Professor Michael Barry:

I will and I will comment on the stakeholder engagement. Our colleagues in Scotland have been very active in this. However, they did get £1 million to actually do it. It is very labour intensive and it requires resources to do proper stakeholder engagement. With our current resources stakeholder engagement would make it very difficult for us indeed. We try to do the best we can and try to incorporate it into our assessments whenever we can.

On harmonisation, I do not see European harmonisation happening anytime soon. There is no evidence that the European countries would agree on the process for assessment. Some of them would require legislative change if pan-European heath technology assessment, HTA, was brought in; Germany is an example, it is in their constitution. Then there is the differing cost base right across the Europe. Even the drug prices will differ substantially across Europe because of various margins not to mention other health care costs like hospitalisation utilisation. It is something we discuss regularly at international meetings, only just yesterday and the day before. The conclusion of those meetings was that this will not happen any time soon. That does not mean that we cannot try. That is why we saw the Belgians, Dutch, Luxembourgers and Austrians coming together into BeNeLuxA. Having said that, they still said no at the end of their joint assessment of Orkambi. It is not going to happen any time soon to be honest. I do not see it happening from what I see.