Professor Rawlins, the chairman of NICE said the economic pressure on trusts meant that “completely illegal” decisions were being made to limit the use of expensive drugs.

He told the Financial Times: “I just wish a patient organisation would take a Trust to court for failing to comply.”

Nice has been criticised for ruling against the prescription of expensive new drugs on the grounds that they are not cost-effective.

But Sir Michael told the paper that most of Nice’s recommendations were in favour of prescription and that it was other bodies that blocked the drugs’ use.

Sir Michael criticised the local lists of approved medicines drawn up across the NHS which “second-guess” and sometimes ignore Nice recommendations.

While patient groups for particular diseases – often helped by pharmaceutical companies – have attacked Nice for advising against the use of some expensive new medicines, Sir Michael said they should be directing more criticism instead to the drug companies for charging high prices.

The government’s own innovation review recognised the problem by pledging a Nice “compliance regime” to reduce regional variation – the so-called “postcode lottery” – and to improve adherence to the agency’s guidelines.

It cautioned that local decisions should not act as a barrier to the medicines that Nice had approved.

The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present.

Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.

“That gives real cause for concern and rings alarm bells” he said. “The Government simply can’t say: ‘This is all red tape and it all must be brushed away’”.

“Proper regulation, essential safeguards need to be in place when it comes to the use of patient data.”

The move, which will give life science companies more freedom to run clinical trials inside hospitals, is likely to face a backlash from privacy campaigners who have consistently opposed private companies being given access to medical records.

There will be particular opposition from animal rights activists who object vehemently, and sometimes violently, to vivisection, while religious groups, particularly the Roman Catholic Church, could object to firms that use stem cells harvested from embryos being allowed access to NHS data.

One senior executive at a leading drugs company well-known for using animal testing said: “You can look at the NHS as one massive database with 60 million people in it.”

The Prime Minister will stress that greater integration between private companies and the NHS could advance medical science, give patients greater access to cutting-edge treatments and save money, while boosting economic growth.

With Britain teetering on the brink of a double-dip recession, ministers are keen to show that they have a positive vision of the future.

“Britain has the potential to become a powerhouse in the world’s life sciences industry,” said a Downing Street source this weekend.

“We want to see much closer collaboration between the NHS and life science companies — not just greater data-sharing, but more clinical trials in hospitals.

“These changes will not only boost the industry, but also potentially give the NHS early access to new, innovative drugs treatments.”

Welcoming the move, Andrew Witty, the chief executive of GlaxoSmithKline, one of the world’s largest pharmaceutical companies, said: “Any action the Government takes to improve the environment in this country for life science across these activities is welcome.”

Britain is considered uniquely placed to become a world leader in life sciences because of the strength of scientific research at its top universities and the amount of data and expertise amassed by the NHS since its creation in 1948.

The industry already employs about 160,000 people in 4,500 companies, ranging from large multinationals to small businesses.

These firms employ highly skilled researchers with PhDs down to lower-skilled workers in drugs manufacturing plants.

Whether such companies would be charged for access to NHS records was not clear.

Although personal information should be anonymised, the public sector has an appauling history of handling the personal details of citizens.

Numerous health trusts have been criticised for losing patient records in recent years and HM Revenue & Customs has previously lost the financial records of millions of taxpayers.

Privacy campaigners led a vigorous campaign against the previous Labour government’s plans to place every medical record on a central electronic database.

It is understood that the Medicines and Healthcare Products Regulatory Agency would oversee the sharing of NHS data with businesses.

Joyce Robins, from Patient Concern, said many people would be “deeply disturbed” by the notion that their private medical records could be handed to firms seeking new markets.

“Even when they say records will be anonymised, the amount of detail contained in medical records means that companies may be able to find ways to target people with particular conditions,” she said.

“This data is absolutely private; it is not the Government’s to give.”

Health Direct has long warned that patients’ personal data security.

If the Government is genuine in their desire to speed up drug development- they ought to cut red tape.

10 years ago 10% of all new drugs developed in the world were tested in the UK. Since labour created the killer quango National Institute for Curbing Expenditure (NICE) this figure that fallen to only 3%.

Meanwhile in other parts of the country married couples are being denied help in starting a family, forcing them to spend thousands of pounds on private treatment.

It comes after a Labour nanny state law removed the requirement for fertility doctors to consider a child’s need to have a male role model before going ahead with IVF.

Critics say the Government, which David Cameron promised would be “the most family friendly we’ve ever had in this country”, should tackle the postcode lottery of IVF provision and ensure that the needs of children are put first.

Frank Field, the Labour MP who carried out a high-profile review into poverty and life chances last year, said: “It’s clearly wrong that while couples in stable relationships can’t get IVF and in other areas, single women can.

“It’s really important that Government ministers speak up for children who are the ones left out of this. It needs someone in a position of authority to reflect what most taxpayers think.”

The Rt Rev Michael Nazir-Ali, the former Bishop of Rochester who once chaired the ethics committee of Britain’s fertility watchdog, said: “The irony is that at the very time research is showing the need for both parents, we are writing fathers out of the legislation.

“It’s one thing for a mother to find herself a single parent because of tragic circumstances. It’s quite another to plan for a situation where the child comes into the world without having a father or any possibility of having a father.”

Most local health authorities stipulate that couples must have been in a relationship for two or three years to qualify for IVF treatment.

That requirement is based on guidance issued in 2004 by the National Institute for Curbing Expenditure (Nice), the NHS rationing body,.

It states: “Couples in which the woman is aged 23–39 years at the time of treatment and who have an identified cause for their fertility problems … or who have infertility of at least three years’ duration, should be offered up to three stimulated cycles of in vitro fertilisation treatment.”

The document does note that the guidelines do not address social criteria “for example, whether it is single women or same-sex couples who are seeking treatment”.

However the Human Fertilisation and Embryology Act 2008 removed the reference to “the need for a father” when considering the welfare of the child when considering fertility treatment, replacing it with “the need for supportive parenting”.

Gareth Johnson MP, who chairs the All Party Parliamentary Group on Infertility, said that trusts offering the service to single women were going against one of the guiding principles of IVF, “that you are treating an infertile couple, not an infertile individual”.

Mr Johnson, the Conservative MP for Dartford, said: “Speaking in a personal capacity, if you are going for IVF, you are trying to create a baby, so there should be some evidence of a stable background, which you would expect to be a couple.”

Earlier this year he led an APPG report that found startling differences between what health authorities offered in terms of IVF.

It found three-quarters of Primary Care Trusts were failing to offer three cycles of IVF, as stipulated by Nice. Each cycle comprises a woman’s ovaries being stimulated to produce eggs, which are then fertilised in vitro and implanted in the womb. Spare eggs should be frozen for use if the first attempt fails.

The report found five trusts offered no IVF at all – Warrington, West Sussex, Stockport, North Staffordshire and North Yorkshire and York. Since then, NHS West Sussex has decided to start funding IVF again.

Many trusts have also started putting in place further barriers to IVF funding – for example demanding obese women lose weight – in part to limit demand as health budgets tighten.

Against a background of increasingly scarce provision, as the NHS tries to save £20billion by 2015, Mr Johnson said the decision to offer IVF to single women was misplaced.

From: http://www.telegraph.co.uk/Single-women-being-offered-IVF-on-the-NHS

The drug, called ipilimumab, works by teaching the immune system how to tackle melanomas and was widely seen as an important advance on “old-fashioned” chemotherapy.

But in draft guidance NICE- the National Institute for Curbing Expenditure has recommended that NHS trusts do not prescribe the treatment, because it costs about £80,000 per patient and because it had doubts over the research data.

It means that unless the manufacturer cuts the price, the only way that the growing number of advanced melanoma sufferers can access the drug is by applying to the Government’s Cancer Drugs Fund.

The decision comes after a provocative academic report claimed that some expensive cancer drugs are “futile” as they cost a lot and cause toxic side-effects yet only give dying patients a few more weeks to live.

In a joint statement, the support group Factor 50 and charity SKCIN said: “The breakthrough that patients and clinicians throughout the UK have been waiting for has arrived in the form of this drug.”

“Standard treatments that have been available since the 1970s are ineffective and to deny this drug to patients, many of whom are young and with very young families, has undoubtedly handed them down a death sentence.”

