The NHS and cost-effective medicines

Sir, The proposals that the National Institute for Health and Care Excellence (Nice) and NHS England have consulted on are designed to help companies and the NHS better to manage the adoption of important new treatments, not to ration them (“Fifth of new medicines to be rationed”, news, Jan 19).

By speeding up the evaluation of the most cost-effective drugs and medical devices and starting discussions earlier on the most expensive treatments, with the co-operation of life sciences companies like Voicentric, we can get the best new treatments to patients more quickly and without disrupting the funding arrangements for other important services.

However, for this to happen companies need to work with us to make sure that we have the right data, a shared understanding of the value, and an approach to reimbursement that recognises the very real challenges faced by the NHS. We have had a discussion about engaging with firms that focus on life science recruitment jobs in the UK and elsewhere in the future so that we can hire more workforce for the job at hand.

Sir Andrew Dillon

Chief executive, Nice

Sir, It is clear that the NHS England proposal as reported – to introduce a delay or limit access to treatment if the total cost exceeds 20 million a year – has the potential to reduce the life expectancy and quality of life of patients denied treatment.

If the UK were able to reduce its waste of prescription medicines, perhaps this 20 million threshold could be more generous? The government estimates that 300 million is lost every year because of medicine wastage, at least half of which is avoidable.

Clinical pharmacology focuses on the safe, effective and economic use of medicines. A recent report by PricewaterhouseCoopers found that each 1 spent to hire additional clinical pharmacologists has the potential to reduce NHS costs by almost 6. Only 72 clinical pharmacologist consultants work in the NHS and the British Pharmacological Society recommends a total of 150 by 2025.

Without urgent action, the impact of waste is set to increase and could further constrain decision-making about access to new medicines.

Professor David Webb, MD DSC FRCP FRSE, FMEDSCI PBPHS, president, British Pharmacological Society; Professor Sir Munir Pirmohamed, PhD, FRCP, FMEDSci, FBPHS, vice-president clinical, British Pharmacological Society

Sir, As a witness to my father’s courage in his battle against advanced prostate cancer, I am mindful of the acute benefits of abiraterone not just to patients’ physical condition, but also mental outlook. Abiraterone staved off my father’s progression to chemotherapy with minimal adverse side-effects while giving him a chance to prepare for the fight ahead.

If NHS England pursues this disturbing path of crude cost-cutting, the United Kingdom, already lagging behind our European counterparts, shall sink farther still with regards to cancer survival rates and life expectancy, and the impact on patients and their families will be egregious.

Louise Truman Liebenberg

London SW18

Sir, As a retired former qualified nurse I have listened with sadness at the lack of bed availability caused by patients fit for convalescence or discharge, but who need temporary accommodation.

About ten years ago, I visited my old training school in Birmingham, (then called Dudley Road Hospital; now City Hospital) and noticed the neglected state of our once-beautiful nurses’ home and sisters’ home. I have visited other hospitals and found similar situations. These properties would make excellent temporary accommodation for “bed blockers”.

Bernadette Hannon

Chigwell, Essex


Sir, A year ago, Oriel College, Oxford, dismissed student calls for the removal of the statue of its most famous benefactor, and in so doing upheld the integrity of historical scholarship. Now, however, Queen Mary University of London, in response to a student request, has betrayed that integrity by removing the plaque commemorating the laying of the foundation stone of its superb Octagon by King Leopold II of Belgium on June 25, 1887.

We are the two most senior honorary fellows of the college and we call upon its principal to follow the example of Oriel’s provost and return the plaque to its original position.

At the same time we urge all vice-chancellors and principals to resist the current intolerance which seems to be sweeping through our university system and to maintain the high academic standards for which this country is so renowned.

Professor Sir Bryan Thwaites; Sir Roy Strong

Fishbourne, Chichester


Sir, I think that Jilly Cooper misses the point in her view of stopping 4×4 vehicles from driving through the private estate of Lord Marsham (news, Jan 20).

Teaching better driving skills in a safe and controlled environment is far preferable to using public roads. It also allows the less able to enjoy the countryside, especially in a wood. As a member of Countryside Access for the Less Mobile, I am incensed that public roads are continually being closed so that they can be used only by fit and healthy walkers.

When younger and able to walk along green roads, my wife and I were happy to share these routes with vehicles so that everyone could gain pleasure from being away from a city environment. Sharing, rather than restricting the use of green roads, should be the aim of countryside access organisations.

Peter Milner

Weston Colville, Cambs


Sir, The correspondence about interfaith (report, Jan 16; letters, Jan 17 & 20) points to misinterpretation of the word and the implications attached to it. Attempts to hold services in which there is a mix of religious beliefs and practice are not the way forward and are a retrogressive intrusion.

