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Friday, August 6, 1999 Published at 13:07 GMT 14:07 UK


NHS rationing: The key areas

A drug to relieve flu symptoms will be scrutinised

BBC News Online examines which controversial treatments will be scrutinised by the National Institute for Clinical Excellence - and why they have been chosen.

From autumn 1999 onwards

Hip replacement

Prosthetic hips can cost anywhere between £200 to £2,000 or more, and the more expensive, modern models are not necessarily any better than the old, cheap ones.

NICE's job is to find out which one works best for and offers best value.

Hearing aids

Recent developments in hearing aid technology have made a big difference, but which aid you get can depend on where you live in the country.

Guidance from NICE will establish what is the minimum standard of hearing aid a patient can expect.

Wisdom tooth extraction

Many people every year have their wisdom teeth removed even though they are causing no problems - having such a serious procedure can cause complications, and NICE must decide whether the potential benefits outweigh the risks.

Cervical Smear Testing

[ image: Should checking smear tests be computerised?]
Should checking smear tests be computerised?
New technology, such as computerised smear test reading, could have a major impact on cervical cancer screening, but would cost a lot of money.

NICE will work out whether the possible advantages of more accurately reading slides are worth the investment, or whether the money could save more lives if spent elsewhere in the health service.

Coronary artery stent

Stents are devices placed inside heart arteries after they have been widened using a balloon placed inside the blood vessel. They are thought to reduce the risk of it narrowing again.

However, some experts say the technique is used inappropriately, and NICE has been asked to answer this question, as well as evaluate a lot of variations on the basic technique used by different surgeons to find out which get the best results.

Cancer chemotherapy using Taxanes

Taxanes are the class of drugs, derived from the yew tree, which include Taxol, a treatment for ovarian and breast cancer.

Taxol costs £7,500 per patient per year, and despite evidence that it prolongs life in ovarian cancer patients, some health authorities are still unwilling to pay for it - a classic example of "postcode prescribing".

NICE will attempt to give definitive advice on whether it gives enough benefit to justify the price to the NHS.

Multiple Sclerosis

[ image: There is some evidence that beta interferon works for MS]
There is some evidence that beta interferon works for MS
Interferon Beta, an MS treatment is expensive, yet there is growing evidence of its benefits in this previously untreatable degenerative condition.

However, many clinicians still feel it is not cost effective enough, and NICE will try to work out whether the NHS should pay.

It will also look at another MS treatment, Glatarimer, and may produce guidelines covering many more aspects of MS treatments.

Influenza drugs

Zanamivir (known as Relenza) and Oseltamivir, although not yet available in this country, are the first ever treatments developed against 'flu.

The NHS fears that demand for these drugs over the winter could leave it with an enormous bills, although the drugs could cut the length of 'flu attacks by days and save the economy money.

NICE is allowed to look at not just the cost to the health service, but the potential benefits to the country.

Asthma inhalers

NICE will look at the variety of devices available to asthma sufferers, but particularly children.

There is much debate on whether some of the more sophisticated of these are worth the money.

Heartburn Treatments

There is evidence that a class of drug called proton pump inhibitors, while effective for some heartburn sufferers, are being used inappropriately by doctors on patients who are unlikely to benefit from them.

NICE will issue firm guidance on who should get these expensive drugs, and who should not.

From 2000 onwards

Anti-inflammatory drugs

Anti-inflammatories are often used to treat bowel conditions such as inflammatory bowel disease and Crohn's disease.

A new type of anti-inflammatories, called Cox-II inhibitors, could work as well, but with fewer side effects, such as the ulcers caused by conventional treatments.

Definitive guidance from NICE would encourage doctors to use them in the right circumstances, as many will be unwilling to substitute a more expensive drug for a cheap one.

Keyhole surgery

Keyhole surgery is thought to make operations far simpler for patients suffering from a variety of conditions, such as hernia.

However, there are some concerns that it is wrong to use keyhole surgery to treat some conditions, and that it is far too expensive to use for others.

Wound care

The way wounds are looked after varies from hospital to hospital, and there is strong evidence that doing it the right way improves quality of life, and recovery time, and reduces the risk of infections.

The aim is to tell every hospital the correct procedure for dealing with surgery wounds.

Implanted defibrillators

[ image: Asthma inhalers for children are to be debated]
Asthma inhalers for children are to be debated
A tiny device implanted next to the heart, it can deliver shocks to correct abnormal heart rhythms.

But they are very expensive compared to drugs which do the same thing.

As the number of patients being given defibrillators is likely to increase, the NHS has decided that guidance should be given to make sure they only get given to certain patients who can benefit the most.

Treatment of cartillage injury

A revolutionary technique involves growing new cartillage cells outside the body from samples taken from a patient, then reimplanting them to treat joint injuries.

Doctors are worried that there is not enough evidence at the moment to prove it works.

Motor neurone disease drugs

Riluzone is one of the only treatments for MND, and has provoked a great deal of debate as to its efficacy.

NICE will look at the available evidence, and give guidance.

Hepatitis C treatments

On the horizon for this hard-to-treat disease is Ribavarin and alpha interferon, which should be licenced soon in this country.

Again, NICE hopes to be able to tell doctors whether it works and can be afforded by the NHS.

Obesity drugs

Any treatment for obesity opens up a potential funding nightmare for the NHS, given the large number of obese patients in England and Wales.

NICE will evaluate the evidence on recently released drugs such as Orlistat and Sibutramine.

Alzheimer's disease

Aricept and Exelon, the only currently-available treatments for Alzheimer's, will be under scrutiny by NICE.

Diabetes treatment

A new class of drugs for Type II diabetes are expected to by licenced late this year. Glitazones are thought to offer substantial benefits to many diabetics.

The government says NICE will ensure "appropriate targeting".

Unstable Angina

Yet another new drug class, called glycoprotein IIb/IIIa receptor inhibitors, is aimed at people admitted to hospital with unstable angina.

NICE will again evaluate.

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