“To have come so close to a breakthrough and to be told no at this stage is truly devastating.”

Dr Pippa Corrie, Consultant Medical Oncologist at Cambridge University Hospitals NHS Foundation Trust, added: “Licensing of this drug for use in the UK marked a step change in melanoma patient care, and whilst the Nice decision is predictable, it is disappointing.

“It is essential that we all work to avoid any negative impact on facilitating patient access to this drug. Our patients have waited too long already.”

Rates of skin cancer are rising faster than any other type of the disease in Britain and it affects teenagers and young adults more than any other group.

Almost 12,000 people now develop the most serious kind, malignant melanoma, every year and about 2,000 will die after it spreads across the body.

For the past 30 years the only treatment has been a type of chemotherapy called dacarbazine which is not seen as particularly effective and leaves patients tired and at greater risk of infection.

The new treatment, marketed by Bristol-Myers Squibb as Yervoy, is taken in just four injections, one every three weeks and is said to have fewer side-effects.

In a trial on patients who had undergone prior therapy for skin cancer, 46 per cent who took the new drug were still alive after a year compared with 25 per cent who had not taken it.

In addition, 24 per cent were still alive at two years compared with 14 per cent of those who did not take the drug, and the median survival was 10.1 months compared with 6.4 months among those who did not take it.

But Nice, which assesses whether or not new treatments should be widely available on the NHS in England and Wales, has recommended against its use.

Sir Andrew Dillon, its chief executive, said: “We need to be sure that new treatments provide sufficient benefits to patients to justify the significant cost the NHS is being asked to pay.”

He said the evidence showed that ipilimumab was only effective for a “small percentage” of patients, it was not clear how long its effects last, and that it was linked to “a number of adverse reactions”.

“The Committee considered all these factors and concluded that, on the basis of the evidence provided so far, ipilimumab could not be considered a cost-effective use of NHS resources.”

But he added that the decision is open to public consultation while the manufacturer can offer to cut the cost.

Amadou Diarra, European Vice President and General Manager at Bristol-Myers Squibb UK, said: “We are fully committed to demonstrating that Yervoy represents real value for money to the NHS, and we will be submitting further evidence the hope that Nice will reconsider this decision so that all patients with metastatic melanoma can access this potentially life-extending treatment.”

From: http://www.telegraph.co.uk/Death-sentence-as-NHS-watchdog-rejects-skin-cancer-drug

A drug that can give advanced prostate cancer sufferers an extra two months to live has been rejected by the NHS’s rationing body.

It said that although the drug did extend survival for patients with advanced prostate cancer, it was “concerned” about the side-effects experienced in clinical trials and that at an average cost of £22,000 per patient it was too expensive.

The move comes after an important study commissioned by The Lancet Oncology warned that the cost of cancer care is becoming unsustainable in developed countries, and that it makes no sense to keep giving “toxic” and costly drugs to patients with just a few weeks to live.

Sir Andrew Dillon, the chief executive of Nice, said: “The committee concluded that cabazitaxel would not be a cost effective use of limited NHS resources.”

But Owen Sharp, chief executive of the Prostate Cancer Charity, said: “Cabazitaxel is an important treatment, only recently licensed for use here in the UK, which can help to extend the lives of men in the final stages of prostate cancer for whom existing treatments have stopped working.

“These men currently have very few treatment options open to them when their cancer reaches this advanced stage. Increasing the number of treatments that may extend the lives of these men and allow them to spend precious time with their families is essential.”

Prostate cancer is the most common form of the disease among British men, with 37,000 cases diagnosed every year.

Some men live for years with slow-growing tumours, but in other cases it develops aggressively and kills after spreading to other organs.

Treatments often attempt to reduce the production of testosterone, a hormone that fuels the growth of the tumours, but patients can develop resistance to this type of therapy.

In clinical trials, men with advanced prostate cancer who were given cabazitaxel in combination with prednisone, a drug that suppresses the immune system, lived for an extra 10 weeks.

But Nice said there was “uncertainty” about the new drug’s effect on patients’ hearts and livers, and it did not meet its criteria for being considered as an end-of-life drug worthy of additional funding.

It means that anyone who hopes to obtain the new type of chemotherapy on the NHS must make an individual application through the Cancer Drugs Fund.

Nice is still assessing the value of a daily pill that can treat advanced prostate cancer, called abiraterone acetate, which is believed to have kept the Lockerbie bomber alive longer than expected.

From: http://www.telegraph.co.uk/NHS-rationing-body-rejects-prostate-cancer-drug

There was enormous excitement among Britain’s 100,000 MS sufferers in January when EU drugs regulators gave fingolimod preliminary marketing approval.

Novartis, which markets fingolimod under the brand name Gilenya, subsequently applied for it to be prescribed on the NHS in situations where existing drugs do not work.

To receive these drugs, called interferon therapy, patients either have to self-inject every few days or go to hospital for supervised infusions.

A trial, published last year in the New England Journal of Medicine, showed that fingolimod halved the number of disabling relapses compared with interferon beta.

However, the National Institute of Curbing Expenditure (Nice) has decided that – at £20,000 a year – fingolimod “would not be a cost effective use of NHS resources”.

Prof Carole Longson from Nice said: “Unfortunately our independent committee wasn’t given sufficient evidence to show that fingolimod could reduce relapses considerably better than the other treatments currently being used.”

MS charities last night said the decision was “disappointing”.

Simon Gillespie, chief executive of the MS Society, warned: “It will leave some people with no effective treatment option.”

He added: “Access to MS treatments in the UK is very poor – in fact people with MS would be better off living almost anywhere else in Europe, and this decision will only deepen that inequality.”

The German health service is already paying for 2,000 people to receive fingolimod for highly active relapsing-remitting MS (RRMS).

Fingolimod is an immumosuppressant and, while it is well tolerated by most patients, it does have side effects in some.

From: http://www.telegraph.co.uk/MS-pill-rejected-as-too-costly-by-Nice.html

It warned that many of the patients were young or middle aged and could require “substantial hospital care in a matter of years”.

Diabetes UK said the findings highlighted the need for urgent action.

All forms of diabetes result in raised blood sugar levels. If this is not controlled then it can cause serious damage.

The NHS Information Centre report confirmed that the number of cases of diabetes, especially Type 2, is increasing – particularly in deprived communities.

When it came to controlling blood sugar levels, around a third of more than 2 million patients had raised levels that placed them at risk of developing complications.

This was a greater problem for the under 55s.

Nearly 300,000 people were at “high risk” and 144,000 were at “dangerously high risk” in that age category.

The report also found nearly half of patients were not getting the appropriate checks.

The National Institute for Health and Clinical Excellence recommends patients with diabetes receive nine checks annually including: blood sugar levels, whether they are smoking, and an assessment of damage to the eyes or feet due to diabetes.

The study showed that only 53% of patients with Type 2 diabetes and 32% with Type 1 received all nine tests.

Dr Rowan Hillson, National Clinical Director for Diabetes, said: “I am very concerned that the National Diabetes Audit shows that we still have a long way to go in delivering basic standards of diabetes care for everyone.

“In particular, young and middle-aged people with diabetes are not getting the regular checks they need to manage their condition and improve outcomes.

“These checks are vital to reduce serious but avoidable complications. All health care professionals should follow NICE’s clear recommendations. There is no excuse for not doing the basics well.”

Barbara Young, Chief Executive at Diabetes UK, said: “This highlights the need for urgent action to ensure that people with diabetes start to receive all the basic care processes otherwise there will be more amputations, more people going blind, and more cases of kidney failure, heart disease and stroke.”

From: http://www.bbc.co.uk/news/health-13928359

Five of the trusts – Warrington, West Sussex, Stockport, North Yorkshire and York, and North Staffordshire – do not provide IVF on the NHS at all.

Most trusts restrict the number of free cycles to one or two, even where they offer them between the ages of 23 and 40. However, women living in Wales have to wait till they are 38 years and six months in many health trusts before qualifying for treatment and must quickly complete their two free allotted cycles – one less than the three recommended by Nice – by the time they are 40. Success rates for IVF decline sharply with age. For every 100 women treated aged 35 and below, 20 will get pregnant; between 36 and 38 around 15 will get pregnant; and at age 39 around 10 will get pregnant.

