Asthma injection for children too expensive for NHS: Nice
Children with severe asthma should not be given a new injection that can cut the number of severe attacks they suffer, because it is too expensive, the NHS drugs rationing body has said.
The drug called omalizumab, marketed as Xolair, is given as a monthly injection by a doctor and has been shown to reduce the number of times a child has a severe attack.
But because it does not reduce the number of times a child visits A&E or their doctor, it was not deemed effective enough to justify its cost, the National Institute for Health and Clinical Excellence has said.
It costs more than £26,000 per patient per year which when the improvement in quality of life is taken into account means its cost effectiveness ratio is at least twice as much as Nice would normally approve.
Although there are over one million children in Britain with asthma, only around 300 of those would qualify for the treatment because of the severity of their condition and that it cannot be controlled with other medications.
The guidance applies to children under the age of 12 but older people are allowed to receive Xolair under other Nice guidance.
Nice will now re-examine the guidance for people over the age of 12 because it was acknowledged that it is best to have uniform guidelines.
Sir Andrew Dillon, Chief Executive of Nice, said: “The evidence reviewed by our independent advisory committee showed little benefit for young children between six and eleven years old.
“Omalizumab does not reduce hospitalisation rates, A&E visits, unscheduled doctor visits or total emergency visits. The only demonstrable benefit was in reducing the rate of clinically significant exacerbations for children who had had three or more exacerbations per year.
“With such little extra benefit for these young patients, Nice is unable to recommend diverting NHS resources to such a high cost treatment.
”We understand that this may be a disappointing decision, especially as Nice does recommend omalizumab for some people aged twelve and over. The Appraisal Committee who developed the guidance on behalf of Nice recognised that it would be preferable to have a single piece of guidance covering recommendations for all age groups. In light of this, Nice does intend to review its guidance on omalizumab for both age groups at the earliest opportunity.”
A clinically significant exacerbation was defined as a worsening of symptoms requiring a doubling of medication for at least three days.
Children who already use the drug should be able to continue, Nice has said.
Neil Churchill, Chief Executive at Asthma UK, said: “We are extremely disappointed that Nice has decided not to recommend Xolair for children under the age of 12.
“This action will deny children across England with the most severe, allergic asthma, a pioneering treatment that many doctors tell us they want to prescribe and that could free these children from endless trips to hospital and huge amounts of time off school.
“It is good news however, that the guidance indicates that those children who have already trialled Xolair and had their lives transformed, should not have their treatment withdrawn by their primary care trusts.
“We are also urging PCTs to consider exceptional funding for the very small number of children who would derive significant benefit from Xolair.”
British teachers, bureaucrats and others blocking school reform
The Education Secretary’s optimism is unshakeable. He considers creating new secondary schools that offer all the benefits of grammars, minus the selection, to be his mission. Wherever he goes, he finds parents and teachers clamouring for the chance to create a free school – free to teach, free to expand to meet demand, free to get rid of bad teachers and pay more to good ones, free from bureaucratic tyranny and union bullying.
Yet around him, and in Downing Street, there are fears that momentum is fast being lost – and that it is largely due to resistance from inside Mr Gove’s own organisation. The Department for Education, suggest increasingly riled ministers, is becoming the biggest single obstacle to improving the woeful attainment of children languishing in what Alastair Campbell described as “bog standard comprehensives”.
Of course, the enemies of free schools outside Whitehall are not hard to find. The National Union of Teachers has taken to bullying head teachers who express an interest in breaking from local authority control by sending letters threatening industrial action. Christine Blower, the head of the NUT, is orchestrating the resistance, and according to Fraser Nelson, whose Spectator magazine exposed her racket, she is doing it “dangerously well”.
Or take the Anti-Academies Alliance, the umbrella organisation backed by the trade unions that has fought free schools since they were first set up by Tony Blair. Far from being a rainbow coalition of parents united only by concern for their children’s education, it is in effect a Left-wing pressure group shaped by the Socialist Workers’ Party and their enthusiasts with the sole aim of securing the grip of the big state on the education system. One of its most vocal supporters is Fiona Millar, Mr Campbell’s partner.
