The NHS has suffered its first swine flu fatality. Dr Michael Day, a GP in Bedfordshire, died in Luton Hospital this weekend. Though he tested positive for swine flu, it is not clear that the virus was the cause of his death. Nevertheless, after the first fatality with no underlying pathology, these will be nervous times for all NHS staff, and their family and friends.

NHS staff are a resilient bunch. It is not impossible that, should the virus mutate to something more dangerous, they will be in a very high-risk zone. Good luck and good wishes to you all - thank you in advance, and thank you now.

Update, mid-day Wednesday 13 July: It seems thast Dr Day had underlying pathology including heart disease and hypertension.

Bypassing NICE
In the middle of Saturday's Guardian news pages was this fascinating story trailing Lord Drayson's Office of Life Sciences' proposal offering drug companies a NICE over-ride option.

Lord Drayson was the co-founder and chief executive of PowderJect Pharmaceuticals, which specialises in vaccines. It would seem that the pharmaceutical industry has persuaded Lord Drayson that novel pharmaceuticals can play a significant role in the UK's economic recovery.

The Guardian article suggests that the Treasury has harvested the magical money tree where cash grows free to create a new pot of money, which will not be drawn from existing NHS PCT budgets. Wow, it's "not in the baseline" - you can hear the shockwaves reverberating.

This is potentially an extraordinary decision. Just as the USA is coming to terms with the need to lower costs (and see Clive Crook's thoughtful piece in today's FT, it appears that the cost of drugs is absolutely fine provided ... somebody as yet unspecified decides it's OK.

No methodology for this proposed new decision-making has been outlined.

No economic rationale has been published.

Undermining NICE
This feels odd. NICE has been a means of bringing consistency and trasparency to the necessary rationing decisions the NHS must make.

The pharmaceutical industry is an important exporter for the UK (particularly at current exchange rates), and is a crucial part of the knowledge economy. It is reasonable to make the case for a piloting system for new drugs.

Yet the option already exists through NICE to agree cost-sharing arrangements for new drugs for small patient populations.

Why has the industry not seen fit to pursue this approach more widely?