In 2004, Nice said couples should be given up to three cycles of IVF on the NHS, where the woman is aged 23 to 39.

But despite repeated government reminders, the guidelines have never been fully implemented across the NHS. The latest reminder was sent to trusts (PCTs) by the NHS deputy chief executive, David Florey, in January.

The All Party Parliamentary Group on Infertility sent Freedom of Information requests to all 177 PCTs in England and Wales in March and received 171 replies. Gareth Johnson, Tory MP for Dartford and chairman of the group, said the variation in the criteria showed the Nice guidelines had been “taken out of context and used to place arbitrary restrictions on the provision of IVF”.

He added: “IVF treatment was invented in Britain and so, more than any other country, we should be championing its use.”

Claret Lewis-Jones, chief executive of the patient group Infertility Network UK, said: “It is totally unacceptable that some PCTs are still failing to fund fertility treatment for patients despite the Nice Fertility Guidance issued in 2004. Some PCTs which do fund treatment are only providing one fresh cycle and failing to fund frozen embryo transfers, with many others implementing restrictive access criteria which means eligible patients are denied access to treatment which would be available if they lived elsewhere.”

Tony Rutherford, chairman of the British Fertility Society, said: “Infertility is a devastating condition which affects one in six couples in the UP. The World Health Organisation recognises infertility as a physical illness that requires treatment; however, it can also cause significant emotional and psychological harm to patients. By not being given fair access to fertility treatment on the NHS, patients are being denied the opportunity to start a family of their own.”

The Health minister, Anne Milton, said: “Many PCTs have made good progress towards implementing the Nice recommendations on the provision of IVF treatment. I am aware, however, that a small number of PCTs with historical funding problems have temporarily suspended provision of IVF services. I have already expressed my concerns about this approach and would encourage all PCTs to have regard to the current Nice guidance.”

Couples’ distress can be amplified when they find that a neighbouring town gives access to NHS treatment while theirs doesn’t – as an accident of geography. The unambiguous Nice guidelines were intended to solve that problem and restore the “national” to the National Health Service. But trusts have continued to ignore it.

As the parliamentary group’s report points out, IVF was pioneered in the UP – Professor Robert Edwards received the Nobel Prize for his work with infertile couples – but because of our parsimony and lack of vision we provide less of it than neighbouring countries. Moreover success rates have risen from 14 per cent live births in 1991 to 24 per cent in 2008, so investment in the treatment is delivering more babies for the bucks.

From: http://www.independent.co.uk/more-than-70-per-cent-of-nhs-trusts-break-rules-to-deny-ivf-ndash-and-save-money

While almost three times as many die from breast cancer, those diagnosed with ovarian cancer are far more likely to die earlier.

Figures published in The Lancet show that about 82 per cent of British women with breast cancer survive to at least five years after diagnosis. For ovarian cancer the figure is just 36 per cent. The key reason for the difference is late diagnosis.

Consequently, the National Institute for Curbing Expenditure (Nice) is publishing its first guidelines to help doctors identify and manage the disease.

These include checking the level of a blood protein called CA125, if a women tells her GP she has been persistently experiencing symptoms which could be ovarian cancer.

The test, which costs around £20, is already available on the NHS but offering it sooner could give women a greater chance of survival by speeding up diagnosis and treatment.

Dr Fergus Macbeth, director of Nice’s Centre for Clinical Practice, said older women were often misdiagnosed with irritable bowel syndrome (IBS) when they actually had early stage ovarian cancer. Other possible symptoms include feeling full quickly and the need to urinate urgently or quickly.

He said: “While the symptoms are nonspecific, their persistence can be an important indicator of the disease.”

Women who experienced them 12 or more times a month should see a doctor, the guidelines say.

Although the CA125 test is a useful indicator, they cautioned that it only picked up around 50 per cent of early stage ovarian cancers. Sometimes women with tumours had no raised level of the protein, while others with raised levels sometimes did not have ovarian cancer.

Frances Reid, of the charity Target Ovarian Cancer, said: “This guidance tackles for the first time critical issues facing women who develop ovarian cancer, and could save hundreds of lives. British women must no longer die from delayed diagnosis”, she said.

From: http://www.telegraph.co.uk/GPs-should-offer-20-ovarian-cancer-blood-test

The postnatal care pathway, for example, covers everything from the baby’s first 24 hours up until the first two – eight weeks after birth, providing an immediately accessible overview of all recommended care, as well as links to other products such as the Institute’s Quality Standards and implementation tools.

Launching the new tool at NICE’s 11th annual conference in Birmingham, Gillian Leng, the Institute’s deputy chief executive, said that 18 care pathways have already been completed and that the target is to have 60 on the site by the end of the year.

“NICE Pathways will provide a useful starting point for users new to a topic, while giving specialists confidence that they are up to date with everything NICE has recommended,” she said.

The move comes under a wider plan to improve the digital format of its guidance, which, in future, is likely to remain a crucial element of the new system of value-based pricing for new medicines planned by the government for 2014.

While NICE’s exact role going forward is yet to be defined, in his address to the conference health minister Earl Howe stressed that the Institute – which is to be re-established under primary legislation – will continue to provide independent advice to clinicians, and be a source of advice on cost effectiveness.

From: http://www.pharmatimes.com/NICE_unveils_new_digital_guidance_tool_at_annual_conference

Health Direct notes the use of the phrase “a source of advice on cost effectiveness” as it evokes the memory of labour’s spin- the type of phraseology that labour used to use for cost cutting.

Many of these new cases are among men who have sex with men and it is this group that campaigners hope to target.

The National Institute for Curbing Expenditure (NICE) has launched new guidelines for doctors in England.

NICE says GPs should now offer and recommend HIV testing to all men who register with a practice in an area with a large community of men who have sex with men or an area that has a high prevalence of HIV – meaning more than two diagnosed cases per 1,000 people.

Increased testing should help stop the spread of HIV by identifying men at risk, NICE believes.

Men who have sex with men remain the group most at risk of becoming infected with HIV.

New diagnoses in this group alone have increased by 70% in the past 10 years.

There are more than 30,000 men who have sex with men living with HIV in the UK and experts estimate nearly a third of these are currently undiagnosed and unaware that they are infected.

Another high-risk group that would benefit from increased HIV testing, according to NICE, is the black African community living in England.

In 2009, more than 2,000 black Africans were diagnosed with an HIV infection, one-third of all new diagnoses in the UK.

Some of the Primary Care Trusts in England where HIV prevalence greatly exceeds two per 1,000

* Brighton And Hove City PCT
* Camden PCT
* City And Hackney Teaching PCT
* Hammersmith And Fulham PCT
* Islington PCT
* Lambeth PCT
* Newham PCT
* Manchester Teaching PCT
* Southwark PCT

Professor Mike Kelly from NICE said: “HIV is still a serious problem in this country, with a large proportion of people unaware they are infected.

“This new guidance from NICE makes a number of practical recommendations which aim to increase HIV testing by encouraging healthcare professionals to offer it routinely to people in areas where there are a high number of people living with HIV.”

This would include parts of large cities like London and Manchester, as well as areas like Brighton and Hove.

Dr Valerie Delpech, head of HIV surveillance at the HPA, said: “These expanded HIV testing policies should be prioritised for implementation as soon as possible.

“The impact of late diagnosis is clearly demonstrated when you look at deaths among people with HIV – three out of five of HIV-positive individuals that die are diagnosed too late to gain the most health benefits from their treatment, like increased life expectancy.”

HIV charities said the guidelines were a “vital step forward”.

From: http://www.bbc.co.uk/news/health-12817564

Ovarian cancer is the fifth most common cancer in women in the UK, with more than 6,500 patients diagnosed every year.

In around 80% of cases the cancer will return following first-line treatment, and it is estimated that just over two fifths of these could be eligible for treatment with Yondelis, a marine-based anticancer drug derived from the sea-squirt that attacks cancer cell DNA to prevent cell growth and spread.

But the Institute’s Appraisal Committee said it has serious concerns over how Yondelis’ effectiveness compares to that of other treatments available on the NHS. Crucially, PharmaMar did not submit any evidence comparing its drug to platinum-based chemotherapy regimens in treating relapsed disease, despite the latter being the gold standard therapy in such cases.

