Tuesday, 13 May 2008


BBC Breakfast is the only thing passable on when I wake up, so I have it mumbling along in the background as I fumble around in the dark, searching for something uniform-like to wear.

This morning (I think) there was the case of a woman whose mum died because she couldn't get a drug which might've extended her life for a few years (bear in mind I never really pretend to be fair and balanced, so my bias is bound to be showing through already). The mother couldn't get this drug due to the fact that NICE don't rate it good value for money. The daughter now goes around the country harassing parts of the NHS to get people similar treatments.

It all seems very noble until you look at it with a shred of realism in your cap. The NHS is an organisation with a finite budget. NICE (who, for the record, I think are a bunch of beancounting dolts who muddle through an arguably difficult job) try to get a fair deal for everyone. These rare, unused drugs are - shockingly - usually rare and unused. This keeps the expense up, generally. High expense reduces their value for money and value overall. Say, for example, rare drug X costs £10,000. It will help one person. Say operation Y costs £1000. 10 operation Ys can be performed for the price of one course of drug X. Very simple way of looking at things, I know. But see where I'm going with this? It's cost-VS-perceived value.

NICE, the NHS and the government in general need to strike a fine balance here. Of course, if the government didn't pay shitty private companies billions of squid for external sub-contracted services that don't work properly, drug X and operation Y might both be available in excess. But they don't, and they're not.

I discussed with DGN today the concept of living in the real world and being ruthless. We agree it's vital, as a nurse (and debatably as a person). If you can't be ruthless you'd be staying back every day to finish your notes, look after patients who have noone to talk to. The NHS takes advantage of the caring nature of the caring profession, which is plain unfair and burns too many good nurses right out. But, then again, maybe that's value for money. And maybe I look like a hypocrite.

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