The NICE clinical guideline on fertility covers: * the best forms of treatment for people who have problems getting pregnant * ways of treating people who have a known condition or reason for their fertility problems * ways of treating people when no reason for their fertility problems can be found
This paper examines the law relating to healthcare resource allocation in England. The National Health Service (NHS) Act 1977 does not impose an absolute duty to provide specified healthcare services. The courts will only interfere with a resource allocation decision made by an NHS body if that decision is frankly irrational (or where the decision infringes the principle of proportionality when a right under the European Convention on Human Rights (ECHR) is engaged). Such irrationality is very difficult to establish. The ECHR has made no significant contribution to domestic English law in the arena of healthcare provision.
All patients in England suffering from a disease which causes blindness are to get access to a sight-saving drug. Lucentis treats age-related macular degeneration, the leading cause of sight loss in the country.
The NHS drugs watchdog has loosened the terms of approval for expensive treatments that extend life in patients with a short life expectancy. Drugs that would normally be ruled out of use on the NHS because they did not represent a cost effective use of resources are now more likely to be made available.
NICE has introduced new criteria for appraising end of life treatments. James Raftery looks at how they might affect availability by applying them to previously refused drugs
The NHS's spending watchdog acted unlawfully when it decided to restrict access to drugs that could help thousands of older women with the bone-thinning disease osteoporosis, the high court ruled today. A judge ruled that the National Institute for Health and Clinical Excellence (Nice) wrongly failed to disclose the economic reasoning behind a decision in October to restrict the supply of strontium ranelate, a drug manufactured by Servier laboratories under the brand name Protelos.
A therapeutic programme hailed by ministers as a hi-tech, cost-effective solution to Britain's growing problem of depression and anxiety has been widely ignored by the NHS, leaving hundreds of thousands of people without access to treatment. Opposition politicians and charities have accused the government of creating a postcode lottery.
Comprehensive guidance for doctors on care at the end of life, including difficult decisions on when to provide, withhold, or withdraw life prolonging treatment, will go out for consultation from the UK’s General Medical Council in March. The draft guidance was approved by the council at its February meeting, subject to minor amendments. The consultation will be launched in the week beginning 23 March and will end in July. The new advice takes account of the Mental Capacity Act 2005; government strategies on end of life care in England and Scotland; GMC guidance in 2007 on consent; recent research; and a Court of Appeal judgment on a legal challenge to the GMC’s 2002 guidance Withholding and Withdrawing Life-Prolonging Treatments (Burke).
Aims: This Handbook represents initial good practice guidance and resources to help PCTs to review current decision-making processes about the funding of medicines with co-operation from Provider Trusts and other stakeholders. Intended audience: Healthcare professionals. Publication history information: Published February 2009. Access: Available to the general public.
The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies. The main focus of the Library is on guidelines produced in the UK, but where no UK guideline is available, guidelines from other countries are included in the collection. NICE issues guidelines of very high quality. They are based on a systematic review of the evidence and have extensive consultation not only with clinicians but also with patients and, where relevant, industry. Professional associations do not have the resources to carry out this type of consultation but they can follow the principles set out in the AGREE protocol which helps guideline writers minimise bias, meet the needs of all stakeholders and maximise clarity.
A trainee teacher with primary refractory Hodgkin’s lymphoma has launched a High Court action against her primary care trust, NHS Surrey, which has refused to pay for her treatment with an unlicensed drug. Philippa Bigham, aged 28, from Frimley, Surrey, has been given a prognosis of two years’ survival without a bone marrow transplantation. But her medical team at the Royal Free Hospital in London want her to have treatment with radiolabelled basiliximab, a monoclonal antibody conjugated with radioactive iodine and also known as CHT-25, before she has the transplantation. The primary care trust has refused to pay for the drug, which costs £3000 ({euro}3500; $4900) for a course of treatment. Basiliximab is licensed in the United Kingdom for use in renal transplant rejection but the radiolabelled version is not yet licensed.
A LESBIAN couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals. The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians. The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility. From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.
