NICE’s Gold Standard Status benefits the UK’s growth agenda – Government must ensure this is maintained

During my nearly 20 years at the National Institute for Health and Care Excellence (NICE), and in the period since, NICE has spearheaded pioneering initiatives in health technology assessment that have established it as a world-renowned and globally respected organisation. A lot has changed in this period – personalised medicines, genetic cures for rare diseases, medicines that work across many diseases – and on the whole, NICE has managed to keep up with the relentless pace of medical innovation in its methods and processes.

But the development of ever-more exciting medicines over the last few years, requires an equally agile and innovative HTA environment. Maintaining NICE’s podium status amongst HTA bodies is reliant on the wider public sector life science ecosystem and, importantly, Government as its sponsor, coming together with NICE to map out how best to  maintain pace with the outside world.

Front and centre for Government and NICE is reversing long standing viewpoints which have, as Wes Streeting recently put it himself, been based on a perception of “medicines spend as a bit of a deadweight cost”. Cost-containment is all well and good, if benefits to patient outcomes are also being factored into policy developments with equal weight. I have become increasingly worried that this might not always be the case.

NICE is quite rightly seen as beacon for fairness and objectivity in a highly charged drug pricing environment. To continue to be held in such high regard, it must be viewed as fiercely independent, obviously from the life sciences industry but also from direct political influence from government and perhaps most importantly from the NHS, our national ‘payer’ for health technology innovation. Being truly independent is not straightforward and NICE has to balance many powerful external voices.  Take the severity modifier now used by NICE in medicines evaluation. Would NICE have set the weighting for this modifier at the level it is if it did not have the policy constraint, set by others, of it needing to be cost neutral with respect to the ‘end of life’ modifier that it replaced?

Similarly, not being able to fully implement indication based pricing as business as usual for medicines with differing relative effectiveness across their indications ignores the fact that each indication for these medicines could be established as cost-effective using NICE’s world leading methods.

By the system viewing medicines as a cost to be contained, rather than an investment in better health, I worry that NICE’s robust and independent arbitration of value for money will increasingly be viewed as failing as the voice of cost control grows ever louder.

Having a world-leading HTA body like NICE isn’t just a nice-to-have for a bit of collective self-congratulation. It can help demarcate us as an attractive place for the billions in potential investment from the life sciences sector. With the US on the brink of a monumental shift in pharmaceutical pricing, shining a light on the UK as a forward-thinking place for health technology adoption at pace and scale could prove to be just the kind of helping hand that HM Treasury is looking for. Amidst the global turbulence for the life sciences sector, the UK could become a beacon of attractiveness.

The talent of my former colleagues at NICE in finding solutions to some of the most difficult issues in medicines policy helps to ensure patients access new medicines at a price that is sustainable for the NHS – but NICE can only continue to be a world-leading organisation if the ecosystem, including Government gives it the space and flex to be so.

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