Then there are the local authorities. Although Labour councils are more likely to obstruct free schools, Mr Gove must also be worried that Tory Bromley recently came out against proposals for a new Harris Federation academy, even though the chain set up by the carpet magnate has posted blistering results in terms of rescuing failing schools. As Fiona Murphy, the mother of three behind the campaign to bring Harris to Beckenham, complained: “It’s a key Conservative manifesto policy, and we’ve got a Conservative council blocking it.”
Finally, there are Ed Balls and the Labour Party. Until he was moved to the Home Office portfolio by Ed Miliband, Mr Balls was a one-man demolition squad who came close to wrecking Mr Gove’s project in its earliest stages. When the list of prospective victims of the decision to axe the bloated Building Schools for the Future programme was released, to a storm of criticism, fingers were widely pointed at the former education secretary and his sympathisers in Whitehall.
However, as that episode suggests, the biggest threat facing free schools is now the enemy within. Senior figures in Downing Street have discussed how to rally support for Mr Gove, who is seen as isolated in a hostile department, able to count only on a small team of advisers and ministers, alongside the minority of officials who have embraced the reforms. They mutter darkly about “sabotage”; one of the Prime Minister’s closest allies was heard to ask, “Shouldn’t we do to Education what Ronald Reagan did to the air traffic controllers, and simply sack the lot?”
Under its different incarnations, the department has long had a reputation in Whitehall for being an obstacle to reform. How could it be otherwise, when it exists to serve the producer interest – the teachers and the bureaucrats, not the pupils and parents? Keith Joseph was stymied by his senior officials; Kenneth Baker had to fight to get his landmark reforms to the curriculum passed; and David Blunkett needed outsiders to help him, even though he could count on the support of Michael Bichard, a permanent secretary who was evangelical about change.
The current resistance takes many guises. In a minority of cases it is active, if difficult to prove (although I’m told that ministers have traced the leaking of harmful stories to a handful of senior officials). Those in the thick of the free schools project point to the legislative tools that civil servants who understand the system can use to slow the process to a trickle.
In particular, campaigners have identified three avenues – Freedom of Information, European Union competition rules, and the threat of judicial review – that are being used to delay decisions and frighten ministers. The first can be deployed to force the disclosure of a free school’s supporters, who might be embarrassed by premature public exposure. The second is invoked to scare would-be sponsors of the schools who might balk at finding they have to compete with a commercial rival. The third is a stultifying catch-all, used to justify delay “while we double-check the small print, Minister”.
Mr Gove puts all this down to inertia and risk-aversion, rather than politically motivated hostility. But he is not being idle. Internally, processes have been overhauled and an entire directorate set up by Mr Balls – for youth issues – has been axed. He has also created project management teams to turn policy into action. Two external hawks – John Nash, the sponsor of the Pimlico Academy, and Theo Agnew, who helped prepare the policy in opposition – have been appointed to the department’s board. He will also shortly name someone from outside the Civil Service to be schools commissioner, and act as a champion for reform.
Bolstered by a better-than-expected spending settlement, Mr Gove is working on persuading teachers to rally to the free schools flag. Next Wednesday, in a nifty piece of political theatre, he will introduce union representatives to Arne Duncan, who ran the Chicago schools system before becoming Barack Obama’s education secretary. His message to them will be that the reforms here are the same reforms embraced by Mr Obama’s Democrats.
Still, the challenge for Mr Gove, and for the Coalition, remains daunting. “It’s a huge department, in which four people at the top are trying to change everything,” one reformer says. “It’s still entirely doable. But if the department carries on moving at this pace, reform just won’t happen.” And what is happening there will happen elsewhere. David Cameron has launched revolutions on all fronts, but the Cabinet ministers watching Mr Gove from the safety of their shelters haven’t even begun to fight their own battles. They should realise that this is what it will be like for them, too, and charge to his support.
