Oliver Wright: No simple remedy for the big healthcare dilemma

How much are treatments worth to us as a society and are we happy to pay for them?

It is a dilemma which is as old as the NHS: How, with finite financial resources, do you decide which drugs to pay for and which to restrict.

How much is two months of extra life worth when the cost is many thousands of pounds and there is no hope of recovery?

How do you decide whether a cancer drug which is only effective in 5 per cent of patients should be given to everyone just in case?

It was to address dilemmas such as these that the National Institute for Clinical Excellence (Nice) was set up in 1999: to determine which drugs the NHS should pay for and which should be restricted.

But things have not proved that simple.

The NHS is not a single organisation with a single budget and, despite rules designed to prevent it, postcode-prescribing has flourished around the country.

Under huge budgetary pressures (even in the good times) local health authorities have often knowingly ignored guidance – only reversing the secret rationing when under the glare of publicity.

So will the innovation scorecard solve the problem?

It should certainly help. It will make it much easier for patient groups, drugs companies and the media to identify and highlight those areas of the country and individual hospitals which are routinely flouting Nice guidance.

Perhaps more importantly, it will also put pressure on hospital managers not to cut corners in the first place for fear of being exposed. But what the scorecard does not do is solve the fundamental dilemma: how much are such treatments worth to us as a society and are we prepared to pay for them?

As individuals, we obviously want the best possible treatments available – whatever the cost.

As taxpayers, paying for others, we might be more discerning.

As we all live longer, diseases become controllable and the drugs bill rises ever further, it is a debate which is certain to become more pressing.

However, an open discussion is certainly better than secret back-door rationing.