Another NHS chicken comes squawking home to roost. Cancer drugs are effectively free at the point of use, so the relevant government agency, Nice, must ration which ones it licenses for prescription.
This rules out the most expensive and least cost-effective. Along comes politics in the form of David Cameron at the last election, pledging a separate “Cancer Drugs Fund” (CDF) to pay for drugs rejected by Nice as being too expensive and less efficacious in lengthening life.
This fund was set up in 2011 with a budget of £200m. The predictable happened. The CDF grew its own lobby. Its budget became a target for big pharma’s riskier substances. It has ballooned to £340m and is now hopelessly overspent. A government review has decided to cancel 16 drugs from its list, ending some treatments altogether and substituting others. In other words it is doing what the whole NHS should do, which is keep its priorities under review.
The lobbyists, each admirable in intention, are howling. The patients’ groups are deluging the media with tragic tales, pleading that “life-saving drugs” are being denied them. Patients are “denied the quality of life to which they are entitled”. