat of infection.

Experts said it was an international problem and needed way more attention.

Prof Davies said: “It’s clear that we’d never see global warming, the apocalyptic scenario is that once i want a brand new hip in twenty years I’ll die from a routine infection because we’ve run out of antibiotics.”

She said there has been just one useful antibiotic left to regard gonorrhoea and drug resistance was a gigantic problem in tuberculosis.

“It’s very serious, and it’s totally serious because we’re not using our antibiotics effectively in countries.

“There’s a broken market model for making new antibiotics, so it’s an empty pipeline, in order they become resistant, these bugs, which they might naturally but we’re breeding them in due to the way antibiotics are used, there’ll not be new antibiotics to return.”

Possible solutions shall be included in her annual report back to be published in March.

Prof Hugh Pennington, a microbiologist from the University of Aberdeen, said drug resistance was “a completely, very significant issue”.

“We do must pay far more attention to it. We want resources for surveillance, resources to deal with the issue and to get public information across.

But he said it was not a difficulty entirely of the UK’s making.

“Individuals are going abroad for operations, going abroad for, as an instance, sex tourism and bringing home gonorrhoea that is a giant problem with regards to antibiotic resistance – after which there’s tuberculosis in lots of parts of the realm.

Prof Pennington said the medicine companies had run out of options too as the complete easy drugs have been made.

“We need to notice that we’re not going to have new wonder drugs coming along because there just are no.”

Monday mornings are A&E ‘rush hour’

Monday mornings are A&E ‘rush hour’

Monday morning was the busiest time of the week

The busiest time in accident and emergency departments in England is Monday morning, hospital data shows.

There are 4,000 cases every hour between 10am and noon on Monday – twice the common.

Late morning was the busiest time of day within the week but Monday came out on top, figures from the Health and Social Care Information Centre show.

There were 17.6 million A&E visits in 2011-12, up from 16.2 million inside the previous year.

The chief executive of the Health and Social Care Information Centre, Tim Straughan, said: “It can be well-known after all that accident and emergency departments are very busy places.

“The undeniable fact that A&E services in England on average see twice the common collection of new cases coming in the course of the door collectively on a standard Monday morning indicates just how much society depends upon these front line services.”