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EDITIONS
Monday, 9 September, 2002, 16:44 GMT 17:44 UK
Schizophrenia policy 'unworkable'
Drugs dose
The new drugs are expensive

New guidelines for the treatment of schizophrenia are likely to be at best unaffordable and at worst unworkable, say experts.

The National Institute for Clinical Excellence (NICE), the body which advises the government on the appropriate NHS treatment and care of patients in England and Wales, has spent months drawing up clinical guidelines for the treatment of the condition.


It is no longer tolerable when you have one good treatment and one treatment that's clearly inferior to give people the inferior one

Dr Andy Clayton
But there is growing concern that the NHS just won't be able to deliver.

Schizophrenia affects more than 400,000 people in the UK. Among them is John Taylor, who has struggled with the condition for almost a decade.

It has taken years to get appropriate drugs which allow him to live a normal life.

"It's still a lottery people don't get the kind of hope and recovery stuff as early as they should."

John helps to plant trees at a mental health project in Derbyshire as part of his therapy.

Limited opportunities

He enjoys the work, but is keenly aware that others are denied such opportunity.

"There are definite gaps, definite gaps in not having enough places to go.

"Just hanging around the bus station or sitting on the bank of a river isn't the best option for people in this day and age."

The new clinical guidelines for the treatment of schizophrenia are designed to ensure that all patients, wherever they live, have access to the best possible care, and to schemes similar to that in which John takes part.

When NICE recommends a drug, the NHS has to fund it within three months. But for more broad-based clinical guidelines - which include suggestions on other types of therapy, and how soon a patient should see a doctor - there is no such obligation.

And NICE's chief executive Andrew Dillon warns that some parts of the NHS will struggle to implement the new recommendations.

Much to do

"For some parts of the country there's going to be a lot to do so they need to look carefully at how they're going to fit that work in given all the other priorities that they have quite properly for people with other conditions and diseases who also need local NHS services."

Dr Andy Clayton, the medical director of the local mental health trust in Derbyshire, will have to sort out those priorities.

In principle he says the guidelines are a good thing. In practice they are already causing him difficulties.

Derbyshire should have 40 psychiatrists working in the NHS, but at present there are at least six posts vacant.

"One of the problems of guidance like this is that you can sometimes end up robbing Peter to pay Paul.

"If we have to fully implement the full treatment for patients with schizophrenia inevitably some other groups that we currently look after may end up with a lower level of service and that's something that morally and ethically I feel is inappropriate."

Expensive

Dr Clayton's trust has calculated that simply funding the new more expensive drugs NICE recommends to treat schizophrenia will cost an additional 3m pounds a year.

"As of today we don't have the cash to do that and if I got all of my doctors to implement those guidance today by the end of the year I'm afraid we'll be a bit in debt.

"I think a way has to be found in this case to get the money to fund these new drugs.

"It is no longer tolerable when you have one good treatment and one treatment that's clearly inferior to give people the inferior one."

And that's the big worry for mental health campaigners. Unless more money is found for many patients, nothing will change.

Paul Farmer, of the schizophrenia charity Rethink, said: "We sympathise very much with trusts who look at a guideline see the cost tag and then look at their current budget which is still, despite additional investment, not looking very promising in terms of their ability to deliver best practice in mental healthcare.

"And from the individual's point of view who now has this guidance in their hands there will be a degree of confusion about why this guidance isn't being implemented in their area."

What's more, he says, if that turns out to be the case, and the new national clinical guidelines for schizophrenia are only implemented piecemeal then what's the point of them?

Louis Appleby, the government's Mental Health Czar, said the NICE guidance would iron out inconsistencies in care across the country.

He admitted that there were problems both with funding, and a shortage of expert mental health staff.

But he said measures were underway to recruit and retain more psychiatrists.

 WATCH/LISTEN
 ON THIS STORY
Mental Health Clinical Director Louis Appelby
"In the past there has been wide variation in availability of these new drugs"
The BBC's Chris Hogg
"It's taken John Taylor years to get appropriate drugs which allow him to live a normal life"
See also:

25 Jun 02 | Health
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