First the good bits!
The standard of care and treatment in the NHS is the envy of most countries
with good reason. It would be difficult to find a more skilled, dedicated and
professional work force in any institution worldwide. They obviously suffer
from the normal cash shortage that any health institution is bedevilled with,
but then, health care is a bottomless pit into which any amount of money can be
poured. All in all the staff do an excellent job, and the NHS itself is good
value for taxpayers money.
Now the not-so-good!
Despite employing some of the best specialists worldwide in the treatment of
Hepatitis C, the powers-that-be then proceed to stifle all the available
expertise by dictating to the professionals exactly how, when, and with which
medication every patient will be treated. The standard treatment is dictated
to the professionals by NICE, the National Institute for Clinical Excellence.
The professionals are allowed no room for experimentation whatsoever, and their
ability to customise treatment for a particular patient is extremely limited.
If your condition falls within the NICE guidelines you will be treated in
exactly the way the guidelines say. There are no other options. The good
part of this is that patients falling inside the guidelines are guaranteed
treatment, and the treatment will
be to the official standard and represent good value for money to the NHS.
The bad bit is that if you are outside the guidelines, or if your particular
case requires different treatment you could be in trouble. There are mechanisms
which allow treatment variations, but they are rarely used as they require
individual documentation and justification for each patient.
The net result of all this is that there is virtually no experimental treatment of Hepatitis C carried out in the UK. Formal trials are virtually impossible to fund unless a drug company chooses to do so, and they are few as the drug companies treat the UK as a small market, and know that even if their trial is successful, they will still have to battle with NICE to get it accepted. There will be virtually no funding available for experimentation with different combinations of existing drugs or different doses. We are not moving forward in our treatment of Hepatitis C whatsoever. Any patient who has been through the normal course of treatment without success has nowhere left to go. NICE does not allow any further treatment.
I propose the following:-
NICE to set up a Treatment Review Body for Hepatitis C consisting of no more
than three experts nominated by NICE.
This review body would be empowered to sanction
variations in standard treatment on a case by case or 'small group of patients'
basis, and would recommend
changes to NICE guidelines if it considered them appropriate. The review body
would be expected to respond within two working days of any application for
treatment variation. This would allow some variation in treatment in difficult
cases, but would keep costs strictly under control.
The same review body would also be able to sanction small scale trials of
variations on existing treatment if a proper case was made for them, and the
review body was convinced that such work was sufficiently different to that
already carried out elsewhere.
The Government to allow, subject to approval by NICE, double the full cost of
any Stage 3 drug trial carried out in the UK by a drug company to be offset
against taxation of profits earned in this country. This subject to the
condition that the intended use of the drug is to treat serious or
life-threatening conditions. This would vastly speed up the process of testing
and approval of drugs as the UK would become a viable proving ground.