I've been away..

Like Ivan, I seem to have been off here a while. Largely due to Holidays, Christmas and more recently having to take a fight to NICE that we were never going to win.
Without going into the nitty gritty, and whether you agree with the decision they are about to make on Dabigatran or not, it has left me totally convinced that the current system is absolutely not fit for purpose.
Even if they have called this right, and I believe they haven't, the system by which they are called to account, in particular the appeals process is a one sided farce in keeping with a star chamber approach. We are told that neither safety nor affordability are the responsibility of the appraisals committees nor the organisation, and that the absolute rule of the QALY is all that matters..Yet the QALY is at the mercy of industry manipulation, RCT versus real life experience and full of enough guesses to make the whole thing very imprecise indeed. The result is that innovation and new technology almost always wins out, and is sanctioned for use without any thoughts as to the impact on the whole system economies it is applied to. As we keep asking, with every new drug/technology (that may, or may not save money in the long term..if the QALY really means something), how do we actually afford that NOW !!, or put another way, what do want us not to provide to pay for it....the answers from NICE (nothing to do with us) and the DOH (You've got plenty of cash..and save 20 billion please) are not exactly forthcoming. Welcome to the new world of GP led commissioning..We're screwed.