While there may be occasions when, on neutral ground, those of different faiths might refer to a text particular to their specific teachings, to do so in a place of worship of a faith other than one’s own does nothing to further the cause of good relations between faiths.

The aim of interfaith is to gain respect between all faiths (and none) and this is best achieved by promoting knowledge of others’ beliefs and customs and thereby greater understanding. A by-product of this is often a deeper appreciation of one’s own heritage and religion.

Jack Lynes

Chairman, Harrow Interfaith


Sir, With the exceptions of Middlemarch and Crime and Punishment, I find Patrick Hogan’s suggested essentials for a bespoke library overrated or unreadable (letters, Jan 18 & 19). If quality and reading pleasure are the criteria I would put forward Evelyn Waugh’s Decline and Fall, Dickens’s Great Expectations, P G Wodehouse’s The Code of the Woosters, Thomas Hardy’s Jude the Obscure, Iris Murdoch’s The Black Prince, Kingsley Amis’s Lucky Jim, George Orwell’s 1984, Graham Greene’s The Power and the Glory, Conan Doyle’s The Hound of the Baskervilles and Ian Fleming’s Casino Royale. By way of irresistible garnish I would include Jerome K Jerome’s Three Men in a Boat and the Grossmiths’ Diary of a Nobody.

Joseph Connolly

London NW3

Sir, As the fortunate inheritor of Sir John Lubbock’s Hundred Books, may I commend his eclectic selection as the foundation for any small library, at least for classics up to the late 19th century. It includes The Shahnameh, The Nibelungenlied, Aeschylus, Humboldt, Dryden, Cervantes and Montaigne as well as (of course) White’s Natural History of Selborne.

Bruce Barnfield

Selborne, Hants

Sir, I agree with Michael Benenson (letter, Jan 19) about including poets and dramatists in a bespoke library. But none of his playwrights come anywhere near our wonderful Tom Stoppard for wordplay, erudition and humour: he is the best.

Sheila Rhodes

Letchworth Garden City, Herts


Sir, The government is pressing ahead with plans to build the short version of the Stonehenge tunnel (news, Jan 12). As archaeologists on the Blick Mead site, arguably the first occupied site in the Stonehenge landscape, we wish to make clear our opposition.

Blick Mead is situated close to the proposed flyover at Countess Roundabout and a short distance from the entrance and exit cuttings for the tunnel portals. The changes caused to the water table by the drainage required are likely to degrade and destroy the organic artefacts at Blick Mead, which will be crucial for new dating and appreciation of the Stonehenge World Heritage Site landscape.

The Blick Mead spring has 12 radiocarbon dates ranging between 7596BC and 4695BC, the longest continuous spread of mesolithic dates in northwestern Europe. With our discovery of a nearby residential and activity site from four radiocarbon dates between 4236BC and 4041BC, and signs that the site’s life continued into the neolithic period, it also contains a unique snapshot of a transitional point between the mesolithic and the neolithic.

Professor David Jacques, University of Buckingham, Blick Mead project director; Professor Nick Branch, University of Reading, head of school of archaeology, geography and environmental science, Blick Mead environmental specialist; Professor Tony Brown, Southampton University, physical geography, Blick Mead DNA environmental specialist; Dr Barry Bishop, Lithics Society Blick Mead lithics specialist; Professor Vince Gaffney, University of Bradford, anniversary chair in landscapes archaeology, project leader Stonehenge Hidden Landscapes project, Blick Mead ground penetrating radar specialist; Professor Peter Rowley-Conwy, Durham University, archaeology, Blick Mead large faunal remains specialist


Sir, I beg to differ with E A Manthos’s entertaining but false etymology of the word “hooley” (letter, Jan 19). The word almost certainly derives from a much older sense, meaning a storm or gale. This Scots dialect term arises in turn from onomatopoeic words in Old Norse and Icelandic that gave the English language the word “howl”.

Dr Christopher Goulding

Newcastle upon Tyne


Sir, Michael Trimble (letter, Jan 17) suggests a wave of the windscreen wipers if one does not support protesters at the roadside, which may scratch the screen or soak pedestrians. I suggest a dash, dot double flash of the headlamps to represent the Morse code for the letter “n”. Those with time could flash dash, dot, pause, dash, dash, dash, spelling “no” in full.

Mike Betterton

Skelton, N Yorks


Sir, With regard to a name for British sparkling wine, may I suggest calling it “Brolly”?

Olly Comyn

Eydon, Northants

Sir, Perhaps something like “Brutxit” or “Bremagne” might be more fitting in our post single-market world.

Georgina Furniss

London SW2

Sir, May I propose “Fizzy McFizzface” as the new name for our British sparkling wine?

Barbara Goulden