For those who follow elections closely, party manifestos are compulsory reading. In some policy areas they set out very specific intentions, in others they offer an overall feel, and in yet others there is a veil of silence. The manifestos of the three main UK parties, as they relate to the future provision of medicines, are no exception.
The Labour manifesto is limited, terse and explicit. If elected, Labour “will guarantee the legal rights of patients, wherever they live, to all treatments and drugs approved by NICE for use in the NHS. We will continue to improve the process of approving new drugs and treatments so that these can be made available to NHS patients more quickly. We will ensure all leading drugs available internationally are assessed by NICE and those which are deemed effective will be available within six months of referral.”
The Labour Party introduced NICE in 1999, have championed it through thick and thin, and are not in a mood to waiver now. After eleven years of development (helped along by two select committee inquiries), the institute is seen by some (certainly me) as a bedrock (perhaps even a jewel) of medicines provision at least in England and Wales (there are other arrangements in Scotland). Interestingly, there was no mention of NICE it in the 1997 Labour manifesto!
The position of the Conservative Party is very different. Against a background in which they will ‘decentralise power’, and in which patients will be “put in charge of decisions about their care,” and “doctors and nurses to get more decision-making powers,” the Conservative manifesto states: “We want more people to access the drugs and treatments that would prolong or improve their lives by reforming the way drug companies are paid for NHS medicines. We will create a Cancer Drug Fund to enable patients to access the cancer drugs their doctors think will help them. To help the fight against cancer further, we will give thousands more people – especially young people – access to effective drugs to treat rare cancers by changing the way these drugs are commissioned’. Elsewhere, David Cameron told the Daily Telegraph that, under the Conservatives, drugs for cancer could be “prescribed by their consultant – whether or not their use is backed by the NHS rationing body.”
Finally, turning to the Liberal Democrats, their manifesto makes no mention of medicines and their provision at all!
What does all this mean? Assuming we can trust pledges in party manifestos to materialise, Labour will continue with its current arrangements regarding medicines provision although with some improvements. They would broaden and accelerate drug revues by NICE and speed the provision to the NHS of NICE-approved drugs. The Conservatives, however, plan real changes. At a very minimum they would introduce schemes that bypass NICE, at least for cancer drugs, with the very obvious risk of undermining NICE’s work, eroding its influence and introducing post-code prescribing as decisions are left to local policy makers.
More worryingly, if their proposals were developed more broadly, the Conservatives have in their manifesto the basis for scrapping both NICE and the current drug pricing arrangements and leaving medication provision open to the free market and with no nationally coordinated policy. To me that would be a nightmare.
Finally, if the Liberal Democrats were to form the next government it would seem from their silence that they would not change the current arrangements, or at least not immediately.
In the provision of medicines in England, Wales and Northern Ireland, the manifestos suggest that there is a real choice between the parties at Westminster.
Joe Collier is emeritus professor of medicines policy at St George’s, University of London