NICE… giving guidance on interventions of uncertain value and providing clinical guidelines and clinical audit packages… NICE’s decisions are based on an assessment of the technology, usually prepared by independent researchers commissioned by the Health Technology Assessment programme. 26 Although many commentators have argued that NICE has been a success, many have asserted that it is not an effective body for the allocation of resources.
Syrett has outlined ‘that there are doubts as to whether cost-effectiveness analysis, which is central to the decision-making process of the NICE Appraisal Committee, is consonant with societal values 27 while Sabin and Daniels argue NICE ‘should incorporate social value judgments into its recommendations to the [NHS]… it gives no priority to worst off (sickest) patients; it aggregates benefits, even trivial ones, so that curing headaches for many people might outweigh saving a few lives.
’28 Furthermore many commentators have argued that NICE reliance on Quality Adjusted Life Year (QALY) technique is an insufficient method of resource allocation. Bate et al assert that ‘even interventions with a low incremental cost per QALY still require extra resources. ’29 While Norheim asserted, ‘more work needs to be done on methods for quantifying the distribution of QALYs. ’30
Alternatives to current methods of resource allocation have been posed by a number of commentators from an ethical, economic and clinical perspective. Donaldson et al from the economic perspective suggest that PCT can eliminate waste of resources by implementing, ‘programme budgeting and marginal analysis. ‘ 31 Donaldson et al give an example of ‘a trust in the east of England[that] used this process to release resources from services that were of little value to mental health patients…
‘ 32 they assert that by not funding unnecessary services, financial resources were better allocated to greatly needed treatments. Furthermore Donaldson et al suggest that there is a tension between national decisions and local health needs; they suggest that there should be a greater focus on local resources allocation decisions which will help to ‘avoid the continuing cycle of boom and bust in health care’33 as these frameworks will be better tailored to these regional needs.
Norheim from the clinical perspective argues for an enhancement of the fairness of resource allocation decisions. Norheim asserts that patients with similar disease of the same severity should be given equal priority by clinicians. In addition Norheim outlines that clinicians, ‘should not always fight for more resources for their patients if this leads to lower priority for other patient groups with stronger claims. ’34 In furtherance to this he adds that clinicians should make transparent choices.
Daniels and Sabin from the ethical perspective argue that ‘decision makers should be accountable for the reasonableness of their decisions… ‘ that the process must be public (fully transparent) about the grounds for its decisions… ‘ and that, ‘decisions should be revisable in light of new evidence and arguments… ‘ 35 In light of the suggested changes to current resource allocation methods; litigation is not a viable means for resources to be allocated within the NHS.
Resource allocation should still be carried out by PCT while NICE guidelines should still be considered, however these bodies along with Health Authorities should create frameworks which are tailored to the needs of the different regional populations in Britain. 1 Keith Syrett, ‘Publication Review Human rights and Healthcare’ (2009) PL 192 2 Syrett (n1) 192 3 Syrett (n1) 192 4 R v North Derbyshire Health Authority, ex parte fisher (1997) 38 BMLR 76 (QBD) 5 Lloyds Rep Med 306 6 E. W. H. C. 2462 (Admin)