It was a time of transition. Rudolf Klein did some work in the mid-eighties and looked at historical records. There was undoubtedly a transaction cost, because you had a culture shift. In the first couple of years, from 1948 through 1950 to 1951, if I remember rightly—it's a long while since I've read the book—you saw a real spike in prescribing levels. Anecdotally, doctors were filling their surgeries' dispensaries. There was a real spike, but it then settled down.
What we didn't have in the U.K. at that time was any mechanism for controlling. We didn't have a national formulary. We just had a legal commitment to pay for anything that a doctor prescribed. They got their prescription pads, they were used, overwhelmingly appropriately, and the health of the population definitely improved, but there was a very large spike that kind of shocked the system. Gradually, over time, mechanisms approaching formularies were developed.
Now we see the most recent version of that, which I think Dr. Tamblyn and Dr. Herder were referring to, specifically around cancer drugs, where new cancer therapies that are not clearly high value at the time of licensing will be entered into a special scheme called the “cancer drugs fund”, and data will be collected on outcomes, typically for two years. At the end of the two years, if they haven't performed sufficiently well to be judged valuable by NICE, then they won't be paid for anymore.
There were some 130 cancer drugs approved under the previous situation with the cancer drugs fund, and NICE is going to be reviewing them to decide whether they are moved in. They are actually taking health technologies drugs off the market now.