Beleaguered NICE is powerless to call off postcode lottery

Since its draft decision not to approve four drugs to treat kidney cancer, the National Institute for Health and Clinical Excellence has endured relentless assault.

The extremes of abuse have been astonishing. The torrent of invective has included an oncologist referring to NICE's "bloodstained portals" and a Daily Mail letter writer employing extraordinary mental gymnastics to link the decision with Abu Hamza's fight against extradition.

This week Panorama pitched in with an examination of the postcode lottery. The once great current affairs flagship is now shorn to 30 minutes to match our depleting attention spans, but it still managed to highlight several issues undermining confidence in the NHS.

Drugs funding

The central theme was wide variation in primary care trusts funding drugs that have not been approved by NICE.

The programme fed public ignorance by not bothering to give the issue a sense of scale. The NHS prescribes millions of NICE-approved, cost effective, efficacious drugs every year; controversy attends a tiny fraction of potential prescriptions.

But the stories of patients in that fraction were moving - who could fail to be touched by the words of a woman in her thirties preparing for her wedding while discussing her funeral?

Patients were interviewed who were suffering from the same illness, seeing the same consultant but receiving different treatments depending on whether their PCT would fund a particular drug.

Should NICE issue guidance to PCTs on the exceptional circumstances in which they would be justified in funding a non-approved drug? Chief executive Andrew Dillon believes national guidance would be appropriate, ensuring a consistent deal for patients across the country.

Both perspectives

On the face of it such guidance would have benefits. It would give PCTs a benchmark for judging applications, give them cover when justifying decisions and reduce variation.

But there are downsides. Guidance could be expected to tightly limit the circumstances in which funding would be acceptable. So patients may well get consistency - a consistent "no".

It would also reduce the leeway for doctors to argue the unique circumstances of a particular patient; exceptional cases, by definition, do not fit national rules.

And, crucially, it would undermine the ability of PCTs to make decisions for the benefit of patients; whether by saying yes, or by deciding funds are better used elsewhere.

There is no cure for the postcode lottery.