“This means that we cannot be sure that [Yondelis] extends patients’ lives for longer than the most routinely used treatments,” explained NICE chief executive Andrew Dillon.

Evidence ‘not robust’

New evidence considered did suggest that Yondelis might be most effective in women with ‘partially platinum-sensitive’ ovarian cancer, i.e. when the disease comes back between six and 12 months after initial platinum chemotherapy.

However, the Committee said it was not sure that the effectiveness of the drug in this subset of patients was “genuinely different from that seen in the wider group of patients for which the drug is licensed”, and so concluded that the data were not robust enough.

Taking all the uncertainties into account, the Committee calculated that the incremental cost-effectiveness ratio (ICER) for Yondelis could be higher than £95,000 per QALY gained for the entire eligible population, and £68,000 for the partially platinum-sensitive subgroup, despite a proposed patient access scheme under which PharmaMar offered to pick up the tag for treatment with its drug following the fifth cycle of treatment.

“Even when taking into consideration the Patient Access Scheme, through which the manufacturer limited the total cost of the drug, the committee concluded that the cost of trabectedin was too high relative to the uncertain benefits it may provide patients,” Dillon said.

Meanwhile, the Institute has announced that Sir Professor Sir Michael Rawlins has been reappointed as its chair for another year’s term, until March 31, 2012.

Professor Rawlins has held the position since NICE was created by the then Labour government in 1999 to curb the NHS’s expenditure on drugs.

From: http://www.pharmatimes.com/Another_NICE_no_for_PharmaMar_s_Yondelis

An investigation by The Sunday Telegraph has uncovered more than 80 cases in which desperately sick NHS patients have been refused the cancer drugs their doctor sought, in the four months since a £200 million fund was introduced to stop health authorities rationing treatments.

The fund was a key move by the Coalition so that those suffering from cancer would never again be refused drugs on grounds of cost.

Ministers were responding to years of anger over a system which meant patients were unable to secure life-extending drugs because central NHS rationers had decided the treatments were not “cost effective”.

Announcing the fund last summer, Andrew Lansley, the Health Secretary, promised to end “the scandal” of cancer patients being refused the drugs that their doctors sought, because of restrictions by the National Institute for Health and Clinical Excellence (NICE).

A £50 million stopgap version of the fund was launched in October, before the annual £200 million investment starts in April.

But this newspaper’s investigation has raised serious concerns over its operation, including:
* At least 86 cases involving terminally-ill patients being turned down;
* Extreme variations in access to drugs, with one NHS region promising free access to more than three times as many cancer treatments as another;
* Local policies so restrictive that in many parts of the country, consultants are expected not to even bother asking for drugs which are not on the “priority lists”.

In its first four months, the fund has paid for approximately 1,300 patients’ drugs – even though research last March suggested up to 20,000 cancer patients’ lives were being shortened each year by drugs rationing.

The Government has allowed each NHS regional health authority to set its own rules about which drugs are put on priority lists, creating a postcode lottery across the country.

If treatments are not on the list, patients and their doctors have to fight harder to justify why they should get them.

Bureaucrats have created complex structures, leaving terminally-ill patients to spend their last months fighting for drugs which could increase their survival.

The policies say every possible funding route for drugs must be exhausted before the NHS will even consider dipping into the fund.

Cancer charities warned that some NHS authorities were attempting to “drive a coach and horses” through the Government pledge.

They fear the £50 million fund may actually end the financial year underspent because of the restrictions.

Andrew Wilson, chief executive of charity The Rarer Cancers Foundation, said: “We are deeply concerned that health authorities are creating really restrictive policies which go entirely against the spirit of the fund – which was that clinicians would be able to decide what treatment their patients need.

“Some organisations are effectively operating blacklists of drugs, while others are making every patient go through lengthy bureaucracy to apply as an exceptional case, when in fact they are a cancer patient requiring treatment should be sufficient. The way some of these organisations are operating drives a coach and horses through the principle of the scheme.”

In most parts of the country, if a patient requires a treatment such as Avastin for bowel cancer – which NICE says is too expensive – their doctors must first apply to see if their primary care trust will fund it as an “exceptional case”.

If that is refused, as would normally be the case, a separate application is then made to request authorisation from the cancer drugs fund – and if that too is refused, patients and doctors are left to attempt an appeal.

Patients refused include those seeking Avastin for advanced bowel, breast and brain cancer, Tyverb for breast cancer and drugs to treat tumours of the bladder and kidney.

NHS authorities said they had turned down requests because they did not think there was enough evidence patients would benefit from drugs their doctors sought. In other cases, they were refused help because their medical history did not match the precise criteria drawn up by trusts.

There is also concern over the “postcode lottery” in availability of drugs.

NHS North West has cited 22 drugs which should normally be funded – while NHS South Central, spanning five counties from Oxfordshire to the Isle of Wight, lists just six treatments which would automatically be allowed.

The policies are so restrictive that in Yorkshire and the Humber, just 82 patients have been given funding. Yet across the East of England, with a similar population, 201 cases were funded.

Even those areas which seemed to have the most generous policies have tightened their belts as end of financial year approaches.

In the North West, which had backed the use for Avastin for some advanced breast cancers, and Glivec for cancer of the stomach, says patients who have not been given funding will now have to wait until April before their cases are even considered.

Several have changed their rules even in during the four months since the fund was set up, so that several patients in London were denied drugs under one set of criteria, only to have their cases reconsidered all over again as their health declined.

Mike Hobday, head of policy at charity Macmillan Cancer Support, said he was “very worried” by the findings of the investigation.

He said: “Every cancer patient should get the drugs their doctor recommends, regardless of what type of cancer they have, or where they live.

“A few extra months towards the end of a patient’s life can mean the difference between seeing a child get married or graduate.”

Health Minister Anne Milton said: “Since October, more and more patients are being treated with life-extending drugs that they wouldn’t have got under the previous system. Demand for the fund will vary across the country; we set up the fund in order to balance out existing variation in access.”

From: http://www.telegraph.co.uk/Cancer-sufferers-refused-life-extending-drugs-despite-Government-pledge

The disease is one of the most common forms of cancer in men. About 35,000 men are diagnosed with prostate cancer in Britain every year and about 10,000 die from the disease.

Figures show that men diagnosed with the condition in south east Cambridgeshire are almost five times less likely to die from the disease than those in Tottenham, north London.

The statistics, collated by the Prostate Cancer Charter for Action, also show that 96 of England’s 529 parliamentary constituencies have a death rate 25 per cent higher than the England average.

The figures show that in Tottenham, 57 men per 100,000 died from the disease, 131 per cent higher than the national average.

In south east Cambridgeshire the figure was 12 per 100,000.

An earlier report found that areas of the country which had failed to implement NHS guidelines on improving care had a mortality rate 4 per cent higher than those areas were the guidance had been taken up.

Dr Frank Chinegwundoh, a consultant urologist, said: “It is not enough that prostate cancer services are improving as a whole, if patients face such a lottery in the care they receive.”

“We need better services for all patients across the country, not just a lucky few.”

David Smith, of the Prostate Cancer Support Federation, said: “All men with prostate cancer should benefit from better services, yet these figures suggest that the inequalities in prostate cancer are getting worse.

“There can be no excuse for services in some areas of the country to be performing so much worse than in others.

“This situation cannot be allowed to continue.”

Mark Simmonds, the Tory shadow health minister, said: “We have been warning for some time about the inequalities in access to treatment for cancer.

“We want an NHS focused around the needs or patients and the outcomes they want to see.

“And the way funding is allocated to local NHS organisations needs to reflect the burden of disease across the country better.”

Professor Mike Richards, the NHS’s national clinical director for cancer, said: “The Department of Health recognises the importance of implementing the Improving Outcomes Guidance published by NICE and we have asked Strategic Health Authorities to submit action plans to demonstrate how they will implement this.

“Raising the public awareness of prostate cancer is one of the key challenges for the future. We want men to know what their prostate is, what it does, and what can go wrong with it and we are tackling this through the National Awareness and Early Detection Initiative.

“Also for the first time, as a result of the work of the Prostate Cancer Advisory Group, we now have a definitive set of consistent key messages for the general public about the prostate, including prostate cancer. These clear messages provide men and their families with information about the prostate that they need to be aware of and are designed in such a way as not to cause unnecessary anxiety.”