The government says it will ban all private transplants of organs from dead donors in the UK. The move comes after media reports of overseas patients paying to get onto the waiting list for organs donated by British people. An independent report said organs were scarce and no one should be able to pay for transplants, to ensure NHS patients did not miss out. Surgeons said it should reassure people organs went to those in most need.
More than 80% of NHS primary care trusts in England fail to offer the recommended three free cycles of IVF to infertile couples, an MP has claimed. The Department of Health says 30% of PCTs provide three cycles of the fertilisation treatment. But Tory MP Grant Shapps, who has contacted every PCT, says these figures are out of date. A "postcode lottery" operates, with rules on age, relationships and other children varying widely, he insists. In some cases women who would be deemed too old for treatment by one PCT would be seen as too young by another.
The government has announced a ban on patients paying for private transplant surgery using organs donated within the NHS. Ministers have accepted the recommendations of an independent report commissioned by the government after concerns that foreign patients were bypassing lengthy NHS waiting lists by paying up to £75 000 ({euro}90 000; $130 000) for a transplantation. Earlier this year it was revealed that the livers of 50 British NHS donors were transplanted into foreign patients over a two year period, with the bulk of the operations taking place in London at King’s College Hospital and the Royal Free Hospital.
Patients with rarer forms of cancer may have been denied potentially life-saving drugs due to a postcode lottery, campaigners said today. A study by the Rarer Cancers Forum found patients faced a postcode lottery when requesting drugs that had not been licensed for their condition, with many people being refused treatment.
A distraught Newtownards father is today set to take his battle for a liver transplant for his severely ill son to the High Court. But while his legal team argue for a judicial review of a rule requiring alcoholics to be off drink for six months before being considered for a life-saving transplant, devoted dad Brian Anderson will travel to King’s Hospital in London to see his son Gareth.
Northern Ireland Health Minister Michael McGimpsey has said he cannot change organ transplant rules to allow Gareth Anderson to be added to the waiting list. Mr McGimpsey said guidelines state that he has to be alcohol free for six months before going on the organ list. “There are not enough livers to go around and the reason behind that guidance is that to be sure that precious gift isn't destroyed by alcohol immediately after, or soon after, the transplant occurs,” he said.
The 2009 Equality Bill will, if enacted, make age based discrimination in the provision of health care and social care illegal for the first time in the United Kingdom. In a speech in 2008, the then health secretary, Alan Johnson, said, "Old age is the new middle age. Health and social care services need to adapt to the changing needs of today’s older people . . . to promote health in old age and help older people to maintain independence and quality of life."
A man serving a life sentence for a double murder has won a High Court victory over his right to have cosmetic surgery on the NHS. Denis Harland Roberts, 59, currently in a Co Durham jail for killing an elderly couple in East Sussex in 1989, wanted treatment to remove a birthmark. An undisclosed policy operated by Justice Secretary Jack Straw had restricted non-urgent inmate treatment. The case may mean other inmates are considered for similar treatments. However, the Prison Service said it was still "entitled to refuse escorts to hospital on grounds of risk". On Wednesday, London's High Court declared the justice secretary acted unlawfully and "contrary to good administration" in failing to disclose his full policy on medical appointments.
The refusal to move a pre-operative transsexual prisoner from a men's jail to a women's prison is a violation of her human rights, says the High Court. Deputy Judge David Elvin QC quashed Justice Secretary Jack Straw's decision to keep the 27-year-old, who cannot be identified, in a male prison.
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.
The Labour party is urging the Scottish parliament to take action to standardise IVF provision across Scotland, after Labour MSP Jackie Baillie discovered wide disparities in provision between the 11 Scottish NHS boards. Ms Baillie contacted all of the boards after having been approached by a constituent who was upset about the length of IVF waiting lists where they lived.
With a national shortage of organ donors, the dilemma faced by surgeons is whether a transplant with what are called "marginal" organs from donors who could be higher risk, such as the elderly or patients with a history of cancer or drug abuse, is better than leaving a patient on a waiting list where they could die before a suitable donor can be found. Figures disclosed to File on 4 reveal that in 1998 13% of donor organs were "marginal", 10 years later this percentage had doubled. Everyone in the transplant field who has talked to the programme agreed the quality of organs from deceased donors was declining, accepting this meant added risks connected to the hearts, lungs, livers and kidneys used for transplants. As one doctor put it, this is a calculated gamble. Arising out of this comes the issue of informed consent. Who should have the final say whether an organ from a dead donor should be used, the professional or the patient?
