NICE and a Not Nice Proposal

A proposal by the Department of Health that ‘wider societal benefit’ should be taken into account when considering whether the NHS should pay for a drug is being challenged by NICE, the National Institute for Health and Care Excellence. At first sight, it is a difficult question. When there are limited resources, we have to accept that we may not always be able to do all that we wish. If the cost of my cancer treatment has to be balanced against your transplant surgery or their psychiatric care, we know that one or other of us may come out the loser — not because of any ill-will, but because there isn’t enough money to do everything. We assume that deciding how to allocate resources will be done as fairly and as compassionately as possible, mainly on medical grounds, to produce the greatest good for the greatest number. Only now there is the suggestion that much more attention should be paid to how ‘productive’ in economic terms an individual is considered to be; and that introduces something new into the mix, something I myself find a little sinister.

The economic productivity of an individual can be measured in various ways. For the Government, the tax revenue to be gained from a highly paid, middle-aged executive is obviously much greater than that from someone who is elderly or unemployed. The potential long-term benefit from a young, highly-paid individual is even greater. But is that the only way in which ‘societal benefit’ should be measured? The elderly, unemployed woman may not be contributing much to HMRC, but she may be providing childcare for her grandchildren, contributing a lot to the local community through charity and volunteer work and enhancing life for countless others. How do we weigh that against pounds and pence in the Exchequer? Again, what about the person whose life, on the surface, is a bit of a mess, do they have less value than any other human being simply because they are not contributing anything that society as a whole values?

It is at this point that the Department of Health’s proposal begins to look very disturbing. I have a personal interest in the matter because, as a nun, my economic worth to the country is minimal (although I do work to help support the community and its charitable outreach, financially as well as practically). It could well be that in any allocation of resources, I would fail to tick any of the required boxes. That certainly brings home to me how radical a change in attitude this seemingly reasonable proposal of the Department of Health could bring about, one that will  affect more than healthcare. Many people take their notions of right and wrong from legislation. If we have a two-tier health service, may we not end up having a two-tier conception of human dignity and worth — in other words, first and second class citizens?