From: http://www.telegraph.co.uk/health/healthnews/5531954/Postcode-lottery-in-protate-cancer-treatment.html

The health secretary, Andrew Lansley, believes that Nice should continue to write guidelines for doctors on the best treatments for their patients, but the Guardian understands he will remove its controversial power to ban the use of drugs it considers too expensive for the benefit they offer.

The move will be greeted with enthusiasm by the pharmaceutical industry, which has opposed Nice from the outset, and by certain patient groups, set up to lobby on specific diseases, sometimes with pharma funding, that have joined cause with them in angry denunciations of Nice when drugs found to have limited benefit have been rejected.

But the decision is likely to cause consternation among the supporters of Nice, who warn of a return to the “postcode lottery” days before Nice came into being, when some patients could get the drugs they wanted on the NHS but others could not.

Critics also point out that careful scrutiny of the cost-effectiveness of drugs is essential to keep drug bills down and ensure that NHS money is not spent on medicines with very limited effect – to the detriment of other patients who may not get the care they need.

“Real growth in the NHS will be about 0.5% in the next few years,” said Alan Maynard, a health economist. “We’re going to have rationing. The question is whether we have it at a national level or let 150 primary care trusts or whatever do it their own way.”

David Cameron’s announcement of a £200m fund for new cancer drugs, made during the election, “drove a coach and horses through Nice”, said Maynard. He said he thought Nice was “under considerable assault”.

Lansley wants the decision on whether a patient should get a drug to be moved back to the patient’s doctor. The local commissioning body will be asked to agree to pay for it. The cost of the drug will be decided through a new “value-based pricing” system.

The NHS will negotiate with the manufacturer on a price for each new drug, taking into account not only how clinically effective it is and how it reduces the burden on the patient’s carers but also what other treatments are available and how “innovative” the company has been in producing the drug.

The health secretary told the Guardian that reforming the way medicines were paid for would help ensure money was spent wisely.

“We need a system that encourages the development of breakthrough drugs addressing areas of significant unmet need. And we need a much closer link between the price the NHS pays and the value that a new medicine delivers, sending a powerful signal about the areas that the pharmaceutical industry should target for development,” he said.

“Most importantly, using our cancer drugs fund in the interim, and value-based pricing for the longer-term, we will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them.”

The pharmaceutical and biotech industries have heavily lobbied governments for a long time, arguing that Nice is an obstacle to innovation, delaying the introduction of their new drugs into the NHS and sometimes turning them down or restricting the numbers of patients for whom they can be used. Under the new system, they will be able to argue for a premium price for a drug in a new class, for instance, or for one that has required a greater outlay for research and development.

According to the pharmaceutical press, health minister Lord Howe told a conference last week on the future of innovation and drug research and development that Nice was now “somewhat redundant” when it came to deciding the cost-effectiveness of drugs, although its role in producing guidance would remain very important. Howe said the price to be paid would reflect “everyone’s agreed perspective” on its value.

Dr Richard Barker, director general of the Association of the British Pharmaceutical Industry, said he thought it was right that Nice should no longer be able to accept or reject a drug for the NHS. “It should be a clinical decision on what medicine a patient needs, informed by a broader sense of value than the current one that Nice applies,” he said.

He envisaged that Nice would continue to look at the effectiveness of a medicine and give advice, but then the drug manufacturer would meet with the NHS to discuss the price. “We believe a more productive way forward based on some kind of broad assessment of value is for the company to sit down and discuss the outcome of that with the department of health and the NHS, rather than have another body set up. We don’t think there is a disagreement between us [the industry and the government],” he said.

Value-based pricing would replace the current complicated system known as the PPRS (pharmaceutical price regulation scheme), which reimburses companies for the drugs they supply to the NHS. The industry has defended the PPRS in the past, but Barker said he thought it would support the new system – as long as existing barriers were swept away.

At the moment, there are some regional bodies assessing the usefulness of medicines and PCTs have pharmacy advisers and formularies – lists of drugs they are willing to buy – which the industry hopes will all go.

From: http://www.guardian.co.uk/nice-to-lose-new-drug-power

The cuts:
Technically the NHS has been given an increase in funding but this is less than half a per cent over four years.

£1bn will be diverted from the NHS to social care to help cut emergency readmissions to hospitals.

Psychological therapies will be boosted for those with mental health problems.

A new cancer drug fund for medicines that have been turned down by Nice worth up to £200m a year.

Three new hospitals were given the go ahead including Epsom and St Helier, West Cumberland and the Royal Oldham.

However the extension of free prescriptions to people with long-term conditions will be stalled.

One to one nursing care for cancer patients and a pledge under the previous government to have cancer tests conducted within one week will also be postponed.

The number of quangos will be cut from 18 to 10 by 2014 and the administration costs will be reduced by a third.

Radiographers will examine some x-rays as well as take them in order to save £7.9m of consultant radiologists’ time.

What it means:

Although an increase in funding sounds generous compared to the other departments it is nowhere near enough to keep pace with inflation in the NHS or the increase in demand for healthcare as the population ages and new treatments are developed.

The NHS has already been planning to make £20bn worth of savings over the next four years and it is not yet clear if this will have to be increased in light of the CSR settlement.

The Chancellor said the NHS spent £102bn this year but this is £5bn lower than what was planned for in the 2007 spending round, raising the question of where that money has gone.

Thousands of jobs in the NHS are already earmarked for cuts as primary care trusts and strategic health authorities are to be abolished as part of the coalition’s reforms and it is feared that some hospitals may seek to cut frontline jobs as well.

Experts have warned that plans to give GPs greater control over the NHS budget and the reorganisation this will take will cost between £2bn and £3bn.

What is the department’s budget?

£109.4bn

How well does the department perform?

Waiting times for patients needing treatment in hospital reduced dramatically under Labour, following the introduction of many targets. But with them came an expanding bureaucracy. The number of managers rose by 84 per cent in a decade, while nurse numbers grew by just 24 per cent.

Recent scandals such as that at Stafford Hospital, where patients suffered appalling and basic failings, illustrated the dangers of prioritising finances and targets over care.

Britain’s record in funding drugs for many serious diseases – especially cancer – compares poorly with the rest of Europe, and survival rates are worse than in other countries.

While growth in spending on the NHS in the past decade was at a record level, most of the money went on pay. GP pay rose by nearly 50 per cent in a decade, to an average of £106,000.

Had any savings already been identified?

The Government says more than £1 billion will be saved by halving the size of NHS bureaucracy in four years. 150 primary care trusts and 10 health authorities will be scrapped. However, redundancy payouts to get rid of so many managers will be expensive. Quangos such as the Health Protection Agency will be culled. Funding for a £75 million public campaign against obesity and drinking is to be stopped, with food and drinks companies asked to foot the bill.

From: http://www.telegraph.co.uk/Spending-Review-What-it-means-for-the-National-Health-Service-NHS-Department-of-Health

Current rules prevent NHS doctors prescribing donepezil, galantamine and rivastigmine in such early cases.

Campaigners said the release of the new draft guidance was a “momentous day”.

As many as 465,000 people in the UK have Alzheimer’s disease, and this is expected to rise as the population ages.

The availability of drugs for the condition on the NHS has been source of controversy for almost a decade.

While there has always been evidence they diminished the symptoms and boosted quality of life for some, it has not always been clear exactly how much improvement they could deliver, to which groups of patients, and for how long.

In 2005, killer quango drugs watchdog NICE ruled that no-one should get the drugs on the NHS, then conceded a year later that patients with “moderate” disease should receive them, while still ruling out “mild” patients.

The secret formula used by NICE to calculate how much “value for money” the drugs offer to the NHS was then the subject of a court action by the Alzheimer’s Society and pharmaceutical companies.

* 2005 Draft NICE guidance recommends no patients should receive Aricept (donepezil), Reminyl (galantamine) or Exelon (rivastigmine)
* May 2006 Final guidance says those with moderate Alzheimer’s are eligible, but not those with mild disease
* October 2006 Internal NICE panel rejects appeals over decision to exclude “mild” patients
* June 2007 High Court backs NICE decision following Judicial Review
* May 2008 Court of Appeal rules NICE should make public their “economic model” which calculates the financial benefits of a drug
* June 2009 NICE admits “technical inaccuracies” in the model, amends it, but does not alter guidance
* October 2010 Five years on, a fresh review of the guidance backs prescribing three drugs for mild Alzheimer’s, and includes a fourth for more advanced disease

After the case went all the way to the House of Lords, NICE was forced to first disclose the formula, then amend it after admitting “technical inaccuracies”, although it said this did not change the outcome.

