NICE was set up to make difficult rationing decisions about which drugs should be freely available on the NHS. So it inevitably comes in for criticism: it is tragic to limit free access to medicine, but it has to be done. However, NICE has failed to end the muddle of “postcode prescribing”, because clinicians do not have to take its views into account. This has led to desperate patients in some areas being denied treatment that they see others are receiving.

Decisions on cost grounds are inevitably complex. Unduly tortuous delays in decision-making are another matter. The charity CancerBACUP has pinpointed a series of unacceptable delays in approving cancer treatments that may deprive patients of potential life chances. It claims that the Department of Health is sometimes unaccountably slow in referring drugs and treatments to NICE in the first place. Then the institute takes at least a year to appraise each drug, and sometimes up to three years.

While doctors are free in theory to prescribe any licensed medicine, in practice few are confident enough. Some are behind the curve of new discoveries outside their speciality. All are under budgetary pressure. Most are thus reluctant to meet patient requests for a particular drug until they see the NICE recommendations. This makes it vital that recommendations are made as speedily as possible.

The impression given is that, under the current regime, even a wonder drug with truly magical properties would simply go to the back of the queue. CancerBACUP believes that treatments which prolong life or increase survival rates, especially where there are no alternatives available, should be fast-tracked outside the quango quagmire. This must be right. The charity also suggests that a group of independent experts should monitor developments in new cancer technologies, including those known to be in the manufacturers’ development “pipeline”.

This last idea could be taken farther. Child cancer survival rates increased dramatically when paediatric oncologists got together to increase the numbers of children in clinical trials for new drugs. The evidence has long suggested that patients in clinical trials fare better than their peers. It is time to consider how more adult volunteers might be involved in clinical trials. The effects of a new treatment are never certain, but that is no reason to deny desperate sufferers a last chance to survive.

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