When should the State withhold an expensive, potentially life-saving treatment from a few people in order to pay for cheaper medicines for many more? It is a question that would have troubled Solomon, and one that the National Institute for Health and Clinical Excellence (NICE) wrestles with every day. As a result it has acquired a reputation as the agency with power to put a price on life, and to decide when death is due. It does indeed assign numerical values to years of healthy human life, with and without drugs, as its chairman, Professor Sir Michael Rawlins, explains in an interview with The Times today. But it would be very wrong to conclude that a single advisory body to the NHS is the average person’s only gateway to the extraordinary advances in modern medicine.

Last year the Government was embarrassed by the courts and this newspaper, among others, into ensuring that Herceptin, the £20,000-a-year breast cancer drug, was made available on the NHS. The outcome was the right one even if patients had to wait too long and individual NHS trusts were left to pay for it. But dozens more drugs of similar complexity and cost, including a new generation of biological cancer treatments, are coming down the regulatory pipeline towards NICE and the NHS. And they will not all be affordable through the simple waving of a ministerial wand. If the public is to benefit from them, government, the pharmaceutical industry, the voluntary sector and, above all, patients themselves must face up to some uncomfortable realities about their cost.

Drugs account for some 13 per cent of total NHS spending. Inflation and an ageing population will put steady upward pressure on that figure in the coming years. But the hiring of 250,000 extra NHS personnel under this Government has left little room for manoeuvre by Department of Health accountants unless they are to shed staff on a large scale.

There is a strong case for doing just that. Too much of the extra £30 billion lavished on the NHS in the past eight years has been spent on expanding the service rather than reforming it, and in particular on over-generous pay deals for managerial staff. Only £1.2 billion, according to Professor Rawlins, has been spent on drugs recommended by NICE. Given that surgery and advice are the only other forms of therapy that doctors can offer, this is not necessarily excessive.

There should be room to rebalance health service budgets. In practice, significant NHS redundancies are as politically implausible as the idea of a minister exposing herself to the charge of manslaughter by vetoing the use of a life-saving drug. This is why Professor Rawlins cautions today that a significant overall increase in NHS spending may soon be unavoidable despite the Chancellor’s insistence that his largesse is coming to an end. Such an increase would certainly make NICE’ s job easier, but it is not the only course.

Ministers should not be expected to adjudicate in individual life-or-death decisions about drug funding. Indeed, NICE was set up to do this for them. But they should make clear in general terms that the existence of costly and sometimes life-saving treatments does not bring a universal entitlement to them. It should not be political poison to suggest that drugs of marginal benefit can be used at patients’ discretion — and expense; nor that charities be encouraged to be more directly involved in funding drug therapies that the NHS cannot afford. At the same time, sensible life choices can steadily lower the service’s overall burden. The more sensible we are, in fact, the nicer NICE can be.