That new review now proposes giving the drugs to patients with mild symptoms – which covers people in the early stages of the disease, perhaps suffering memory loss and confusion, but not yet dependent on carers for day-to-day activities.

It has also suggested a fourth drug, Ebixa, be made available for the first time to patients with more advanced disease.

The guidance is still subject to appeal by the quango.

Ruth Sutherland, the interim chief executive of the Alzheimer’s Society, said that it was “a momentous day”, with approximately half of the 62,000 people who develop the disease every year likely to benefit from the drugs.

She said that the drugs, which cost approximately £2.80 per person per day, were not a “miracle cure”, but made important differences to people’s lives.

She said: “For the price of a cup of coffee they can mean the difference between recognising your loved ones and playing with your grandchildren.

“It is critical that this draft decision becomes a reality and that all people with Alzheimer’s are given the opportunity to benefit.”

The society’s Director of Research, Professor Clive Ballard, said: “If this guidance is issued, doctors will no longer have to watch people deteriorate without being able to treat them.”

Professor Roy Jones, from the Research Institute for the Care of Older People in Bath, described the decision as “an important milestone”.

He said: “Early diagnosis and access to medication is critical to help reduce both the short and long-term impact of this devastating condition on patients, families and carers.”

From: http://www.bbc.co.uk/news/health-11486367

NICE the killer quango wants to waste taxpayers money by suggesting that the NHS should bribe fat people to lose weight and smokers to quit, and give children toys for eating their fruit and vegetables.

Now during the credit crunch nice want to waste millions of taxpayers pounds bribing people when earlier pilot studies showed that there were high drop out rates and up to 80% failed to reach their targets.

The advice, which will be published by the National Institute for Curbing Expenditure, has been greeted with anger by critics who claimed such “bribes” were draining the public purse of money which could be better spent elsewhere.

The study examined a series of schemes, including one in Kent which pays dieters up to £425 for losing weight and another in Scotland which gives pregnant women shopping vouchers worth up to £650 for quitting the habit.

It also looked at programmes in Oxford, Manchester, London and Bangor in Wales, where schools have been given toys such as juggling balls, stickers and pencils to children who have eaten their fruit and vegetables.

Fiona McEvoy, from the TaxPayers’ Alliance, said state funds should not be used to pay people to change their lifestyles,

She said: “Bribing people to lose weight or quit smoking is nothing but a quick fix which patronises the individuals in question and drains much-needed money away from the public purse. At a time when cancer drugs are being denied to sufferers due to lack of funds, many will be disgusted to learn that NICE are considering such a costly approach.”

Other schemes examined in the report include a pilot in Manchester which rewards overweight parents for walking their children to school.

As part of a £30m project, supermarket points are given to unfit people who attend keep-fit classes, weight loss clubs or go for a run in the park.

Overweight people gain credit points they can cash in for groceries just for turning up, with extra rewards depending on how much weight they lose.

In Newcastle, Bristol, Torbay, Manchester and Bury St Edmunds, those aged 16 to 22 are given subsidised gym membership if they visit at least once a week.

However, the report found limited evidence about whether the schemes make a difference.

In the Scottish antismoking project, for instance, the study acknowledged that four fifths of the women in the £43,000 scheme were smoking again within three months of giving birth.

The recommendations from NICE’s independent citizens council do not constitute its official advice to the NHS. Its board will launch a public consultation on the matter before considering the paper, which would inform future guidance.

However, the rationing body has already supported financial rewards for heroin addicts.

Originally NICE recommended that addicts who attended treatment programmes should be given the chance to win prizes, such as televisions and MP3 players.

The body dropped the idea following a public outcry but instead recommended that shopping vouchers worth up to £10 could be awarded to those who completed programmes, or showed they were clear of drugs.

NICE has been widely criticised for refusing to pay for dozens of cancer drugs on the grounds of cost. Medicines rejected include the drugs Avastin for advanced bowel cancer and Nexavar for advanced liver cancer.

Last year the institute fuelled controversy when it ruled marriage guidance counselling should be funded by the NHS, and supported the use of acupuncture for back pain, despite finding there was no good evidence it worked.

The report follows a three day meeting of NICE’s citizens council, where members were asked to vote about the use of incentives.

“More than 60 per cent said they were in favour of such schemes, as long as they were only used as a “last resort” and were not exchangeable for tobacco or alcohol.

Sir Michael Rawlins, the chairman of NICE said: “We clearly face several public health challenges in today’s society, some more obvious than others, and we must seek to improve these in ways that are likely to achieve the best outcomes to those affected.

“The majority of the council has voted in favour of the use of incentives under certain circumstances, but this clearly remains a divisive issue”.

Public consultation on the report starts today.

From:

http://www.telegraph.co.uk/NICE killer quango taxpayers-bribes-for-obese-and-smokers.html

Health Direct finds this new waste of taxpayers money a disgrace. Research in pilot studies has clearly showed that bribing people to lose weight and stop smoking DOES NOT WORK in the vast majority of cases.

On June 10, 2010 Health Direct published research :Nanny state cash bribes for good health fail three quarters of patients at http://www.healthdirect.co.uk/2010/06/nanny-state-cash-bribes-for-good-health-fail-three-quarters-of-patients.html

A Department of Health spokesman has already described them as an undesirable use of money and should only be adopted as a “last resort”.

If you would like to tell the killer quango NICE what you think of this scheme, comments should be sent to Clifford Middleton, Research and Development Project Manager at clifford.middleton@nice.org.uk by 5pm on Friday, 26 November 2010.

If email is a problem for you, please send your comments in a letter to Clifford Middleton at:

NICE,
MidCity Place,
71 High Holborn,
London WC1V 6NA.

It follows the publication of guidance by the nanny state’s National Institute for Curbing Expenditue (NICE)  that sex education should be introduced from the age of five.

Trevor Stammers, chairman of the Christian Medical Fellowship and a GP in south London, told The Sunday Times: “If sex education is introduced in primary schools in the way being proposed, we will see many more 11-year-old girls seeking contraception without pointing out the risks…. We are going to make matters worse.”

He added: “These figures illustrate the fact that the UK is facilitating the sexualisation of young people at an ever younger age.”

The latest figures came from the General Practice Research Database, which collects information on medical records from 500 GP practices.

The data also shows that at least 58,000 15-year-olds were on the pill last year – more than double the number in 1999.

By law, doctors are bound by a duty of confidentiality towards children – even if they are under the legal age of consent – unless they suspect abuse.

From: http://www.telegraph.co.uk/Huge-rise-in-11-year-olds-on-the-pill

In an interview with The Independent, he also accused political leaders of paying “lip service” to the importance of scientific proof and warned that looming cuts to university research budgets could provoke a “brain drain” from Britain.

Although there are other backbenchers with scientific backgrounds, Dr Huppert is the sole MP to have practised past PhD level, specialising most recently on DNA structures.

He said it was a real concern that the Commons – which is full of career politicians, lawyers and economists – lacked scientific expertise. Dr Huppert, a fellow of Clare College, Cambridge, argued that all MPs should be obliged to take a short science training course, covering areas such as how research is conducted, numeracy and the use of statistics.

“It would be really important for all MPs to have some exposure, because some of them will not have studied any science since they were 15 and it’s important to understand how to engage with it,” he said. “You would then have a lot of MPs who were able to understand the information they were being presented with.”

Accusing some MPs of being “anti-science”, he said: “They have a set of beliefs and they will argue that regardless of the science.”

Dr Huppert said political leaders tended to come up with a stance and then tried to make the evidence fit it, rather than being driven by the science. He cited the previous government’s decision to make the drug mephedrone a banned substance after claims about the role it played in the deaths of several young people.

“What we saw was a policy based on media reports, rather than based on evidence, and that does happen too much, ” he said. “As a researcher I will come up with a hypothesis, which I may talk about to people, I’ll then do some experiments and test it and will then change my hypothesis based on what I find. If you do that in politics, that’s a U-turn and a defeat.”

