A symposium held by the Health Economics Research Centre (HERC), found that many of the problems that existed within England’s National Health Service 60 years ago remain to this day.
The symposium, Pharmaceutical policies in the long run: Reflections on the 60th anniversary of the Hinchliffe Report, held on 11 November, was attended by around 80 people. Delegates discussed the Cost of Prescribing (Hinchliffe) Report, published in 1959, which was the result of almost two years of work by the Committee on the Cost of Prescribing, chaired by Sir Henry Hinchliffe. The British government had tasked the committee to investigate rising pharmaceutical expenditure following the introduction of the NHS. The report made several landmark recommendations: sustainability of pharmaceutical expenditure, generating and reporting of clinical evidence, training of medical practitioners, and the economics of drug development and marketing.
The event’s 14 speakers were from the NHS, the Institute for Fiscal Studies, the Office of Health Economics, and the Universities of Oxford, York and Bournemouth, and King’s College London. NDPH was represented by Professor Sir Rory Collins, and Professors Louise Bowman, Philip Clarke and Martin Landray. Several themes emerged, including a problem highlighted in 1959 – high cost drugs. The expensive drugs of the 1950s were anti-infectives used in primary care. Now they are hospital treatments for cancer and rare diseases, focusing on ever-smaller patient populations. Speakers presented possible funding decision frameworks for considering the trade-offs between health gain and stimulating innovation.
Darrin Baines, Professor in Health Economics at Bournemouth University, outlined how the prescription charge, introduced in 1952, had not realised expected savings, as patients and GPs changed their behaviour to avoid the ‘tax on illness’. Prescription charges were abolished in 1965, as recommended by the Hinchcliffe Report, but were reintroduced in 1968. Prescriptions are once again free in Scotland and Wales, and as a UK general election approaches, prescription charges are back on the agenda. Baines concluded that prescription charges have remained a challenge for successive governments.
Reducing research and development costs, to enable more evidence to be generated and to maintain profitability was another theme. The symposium considered the advantages of NHS data to streamline trials, the increased role of information technology, and the need for updated regulations, which Professor Landray noted are out of date.
Perhaps the most notable change in the past 60 years has been the introduction of the National Institute for Health and Care Excellence (NICE), which publishes guidelines on care and the use of drugs and technology. Expert bodies like NICE play a valuable role in evaluating clinical evidence for drug efficacy, rather than relying on individual clinicians to interpret what the Committee regarded as ‘extravagant sales propaganda’ from manufacturers.
The need for clinicians to be trained in health economics, and the influence of the Hinchliffe report on advertising regulations (as a result of its warnings on ‘extravagant sales propaganda’) were also addressed.
Professor Sir Rory Collins’ closing remarks on progress and diversity noted that the original Hinchliffe report called for “a permanent expert body, to include men with business experience”. He pointed out that 50% of the speakers at the event were women, as are many at NICE, that “permanent expert body”. NICE, he said, is an ‘extraordinary achievement’. He warned, however, of the dangers doctors around the world face in terms of a love of ‘novelty’ and ‘best available’ treatments, rather than what simply works and is good value, and suggested that NICE guidelines could be extended to other countries.
Dr Liz Morrell, Senior Researcher at HERC and one of the symposium organisers, said: ‘What made this symposium so interesting was the mix of people, and the wide range of presentations – it’s rare to discuss health economics, medicines shortages, trial regulation, drug marketing and training of doctors all in one day. Bringing this range of perspectives together helped stimulate new ways of thinking about an old problem.’