28th June 2016

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Sir Andrew Dillon - boss of NICE, in conversation with Roy Lilley
Let's cheer ourselves up.  First ten tickets today 1 each.  Second ten 5.
First come first served.
News and Comment from Roy Lilley
Brexit won't really change the fact that right across Europe people want a job, somewhere safe to live and a relationship that makes them feel good.
The golden triangle of public health.  If only we could all have it.
For most of us Europe is the place we go to on holiday, a conference or a match.  For others it is a place they go to work.
The Confed has a Euro-Office.  Their web-site says; 
"The NHS European Office provides the essential link between European policy and NHS organisations."
There is also a line:
"...in light of the outcome of the referendum on the UK's membership of the EU, we will follow developments closely and consider possible implications for the NHS."
I think their only development now is following the removal van.
There is another organisation that has been quietly working away in the EU; NICE.  They depend, heavily, on working relationships with EU organisations and partners.
Beyond the EU, NICE has a global reach.  Vietnam, Ghana, Mexico; NICE has worked with policy-makers and academics from over 60 countries.
In addition to government sources, NICE receives funding from the World Bank, World Health Organisation, the UK Department for International Development and charitable foundations such as the Commonwealth Fund, for analysis and policy advice.
NICE is big business.  In 2013/4 it turned over 67m.
All this is a long way from 1999, when NICE was the Labour response to the spiralling cost of drugs and the so-called 'post-code lottery'; the availability of treatments left to the decision of the local health authorities.
Critics called it rationing.  Others 'putting a rationale behind the use of resources'.  NICE's first chairman, the peerless Sir Michael Rawlins, presented a compelling case that positioned NICE as a standards setting body.
Big pharma was incandescent.  The first drug appraised by NICE was the Flu-drug Relenza.  It was turned down.  The manufacturer, Glaxo, had a spikey boss, Richard Sykes, who headed for Downing St for a row.  Tony Blair sent him away with a flea in his ear.
Sykes threatened to take his company to Timbuctoo.  An empty threat.  They are still here.  Nevertheless, 1,700 people lost their jobs.
The old assumption had always been; 'we are big pharma and we have made some stuff and you are going to buy it'.  The new message to pharma;'if you can't show it works, we aint gonna buy it'.  Pharma now do deals.
Even so, pharma still works in a pretty straightforward way.  They discover, trip over or serendipitously find a molecule that might do something.  They prove that it doesn't kill dogs, works better than nothing (they call it placebo), create a marketing strategy and try and sell it.
NICE now say; how much, what does it do and by the way, prove it.
More recently, NICE has acquired a public health remit.  They tell us to walk up the stairs and stop making our kids fat.  Masters of the obvious.
Pharma relationships have improved since the Sykes days but such is the nature of discovery and the cost of marketing and R&D that drugs, of an almost experimental nature, that might give a patient a chance of an extra month or two of life, what you'd want for your husband, mother, family or yourself... are, in the scheme of things, not affordable.
Politicians set up a cancer drugs fund.  It undermined the iron logic of NICE but relieved the pressure on MPs, from emotional constituents, that see the world entirely differently.
NICE are predictable and can be very slow at their task.  They have become a huge business; sprawling and their judgements are starting to look flawed. 
Safe-staff guidelines; not their finest hour, in which no reference was made to RCN advice and the work lifted largely from Anne Marie Rafferty.
The NICE impact assessment estimated; "The cost of implementing... guidance for adult acute wards... could be anything from 0 to 414m".  They didn't know.
In austerity it's difficult to see they would pass one of their own value for money tests.  The Scottish Medicines Consortium is smaller and some claim, more nimble.
Just what is the future for NICE?  

NICE, or NASTY; Not Available So Treat Yourself!      
Come and hear me discuss this and other topics with the boss Sir Andrew Dillon at the HealthChat on the 18th July at the King's Fund.  
Special deal in the yellow panel at the top of the page.
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Sir Andrew Dillon
18th July - King;s Fund - 5.30pm
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Health Chat
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A presumed infectious event in England and Wales 2014-5 lead to higher deaths in those with neurological and other disorders.
Fascinating, journal must read as usual.
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - Not-Monitor will cap staff expenditure in an attempt to stop runaway agency costs.
>>  I'm hearing - pharma concerns about Brexit.  companies doing clinical trials can run multi-country studies by registering on on EU data base.  Post Brexit it looks like they will have to make multiple applications.
>>  I'm hearing - Brexit means we will be outside the European Medicines Agency that approves drugs for use in the EU.
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