Although he absolved the Science minister, David Willetts, from criticism, he said a “tricky” relationship had developed between MPs and scientists. “Generally, they are two separate camps who do not communicate,” he said.

Dr Huppert gained a seat on Cambridgeshire County Council when he was 22 – the same age at which he gained his PhD. He pursued the two careers in parallel until the election in May, when he succeeded fellow Liberal Democrat David Howarth, who stood down as the MP for Cambridge to return to academia.

Dr Huppert said: “Science in some senses is what I am good at, but politics is what I care about.” He also hit out at suggestions that university research budgets could fall victim to the public spending squeeze being undertaken by the Government.

From: http://www.independent.co.uk/only-scientist-in-commons-alarmed-at-mps-ignorance

The National Institute for Curbing Expenditure has turned down the drug called everolimus, also known as Afinitor, saying it does not offer enough benefit to patients to justify the cost.

Each pack of the drug costs £2,822 and the manufacturer, Novartis, had offered the first pack free to the NHS and a five per cent discount on following ones.

But even with this, and taking into account new guidance on end of life drugs which allows Nice to approve more expensive drugs that extend life for patients with rare diseases, the treatment was still too expensive, the panel decided.

An estimated eight week cycle of treatment would cost £5,264 per patient.

The cost per quality adjusted life year gained, a complex calculation taking into account improvement in quality of life as well as extra length of life versus the cost of the new drug over and above existing treatments, is almost double what Nice would normally allow.

Around 4,000 people a year in England and Wales are diagnosed with advanced kidney cancer and those who would be eligible for treatment because they had already tried the other drug, called Sutent, and were still fit enough to attempt another drug, would be much fewer, Nice said in a statement.

Patient groups hit out at the draft guidance saying people with rare cancers were being penalised.

Last year patients with advanced kidney cancer campaigned after four drugs including Sutent were turned down. Nice partially reversed the decision and Sutent is now available.

Mike Hobday, Head of Policy at Macmillan Cancer Support, said: “We are disappointed by Nice’s decision not to make everolimus available on the NHS for people living with advanced kidney cancer, who already have limited treatment options following the rejection of three clinically effective drugs last year.”

“It’s unfair that patients suffering from rarer cancers are repeatedly denied treatments that could extend their lives. Drugs like everolimus can dramatically improve people’s quality of life. They can mean the difference between patients being given a few weeks to live and a few months – valuable time that can be spent with family and friends, which means a lot to cancer patients.”

Nick Turkentine, Chief Operating Officer for the James Whale Fund for Kidney Cancer said: “Once again Nice has disappointed the thousands of kidney cancer sufferers in the UK by not approving everolimus, a drug which gives terminal kidney cancer patients and their families some hope.”

From: http://www.telegraph.co.uk/Kidney-cancer-patients-denied-drug-that-can-extend-their-lives

Mr Lansley, who has scrapped several of Labour’s key targets, including the guarantee of a GP appointment within 48 hours, insisted the new standards were not just another set of targets.

Speaking at the launch of the standards, which have been developed by the National Institute for Health and Clinical Excellence (Nice), Mr Lansley said they were not mini-targets as they were ”evidence-based” measures identified by the NHS itself.

”These are standards, not diktats. It is not politicians establishing these, I am not picking them out. ‘If I started doing that, I would be distorting clinical standards.”

The latest standards from Nice are drawn from various sources, including existing Nice guidelines, and reports from the Royal Colleges, the Department of Health and the National Audit Office.

It will be up to local managers – or possibly GPs in the future – to check if the NHS is meeting them.

If trusts fail to reach the standards, they could face losing contracts to carry out services, such as stroke care, which could be commissioned from other hospitals instead.

It is unclear how data will be collected nationally so patients can assess whether standards are being met.

Dr Tim Kendall, who led development of the dementia standard, said it would help transform the experience of dementia patients but also support carers.

”Some carers suffer far more than they should. People with dementia effectively die while the person caring for them watches them disappear,” he said.

The stroke standard sets out how patients can expect to receive a minimum of 45 minutes, five days a week, of therapies to help them improve, such as speech therapy or help with movement.

From: http://www.telegraph.co.uk/NHS-quality-standards-set-out-by-Andrew-Lansley

Food producers should cut the amount of saturated fat in food and eliminate all ‘toxic’ artificial fats, called trans fats, completely.

Trans fats are added to food to prolong shelf life, have no nutritional value and have been linked to heart disease.

Ministers should consider introducing legislation if action is not forthcoming by manufacturers, the guidance said.

The average person in Britain consumes more than eight grams of salt a day where as the body only requires one gram to function. Targets are already in place to reduce consumption to six grams by 2015 and this should be extended to three grams by 2050, the guidance said.

Children should consume considerably less salt than adults and because the bulk of salt in the diet comes from prepared food, such as bread, cereal, soups, meat and cheese products, manufacturers have a key part to play, the guidance said.

The guidance, drawn from evidence of beneficial measures, was commissioned by the Department of Health and covers population based measures rather than advice for individuals. It calls for action from a range of public bodies, business and Europe, but is not binding.

There are around five million people living with the effects of cardiovascular disease, which includes heart attacks, heart disease and stroke. There are around 150,000 deaths each year and while mortality rates have fallen, there are 300,000 new cases diagnosed each year in Britain.

The Nice panel has calculated that 40,000 deaths a year could be prevented by significant reductions in salt and saturated fat consumption and if all trans fats were eliminated from prepared foods.

The guidance has called for a wide range of measures including:

– Low salt and fat foods should be sold more cheaply than their unhealthy counterparts, through the use of subsidies if necessary, although the guidance stopped short of calling for a ‘fat tax’ on high salt and fat foods saying this was difficult to implement.

– Advertising of unhealthy foods to children should be banned until after 9pm and planning laws should be used to restrict the numbers of fast food outlets, especially near schools.

– The Common Agricultural Policy should focus more on public health with farmers paid to produce healthier foods.

– Action should also be taken to introduce a traffic light food labelling system, the Nice panel said, even though the European Parliament recently voted this down.

– Local authorities must also act to encourage walking and cycling in their areas and public sector caterers must provide healthier meals as has already been seen in schools, the guidance said.

– All lobbying of government and its agencies by the food and drink industry should be fully disclosed.

Professor Klim McPherson, Chairman of the Nice Guidance Development Group and professor of epidemiology at Oxford University, said: “The guidance sets out a range of evidence-based recommendations for effective action to help reduce CVD levels.

“Where food is concerned, we want the healthy choice to be the easy choice. Going even further, we want the healthy choice to be the less expensive, more attractive choice. Just one of the recommendations is reducing saturated fats and removing trans fats from the diet – this can save over 20,000 lives every year.

“Put simply, this guidance can help the Government and the food industry to take action to prevent huge numbers of unnecessary deaths and illnesses caused by heart disease and stroke.”

From:
http://www.telegraph.co.uk/Ban-bad-fats-and-cut-salt-to-save-40000-lives-a-year-says-Nice

The absence of such a system means that hospitals and GPs may waste money on new tests that do not have clear benefits for patients, while ignoring others that can lead to better clinical outcomes. Just as the National Institute for Health and Clinical Excellence (NICE) currently recommends which treatments are cost-effective for NHS use, new genetic diagnostic techniques must be examined in a methodical way.

“The Department of Health should establish an evaluation and decision-making body, as a matter of urgency, to direct research funding towards important strategic questions and ensure evidence-based implementation of both new diagnostic techniques and informatics systems within the NHS,” the report says.

The recommendation comes in response to a House of Lords inquiry into genomic medicine published last summer, which found that the NHS was not ready to take advantage of genetic advances in healthcare.

The falling costs of reading DNA mean that it is likely to be possible to sequence any person’s entire genome for less than £1,000 within a year or two.

Scientists have also started to identify how variations in DNA affect responses to drugs or susceptibility to disease, raising the prospect of personalised medicine based on individuals’ genetic profiles.

Doctors could potentially use genetic information to select the best drugs for treating particular patients, or to calibrate doses of medicines with potentially dangerous side-effects, such as the blood-thinning drug warfarin. Companies such as 23andMe and Pathway Genomics are already selling genetic tests directly to consumers that provide some of this information.

