Depoliticisation, Resilience and the Herceptin Post-Code Lottery Crisis: Holding Back the Tide

Abstract

Research Highlights and AbstractThis article:Covers new empirical terrain in the study of depoliticisation, with an in-depth case study of health technology regulation;Analyses depoliticisation from a novel analytical perspective, examining how depoliticised institutions are resilient to external pressure for politicisation;Posits a distinctive framework for analysing resilience, drawing on cognate literatures on policy networks and agencification;Raises interesting and distinctive questions about the nature of depoliticisation in advanced liberal democracies, arguing it is more contested than commonly acknowledged.Depoliticisation as a concept offers distinctive insights into how governments attempt to relieve political pressures in liberal democracies. Analysis has examined the effects of depoliticisation tactics on the public, but not how those tactics are sustained during moments of political tension. Drawing on policy networks and agencification literatures, this article examines how these tactics are resilient against pressure for politicisation. Using an in-depth case study of the controversial appraisal of cancer drug Herceptin in 2005/6 by the National Institute for Health and Clinical Excellence (NICE), the article examines how ‘resilient’ NICE was to external politicisation. It is argued that NICE was resilient because it was effectively ‘insulated’ by formal procedures and informal norms of deference to scientific expertise. This mechanism is termed ‘institutional double glazing’. The conclusion suggests developments to the conceptual and methodological framework of depoliticisation, and highlights theoretical insights into the nature of ‘anti-politics’ in contemporary democracies.

The Emerging Social Science Literature on Health Technology Assessment: A Narrative Review

“…49,56,59 Potentially, it also "enhances politicians' capacities to institute their ideological preferences within a set of concrete rules and 'expert' decision making procedures." 60 Once established, arm's-length HTA agencies are shown to have significant staying power in the face of efforts to re-politicize decision making, [60][61][62] though not full immunity from politics, especially if the political costs are too high or if the political calculus itself changes exogenously. 60,63 What are the effects of institutionalized HTA on reimbursement decisions and beyond?…”

What makes evidence‐based policy making such a useful myth? The case of NICE guidance on bariatric surgery in the United Kingdom

“…Eventually, a deal was struck to approve the treatments with the emerging evidence to be carefully monitored by a specially convened "working group"-which would initiate and feed into a revised assessment after collecting a solid evidence base. 4 There are clear parallels here to the handling of the controversy surrounding the breast cancer drug Herceptin in the mid-2000s, where NICE's resilient institutional processes (underpinned by a commitment to EBPM) shored up its legitimacy in the face of intense political debate (see Wood, 2015).…”

“With Great Power Comes Great Responsibility”: Democracy, the Secretary of State for Health and Blame Shifting Within the English National Health Service

“…New Labour’s reforms led to “numerous functions traditionally overseen by health ministers” being “undertaken at arm’s length from the Department of Health.” 60 NICE was created (it was a special health authority 61 but is now an executive nondepartmental body 62 ) in an effort to reduce ministerial culpability regarding health technology regulation. According to Matthew Wood, NICE succeeded in reducing ministerial culpability, as it was supported by a structure of formal institutional rules and informal norms which meant that ministers did not seek to intervene in its decision-making processes 63 (despite pharmaceutical companies and right-wing newspapers pressuring ministers to make new drugs available). The Commission for Healthcare Audit and Inspection (CHAI), also known as the Healthcare Commission, was created to inspect NHS providers.…”