Her submission for the prize was an essay entitled: 'Applications of the Understanding of Neuroplasticity in the Advancement of the Treatment of Neurological Conditions.'
As part of the award she was invited to review the book 'NICE at 25: a quarter century of evidence, values and innovation by Emeritus Professor Peter Littlejohns, King's College London, former public health theme lead for ARC South London.
My sister has severe cerebral palsy, and while growing up I had many questions about her condition: why couldn’t she walk? Why couldn’t she talk? These questions stimulated a more profound interest in the field of neuroscience. Having completed my ‘A levels’ at Gowerton Comprehensive School, I have commenced studying neuroscience at King’s College. What fascinates me so much about the brain is its ability to change and adapt throughout its lifetime. The brain’s ability to rewire itself due to neuroplasticity offers the potential of many different treatments for conditions like traumatic brain injuries, neurodegenerative disease and psychiatric conditions. One of the reasons for NICE to be established 25 years ago was to support innovation and it was a great pleasure to be given the opportunity to read the recent book and comment on how the National Institute for Health and Social Care has evolved over the years and perhaps consider what it needs to do to help new scientists like me in the future.
As a young person who has grown up only knowing the times of austerity, Brexit, Covid-19 and a cost-of-living crisis it was fascinating reading about the establishment of NICE and its early days. How in 1999 it represented the cornerstone of a new Labour government’s policy to reform the NHS. The Institute was to improve and reduce variation in quality of care by distributing guidance on best practice, ensure that the new investment that came into the NHS was well spent on cost-effective interventions and to speed the uptake of innovative interventions. Witnessing the same rhetoric today with the current Labour government makes me hope that the restoration of the NHS that was witnessed under Tony Blair can be repeated and NICE can continue to play its part.
Because of the nature of NICE’s work it was always going to be controversial. Talking to Professor Littlejohns, the founding Clinical and Public Health Director, he said that they were more worried if guidance was developed that was not controversial, as that was the main point of NICE.
The Institute was there to address issues that other institutions avoided - no controversy meant that NICE would not really add value. However, I was personally, shocked by how economics-driven NICE’s decisions actual were. It made it easy to understand why it had faced repeated criticism over not funding treatments for cancers, multiple sclerosis and other conditions.
As long as, NICE rejects any treatments based on economic grounds it will always face criticism. But what really stood out for me was the controversy over the Highly Specialised Technologies (HST) protocols. Where do you draw the line that makes a disease ‘rare enough’ for extra funding? One of NICE’s founding principles was to tackle disparity in access to care. But surely this in itself creates further issues with regards to access to provision? It seemed to be that NICE still has a job to do to explain and justify the use of a Quality Adjusted Life year. The Economics chapter was the most difficult to understand.
As I have said reducing the disparity in access of care, the so-called postcode lottery of healthcare was one of NICE’s founding principles. Though the problem may have been remedied slightly since NICE’s creation, differing lengths of waiting lists and differing wait times between health boards, means continuing disparity in access.
As a young person wishing to work in the scientific field, this will certainly affect where I may wish to live and continue my studies in the future. Though NICE’s work may have remedied some of the healthcare ‘postcode lottery,’ there is still much work to be done.
One particularly interesting aspect was the impact that politicians could have (albeit Prime Ministers) on an institution such as NICE. David Cameron’s decision to promise the creation of a Cancer Drugs Fund (to fund cancer drugs NICE said no to) in his manifesto in 2010 was a key example. His decision caused great anxiety within NICE, by undermining several of its key principles. However, the Cancer Drugs Fund, soon proved to be unfordable and worsened regional disparities in access to health care. It ceased to be a threat to NICE and the Institute was asked to take it over. However, these occasions of interference were rare, both politics and the judicial system have displayed a reluctance to intervene in NICE, which was a key feature in its longevity.
One instance of the judiciary system being used against NICE did stand out. R (Fraser) v NICE, 2009 EWHC 452 This interested me because it seemed so obvious that people with chronic fatigue syndrome needed other treatments, not just Cognitive Behavioural Therapy and exercise. It raised the question of whether NICE’s focus on economic impacts of treatments and the nature of the evidence it used has led to some patients being denied treatment that they need and also, whether NICE needs to adjust its decision making to reflect the impact of a condition on the patient’s life, and perhaps take a more personal approach to treatment funding because though the decisions may not be personal, the effects that they will have are certainly personal.
In the future, I hope that NICE expands its outreach so that more people understand the institute and its role in the NHS. Particularly in the young population. Until reading NICE at 25 I didn’t have a true understanding of NICEs position in the NHS and its role assessing treatments and supporting innovation in the scientific field. It is interesting to see that the present Secretary of State for health is advocating strongly for a major role of the NHS in driving innovation in the health care sciences As a Neuroscience student hoping to go into research, I applaud this and think it is vital to understand how the institute can contribute to this endeavour.
The new Labour government has recently launched a consultation on how the NHS should be reformed Members of the public as well as NHS staff and experts are invited to share their experiences, views and ideas for fixing the NHS. The future role of NICE needs to be part of this debate in order for it continue to be a key part of the NHS for another 25 years.
It is interesting to see that the present Secretary of State for health is advocating strongly for a major role of the NHS in driving innovation in the health care sciences. As a Neuroscience student hoping to go into research, I applaud this and think it is vital to understand how the institute can contribute to this endeavour.
Having been steeped in NICE issues for 25 years it is refreshing to view it from the perspective of someone who has intimate understanding of health issues and an enthusiasm for the power of scientific research to bring about change, and yet was not even born when NICE was established. Nia raises 3 key issues. First health disparities still exist and it is likely that broad policies rather than specific interventions are required to bring about change. Second, bringing money into the decision of who receives health care will always be contentious.
It is apparent from Nia’s views on this that the Institute needs to continually debate and discuss with the public and professionals its rationale in order to maintain credibility. Prioritising health care through the assessment of value for money remains a key way to improve health care for all. Third the inclusion of innovation into health care is key to improvement in quality but needs to be carefully managed in order to ensure it adds real value. As Nia highlights the current secretary of state in a number of recent speeches has made this a main feature of the narrative behind his reforms and 10-year plan, He links this to the NHS itself being an “engine for growth”.
As well as the role of research in achieving growth he emphasises that a healthy work force is a prerequisite to a healthy economy. He has already announced significant resources directed at new technology to detect cancer
While few would dispute this approach it does raise issues of where the future NHS priorities will be directed. In a Nuffield Trust blog, Gainsbury raises a concern that this could lead to perverse incentives when prioritising health care provision.
She rightly highlights that a healthy work force is but one of a range of objectives to which the health system aspires and concludes that a transparent framework for working through and balancing different principles underpinning prioritisation decisions is what is needed. She suggests that a national conversation on the NHS’s future could take place alongside the 10-year plan. This discussion should involve public input on the values guiding the allocation and prioritisation of scarce health care resources.
In our ARC South London research we have described such a framework We have shown that involving the public in generating the principles underpinning the frameworks is crucial to their credibility but applying any framework in routine commissioning is problematic and will need considerable support to make it work
We have also suggested that if the reforms that Wes Streeting is hinting at are as radical as purported then a new social contract between government, the health service and people will need to be created.
We have shown that involving the public in generating the principles underpinning the frameworks is crucial to their credibility but applying any framework in routine commissioning is problematic and will need considerable support to make it work.