A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute of Clinical Excellence (Nice) provisionally ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body's Scottish equivalent has recommended patients in Scotland be treated with the drug.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
The medicines watchdog, NICE, is to lose its power to turn down new medicines for use on the NHS. It will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends, the Department of Health has confirmed. Instead, groups of GPs will decide whether a drug should be funded or not. Ministers hope to make new drugs affordable to the NHS by negotiating with pharmaceutical companies on price. The plans, called value-based pricing, are set to come into effect in 2014. They are subject to consultation.
All new IVF treatment will stop in Surrey as the NHS tackles a deficit this year of £125m. The board of NHS Surrey met in Cobham on Friday to look at how to tackle "serious financial challenges". A spokesman said current courses of IVF would continue and women nearing 40 would still be considered, with IVF policy to be reviewed next November. NHS Surrey is also no longer funding some treatments including acupuncture and some cosmetic procedures. Treatments which would no longer be funded included male baldness, facial blushing, tattoo removal and spinal epidural injections for chronic back pain.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.
In the recent White Paper, Equity and Excellence: Liberating the NHS, there is a commitment to providing better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. In the Atlas, Right Care presents a series 34 of maps of variation selected from topics which National Clinical Directors and others have identified as being of importance to their clinical specialty. We have worked with a wide range of teams in the Department of Health, Observatory network and primary care organisations to create this Atlas.The Atlas also contains a guide to the tools and data available for analysing health investment.
Hospitals in north Merseyside are planning to use the anti-trespass powers used to ban “hoodies” from shopping centres to shift patients who are blocking beds. NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed. A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.
A cancer patient who was supposed to receive regular check ups says he was devastated when he was finally seen and told the disease had spread. Retired teacher Henry Clark from Narberth, Pembrokeshire, needed three-monthly check ups at West Wales General Hospital, Carmarthen. But "serious failures" meant he was not seen for more than a year. Hywel Dda Health Board has been criticised for what happened and has apologised.
A 22-stone ex-policeman trying to persuade a health authority to fund obesity surgery started the latest round of his legal fight today. Grandfather Tom Condliff, of Talke, Staffordshire, who is 62 and 6ft 2in, says he needs stomach surgery to save his life. But the North Staffordshire Primary Care Trust (PCT) refuses to fund a laparoscopic gastric bypass operation. In April, the High Court refused to quash the PCT's decision not to provide the surgery. Today, Mr Condliff's lawyers sought to overturn the High Court ruling in the Court of Appeal.
A 22-stone ex-policeman has lost his Court of Appeal fight to force a health authority to fund obesity surgery. Tom Condliff, 62, said he needed a gastric bypass operation to save his life after becoming obese due to the drugs he takes for long-term diabetes. The Stoke-on-Trent man challenged a decision by North Staffordshire PCT to refuse to fund the procedure. Court judges expressed "considerable sympathy" but ruled the funding policy did not breach human rights laws. Lord Justice Toulson, one of three judges sitting on Wednesday, said: "Anyone in his situation would feel desperate." Mr Condliff, of Talke, who has a body mass index (BMI) of 43 - not high enough under his PCT's rules to qualify for surgery - lost a High Court battle over the decision in April. But his lawyers had argued the PCT had applied a funding policy which was legally flawed and breached his human rights.
Tom Condliff, who weighs 22st, was not considered fat enough to have a gastric bypass operation by his local Primary Care Trust and both the High Court and the Appeal Court ruled that its decision was lawful. But less than a month after his latest setback, the 62 year-old from Staffordshire has been told that his latest “individual funding request” has been successful on the grounds of his exceptional circumstances and he will now be treated. He told the BBC: “I am very, very pleased about the PCT's decision but at the same time I am rather concerned that I haven't changed since the last time the request for IFR in September last year, was put in. “It was turned down then. So I don't know why it has been granted this time. “I am looking forward to being able to get out of the house and to enjoying myself and having a decent quality of life.”