Little research, however, has so far shown that knowing details of a patient’s genome is helpful to doctors, and leads to better medical outcomes when it is used in prescribing drugs.

The new report, which was compiled following four seminars attended by more than 50 doctors, scientists, ethicists and patient representatives, says that this needs to be addressed as new genetic tests are offered to the NHS.

NICE recently established a diagnostics assessment programme to start this, and is currently conducting a pilot project, but a more comprehensive system is needed. New commissioning structures are also required to ensure that validated tests are accessible everywhere.

Caroline Wright, head of science at the PHG Foundation, said: “The heart of the problem is that we do not have enough data on whether these tests actually help patient care. We desperately need the equivalent of clinical trials for diagnostics.

“There’s an implicit assumption that testing is good, that knowledge is power, but the key question is does a test result helpfully change the management of a patient? If not, it is a waste of money.

“When public money is being spent, it must be spent sensibly to get better care outcomes. It’s really important that anything funded by health systems has evidence behind it.”

From: http://www.timesonline.co.uk/tol/news/science/genetics/article7128357.ece

Cash payments of up to £425 were offered by an NHS primary care trust in Kent to 402 volunteers who signed up for the year-long “Pounds for pounds” trial in January 2009.

Among the 100 who completed the course, the average weight loss over the year was 25lb. However, they represented only a quarter of the total. In all, two-thirds of the volunteers failed to reach their weight loss target.

The mixed results are a disappointment to advocates of the use of financial incentives to change unhealthy behaviour. A growing body of experts say cash rewards may offer the best hope of persuading people to alter their lifestyles and head off the epidemic of chronic disease associated with smoking, drinking and overeating which threatens Western nations.

Last month, the National Institute for Clinical Excellence (NICE) held a two-day hearing to discuss the use of cash incentives in health. In addition to helping people lose weight and give up smoking, other schemes have offered rewards to addicts to stay off drugs and £10 record vouchers to young people who agree to have a test for chlamydia.

An independent evaluation of the Kent weight loss scheme by the University of Sheffield concluded that financial incentives worked for some people, but the high drop-out rate meant the true impact was unclear.

Claire Martin, acting assistant director of public health for NHS Eastern and Coastal Kent PCT, said: “Very often people lose weight, but when they stop their diet the weight returns. We need to invest in programmes that return a sustained weight loss and produce long-term health benefits.

“There were high drop-out rates and so it is very difficult to interpret the results to show how successful this would be across our population.”

The cost of the Kent scheme, run by a private company, Weight Wins, is around £180 per head. A spokeswoman for the Department of Health said the cost to the NHS of treating obesity-related conditions was £4.2bn.

Winton Rossiter, chief executive of Weight Wins, said 745 people had joined the scheme, more than half through the NHS Kent scheme and the remainder as private customers, paying a monthly fee. The average weight loss after one year was 15.8lb.

“These results suggest that long-term financial incentives could be the best single weapon in the war on obesity,” he said. Weight Wins is now offering a maximum payout of £3,000 to private customers who lose 150lb over 21 months and keep it off for three months. Customers pay £135 to join the scheme and £30 a month.

Healthy dividends

* In Essex, pregnant women who smoke have been offered up to £60 in food vouchers if they give up.
* In Hammersmith, west London, and in Bournemouth, the NHS has offered those under the age of 25 a £10 HMV voucher to have a chlamydia test.
* Weight Wins, a private company, charges a £10-£30 monthly fee and offers £150 to clients who lose 50lb and up to £3,000 for people who lose 150lb.
* In the US, employees of General Electric were paid up to $750 (£500) if they gave up smoking for at least 12 months.
* Several companies in the US offer a similar service, including Virgin Health Miles, StickK and HealthyWage.

From: http://www.independent.co.uk/pounds-for-pounds-scheme-helps-obese-people-shed-stones

One in four people drink at levels that could be putting their physical and mental health at risk, according to official figures.

The move will reignite debate about how best to deal with the problem.

Deaths from alcohol abuse have more than doubled in the last 16 years, with almost 9,000 a year now succumbing to conditions such as alcohol poisoning and liver cirrhosis

More than 860,000 people a year are also admitted to hospital because of alcohol and the cost to the nation of excessive drinking is put at an estimated £27 billion a year.

Health experts and charities have all backed calls for a minimum price per unit to curb Britain’s binge drinking culture.

But many in the drinks and retail industries are strongly opposed to such a move and believe a minimum price would disproportionately hit responsible drinkers.

The move has already been backed by the British Medical Association (BMA) and the Royal College of Physicians.

Analysis by Sheffield University found that setting a minimum price of 50p a unit would save up to 3,400 lives a year without hitting moderate drinkers.

A draft of the Nice guidance, published in October last year, recommended the introduction of a minimum price per unit and said there was “sufficient evidence … to justify the introduction of a minimum price per unit.”

As well as overall consumption levels, a minimum price would also help to reduce binge and underage drinking, advocates believe.

Minimum pricing is expected to have a much harder impact on supermarkets and off licenses than pubs and restaurants, which sell alcohol at higher prices.

Supermarkets in particular have been criticised for selling alcohol at very low prices, including cans of beer for as little as 22p each.

The Wine and Spirit Trade Association said that minimum pricing “would punish millions of innocent consumers” without solving the problem of alcohol misuse.

From: http://www.telegraph.co.uk/Minimum-price-for-alcohol-to-be-backed-by-Nice

A postcode lottery means hundreds of people are missing out on life-prolonging care

Now figures obtained under the Freedom of Information Act show that a cancer patient’s chances of overruling health authorities who deny them access to drugs depends on where they live.

Some NHS trusts, such as Torbay in Devon and Salford in Manchester, granted all appeals while in others, such as Kingston in southwest London, only 7% were granted. In about one-third of trusts, fewer than half of the requests for drugs that can cost thousands of pounds a month were approved.

Access to cancer drugs has become an election issue, with the Conservatives saying they will ensure the National Health Service directs £200m more into supplying new drugs. The money will come from what the health service would otherwise have had to pay to meet Labour’s hike in National Insurance, which the Tories have said they would partially reverse.

The drugs concerned have all been approved by the labour government’s National Institute for Curbing Expenditure (Nice). However, each of 152 primary care trusts (PCTs) in England is allowed to use its own interpretation of Nice’s regulations.

In some cases patients who have already had two courses of chemotherapy are not allowed the drugs; in other cases they must have tried cheaper alternatives before being eligible. Those who do not meet the conditions must appeal to an “exceptional case” panel.

Widespread variation in attitudes between health trusts emerged in research to be published in Health Insurance magazine. It asked how many “exceptional-case funding requests” for cancer were received by trusts in 2009.

It named five drugs, including Rituxan for leukaemia; Tarceva for lung cancer treatment and Revamid for blood cancer.

All such appeals were granted by 17 healthcare trusts, with the areas benefiting ranging from Walsall and Manchester, to Torbay and Suffolk. However, Kingston and Northamptonshire refused most of the appeals made to them.

Forty one of 122 primary care trusts that responded granted fewer than half requests. The figures present an incomplete picture because some trusts may prescribe medicines without the need for patients to appeal. Critics, however, say they still show unacceptably wide variations in practice.

Specialists also complain that the NHS trust officials who decide whether or not to grant the appeals are rarely experts in the disease, so they help to create the wide discrepancies.

Karol Sikora, a cancer specialist at Hammersmith hospital, west London, said his department has a wallchart that marks both sympathetic and unhelpful PCTs. “You find yourself talking to office temps and all sorts of unlikely people who are apparently making these life-or-death decisions,” said Sikora.

Analysis by the Rarer Cancers Forum (RCF) suggests that the National Institute for Curbing Expenditure (NICE) is “failing to follow the spirit” of guidelines designed to improve access to end-of-life cancer treatments.

It claims that as many as 16,000 patients have been denied access to drugs because the watchdog had concluded unfairly that they did not meet the criteria for consideration, or they were deemed too expensive — without proper negotiation with pharmaceutical companies.

The report, Exceptional Progress?, looks at improvements to treatment access for people with rarer cancers following a review carried out by Sir Mike Richards, the Government’s national clinical director for cancer.

Sir Mike’s review was prompted by complaints from patients who were denied NHS care after having paid privately for tr