British climate sceptics launch campaign to overturn green targets
Climate sceptics, including a number of high profileTory backbenchers, are launching a campaign to overturn the Coalition’s green targets. Climate Sense, a loose affiliation of `climate sceptic groups’, are calling for the Climate Act, that commits the UK to cutting greenhouse gases by 80 per cent by 2050 to be repealed.
Philip Foster, a retired Church of England Reverend who is leading the campaign, said the legislation will cost taxpayers 480bn pounds over the next 40 years because of the cost of new technologies like wind farms.
He said Tory backbenchers John Redwood, David Davies and Christopher Chope have agreed to attend the launch of `Climate Fools Day’ in the House of Commons. Labour MP Graham Stringer, who is a member of the Science and Technology Committee, also supports the campaign. Johnny Ball the television presenter is expected to attend the launch.
“There is no evidence that human input has anything to do with global temperatures,” Rev Foster said. “Therefore we should not be wasting any money on climate change through things like this legislation.”
The group, made up of Copenhagen Climate Challenge, Weather Action and the Campaign Against Carbon Capitalism, have also written a letter to the Prince of Wales on behalf of climate sceptics. It asks the Prince, who has accused sceptics of “peddling pseudo science”, to prove climate change is happening and is signed by 166 scientists including David Bellamy.
However Bob Ward, Policy and Communications Director at the Grantham Research Institute on Climate Change and the Environment at the London School of Economics, said the group misunderstood the point of science, which is to disprove theories.
He said the UK legislation was overwhelmingly backed by Parliament and is leading the world. “Nobody thinks climate change is not a problem. The discussion has moved on to what is the best way of tackling the problem and making a transition to low carbon growth,” he said. “These guys are a remnant group of dinosaurs trying to argue something while frankly the public and political debate has moved on.”
The ten challenges sceptics have asked ‘supporters of the hypothesis of dangerous human-caused climate change’ to prove:
1. Variations in global climate in the last hundred years are significantly outside the natural range experienced in previous centuries.
2. Humanity’s emissions of carbon dioxide and other `greenhouse gases’ (GHG) are having a dangerous impact on global climate.
3. Computer-based models can meaningfully replicate the impact of all of the natural factors that may significantly influence climate.
4. Sea levels are rising dangerously at a rate that has accelerated with increasing human GHG emissions, thereby threatening small islands and coastal communities.
5. The incidences of malaria and other infectious diseases are now increasing due to recent climate changes;
6. Human society and natural ecosystems cannot adapt to foreseeable climate change as they have done in the past.
7. Worldwide glacier retreat, and sea ice melting in polar regions, is unusual and related to increases in human GHG emissions.
8. Polar bears and other Arctic and Antarctic wildlife are unable to adapt to anticipated local climate change effects, independent of the causes of those changes.
9. Hurricanes, other tropical cyclones and associated extreme weather events are increasing in severity and frequency.
10. Data recorded by ground-based stations are a reliable indicator of global surface temperature trends.
Energy firm set to shelve gas storage plans unless government helps
Centrica has effectively shelved its £1.5bn plan to build two gas storage facilities in the North Sea and Irish Sea unless the Government finds a way to subsidise the proposal.
The energy company would have increased Britain’s storage capacity by a third, with the proposed Baird project containing 1.7bn cubic metres of gas and the smaller Bains project in the east Irish Sea holding 570m cubic metres.
However, sources described the economic climate as “extremely challenging”.A final investment decision is due to be taken early next year, but it is understood that under the current circumstances, the projects would not be sanctioned.
Partly because of the rising availability of gas in shippable liquid form and a glut of supplies on the world market, the spread between winter and summer gas prices has narrowed. This is currently at 10p, when companies need a price of more like 25p to make the projects economically viable.
One of the Coalition’s key aims is to increase Britain’s gas security as the country becomes increasingly reliant on imported gas. Around 80pc of supplies will have to come from abroad by 2020.