Hospitals to pay price for failure to innovate

Patients to be told if health authorities blacklist latest drugs

Patients across the country will soon be able to see whether their local hospital or health authority is rationing care as part of government plans to eradicate "postcode prescribing" in the NHS.

From this autumn, every hospital and commissioning body in England will be forced to start publishing statistics showing how many of its patients are being provided with the latest drugs and treatments recommended by the National Institute for Health and Clinical Excellence (Nice). The move will mean that, by next year, every hospital and health trust will be rated using an "innovation scorecard" allowing patients to compare services and treatments offered in different parts of the country.

Those health authorities found to be denying approved treatments are likely to face censure from the Department of Health.

The plans are due to be announced by the head of the NHS, Sir David Nicholson, next month, The Independent understands. At first the "scorecard" is likely to be made up of around 20 key treatments and interventions where uptake across the NHS is known to be inconsistent. It is expected to be expanded over time to include all new drugs recommended by Nice for widespread use in the NHS.

Ministers hope that the move will bring an end to the problem of "postcode prescribing" where health authorities deliberately restrict access to approved drugs to save money.

Last year it emerged that about a quarter of primary care trusts were blacklisting more expensive drugs in favour of cheaper generic versions, which are sometimes not as effective. Among those banned in some areas were Lipitor and Crestor, two branded statins for cutting cholesterol in people at raised risk of strokes.

Three weeks ago Sir Michael Rawlins, the chairman of Nice, accused trusts of "messing around with the law". "They want to use their money for other purposes: I understand that. But the law is the law, and ... the law clearly says that when Nice gives a positive view of a drug, patients are entitled to it if their doctors think it is appropriate," he said.

Announcing the move, the Health minister Paul Burstow, pictured, said allowing patients to see where drugs were being restricted would be a key catalyst for change. "Patients have a right to drugs and treatments that have been approved by Nice.

"NHS organisations must make sure the latest Nice-approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not.

"Being transparent with data like this is the hallmark of a 21st-century NHS. It is a fundamental tool to help healthcare professionals improve care."

Sir Andrew Dillon, chief executive of Nice, said the organisation has been working with the NHS Information Centre on drawing up a scorecard of around 20 indicators to assess how NHS organisations were adopting Nice appraisals.

He said the intention was to launch the scorecard in September and it would act as a "benchmark on expected levels of uptake" which would be relevant to patients, doctors and commissioners.

"This is a step change in the detail with which we will be able to see how trusts respond to our recommendations," he said.

"It will be valuable not just to patients but also help hospitals assess how well they're performing and ensure that best practice is disseminated across the NHS."

Sir Andrew added that, in the past, there had been numerous barriers to uptake of new drugs – sometimes financial but often organisational.

"We know that changing professional practice can take time. Doctors, although positively orientated, nevertheless take time to be made aware of the benefits of new treatments for patients.

"What we hope is that the scorecard will help rapidly get a consistent response to national guidance."

But hospital managers expressed some concern that the new system could be bureaucratic and warned that they were facing financial constraints which limited their room for manoeuvre.

David Stout, deputy chief executive of the NHS Confederation, said, "It is important that any new measures do not lead to unnecessary bureaucracy or a duplication of information with no real benefits for hospitals, GPs or patients.

"It is also important to remember that the NHS is facing an unprecedented financial challenge and organisations must live within their means while providing high-quality care.

"We can only afford to provide new drugs where they are cost-effective and demonstrably add real patient benefits. In a health system with no financial growth, any new costs have to be offset by savings elsewhere."

Katherine Murphy, chief executive of the Patients Association, said it would be crucial the information be made available in a format that was meaningful to patients. "They must be in a position to hold the NHS to account because at the moment that doesn't happen. We know the NHS is hopeless at introducing new ideas."

Clare Gerada, president of the Royal College of GPs, said that, while she supported the aims of the scheme, she was sceptical about how effective a scorecard would be. "Will it be a bureaucratic tickbox or will it be something more sensible?" she asked.

Rationing care: Not everybody gets the best treatment

IVF

Despite the publication of Nice guidelines in 2004, patients have experienced inconsistent access to IVF on the NHS, with trusts ruling that some women are too old, too young or have not been with their partner for long enough. Last year, a married couple from Portsmouth who had tried unsuccessfully for a baby for more than three years and were repeatedly refused IVF funding by Portsmouth City PCT won a rare legal victory to secure treatment. They had originally been denied because the husband had a child from a previous marriage.

MS

In an attempt to cut costs Rachelle Ledsam, a 45-year-old MS sufferer, was denied a treat-ment known as Functional Electrical Stimulation – which uses electric currents to re-activate nerves connected to a parlaysed muscle – by her local health board even though it was recommended by NICE. She said the treatment "offers a glimmer of hope and to snatch it away is diabolical".

Gastric bypass

There has been inconsistent application of Nice guidelines on the provision of gastric bypass surgery. Some people in North Staffordshire, for example, have only been able to get treatment if they had a BMI index of more than 50, despite the watchdog's recommendation that it be made available to those 15-points lighter on the obesity scale. Tom Condliff, a 62-year-old former policeman who suffers from diabetes, became the first man in Britain to take legal action against his primary care trust after they denied him the surgery. "It makes me feel very angry and upset," he said. "I live less than a mile from Stoke-on-Trent PCT, which follows the Nice guidelines. If I lived there, I would have had this lifesaving operation years ago."

Treatment of arthritis, heart attacks and strokes

In 2011 it was revealed that around a quarter of primary care trusts were blacklisting some more expensive drugs in favour of cheaper versions. Some had banned Lipitor and Crestor, statins that cut cholesterol in people at raised risk of heart disease and stroke. Sufferers of rheumatoid arthritis have faced similar difficulties.

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