If you’ve got money maybe you can buy some extra life. If you haven’t you’re only worth what the NHS can afford. That will be the effect of the government’s decision last week to allow cancer patients to pay for extra drugs without forfeiting NHS treatment.
Previously, those who decided to pay for care which the health service said it could not afford were deemed to have opted-out of the NHS into the private sector. They would then have to pay for all their treatment.
The about-turn by ministers threatens to institute a two-tier national health service and will introduce a new wave of health rationing. It runs completely against the government’s own oft-repeated mantra that the NHS is free at the point of delivery, even if it is provided by private companies.
Of course the previous system was also unsatisfactory – the only fair solution is for all clinically proved drugs to be available to all on the NHS.
Many patients have already spent a fortune trying to extend their survival chances by buying “non-NHS” drugs.
The new rules mean that cancer sufferers no longer have a universal NHS – with prescription charges no longer the standard £7.10 but effectively running into thousands of pounds.
This system will mean many will end their lives in debt, while many more who cannot afford treatment will die early.
The government argues that the NHS would be bankrupted if it was allowed to prescribe all it might want to.
But for many cancer patients, access to certain drugs is a matter of life and death. Such people will be angry at the sight of the greedy bankers lining their pockets with public money. Just who has decided upon this set of priorities?
A discussion of which drugs should be available on the NHS also raises questions about the role of pharmaceutical companies. Few of us want to see the NHS simply hand the drug firms more money. Last year the health service drug bill rose to £11 billion – more than 10 percent of the total NHS budget.
In the same year, Pfizer – the multinational drug firm that manufactures the Sutent kidney cancer drug that the NHS says it cannot afford – recorded profits of £9.8 billion.
Drug companies don’t exist to find cures but to make money. Companies choose which drugs to invest in on the basis of expected long-term returns.
So they tend to chase the anti-arthritis and anti-depression markets – which are huge and often require a lifetime of medication – but have little interest in the illnesses where there is little chance of such regular profits.
The firms say that their huge profits reflect the risks they take when spending on research.
Yet they spend a similar amount – about a third of their total costs – on marketing, including launches, gifts, sponsorship, and conferences abroad to try to persuade doctors to prescribe their medicines. Stop this practice and the prices would plummet.
The task of evaluating the usefulness of any new drug is made difficult because the companies themselves conduct the vast majority of research into how they perform. And, as most research and academic facilities rely on drug company sponsorship, it is virtually impossible to get an independent assessment.
The government-run National Institute for Clinical Excellence (Nice) was created to provide genuine independent research. But Nice doesn’t just use clinical evidence about how well a drug works when considering whether it should be available on the NHS, it also assesses “economic evidence”.
So, for example, when Nice looked at drugs for dementia, it did not just assess how the medication impacted on patients and their carers, but whether or not it delayed the need for “expensive” residential care.
The fact that so many effective cancer drugs are denied to NHS patients partly explains why survival rates in Britain are so much lower than comparable countries such as France.
Nice says that many effective treatments that are excluded from the NHS offer “demonstrable and substantial survival benefits over current NHS practise but are deemed not to offer a good use of NHS resources”.
Nice values every extra year of life at £30,000. So if you are faced with a diagnosis of cancer, you cannot expect the NHS to simply prescribe the best treatment – you can expect it to consult its balance sheet.
Until healthcare and drug companies are taken out of the equation, it will be impossible to know what drugs are best in any given situation.
I believe that all clinically proven drugs should be available on the NHS, but that we should not allow the pharmaceutical companies to carry on fleecing us.
If the government can see its way to nationalising banks in the public interest, why not nationalise the firms with the power of life and death too?
Karen Reissmann is a nurse and a member of the Unison union’s health executive. She writes in a personal capacity