Friday, August 04, 2006

Hepatitis C and the NHS

Hepatitis C and the NHS

First the good bits!
The standard of care and treatment in the NHS is the envy of most countries with good reason. It would be difficult to find a more skilled, dedicated and professional work force in any institution worldwide. They obviously suffer from the normal cash shortage that any health institution is bedevilled with, but then, health care is a bottomless pit into which any amount of money can be poured. All in all the staff do an excellent job, and the NHS itself is good value for taxpayers money.

Now the not-so-good!
Despite employing some of the best specialists worldwide in the treatment of Hepatitis C, the powers-that-be then proceed to stifle all the available expertise by dictating to the professionals exactly how, when, and with which medication every patient will be treated. The standard treatment is dictated to the professionals by NICE, the National Institute for Clinical Excellence. The professionals are allowed no room for experimentation whatsoever, and their ability to customise treatment for a particular patient is extremely limited. If your condition falls within the NICE guidelines you will be treated in exactly the way the guidelines say. There are no other options. The good part of this is that patients falling inside the guidelines are guaranteed treatment, and the treatment will be to the official standard and represent good value for money to the NHS. The bad bit is that if you are outside the guidelines, or if your particular case requires different treatment you could be in trouble. There are mechanisms which allow treatment variations, but they are rarely used as they require individual documentation and justification for each patient.

The net result of all this is that there is virtually no experimental treatment of Hepatitis C carried out in the UK. Formal trials are virtually impossible to fund unless a drug company chooses to do so, and they are few as the drug companies treat the UK as a small market, and know that even if their trial is successful, they will still have to battle with NICE to get it accepted. There will be virtually no funding available for experimentation with different combinations of existing drugs or different doses. We are not moving forward in our treatment of Hepatitis C whatsoever. Any patient who has been through the normal course of treatment without success has nowhere left to go. NICE does not allow any further treatment.

I propose the following:-
NICE to set up a Treatment Review Body for Hepatitis C consisting of no more than three experts nominated by NICE. This review body would be empowered to sanction variations in standard treatment on a case by case or 'small group of patients' basis, and would recommend changes to NICE guidelines if it considered them appropriate. The review body would be expected to respond within two working days of any application for treatment variation. This would allow some variation in treatment in difficult cases, but would keep costs strictly under control.
The same review body would also be able to sanction small scale trials of variations on existing treatment if a proper case was made for them, and the review body was convinced that such work was sufficiently different to that already carried out elsewhere.
The Government to allow, subject to approval by NICE, double the full cost of any Stage 3 drug trial carried out in the UK by a drug company to be offset against taxation of profits earned in this country. This subject to the condition that the intended use of the drug is to treat serious or life-threatening conditions. This would vastly speed up the process of testing and approval of drugs as the UK would become a viable proving ground.

We should institute a policy such that every person who submits a blood sample for any test will have that sample tested for Hepatitis C and HIV unless the person is already on file as having done so. This will not inconvenience any patients at all, nor impact on their civil rights. It will save lives at minimal cost. If we can test every blood donor's donation, why can't we test anyone who is giving a blood sample? We should give serious consideration to compulsory testing of the entire prison population for their own good, and that of fellow inmates.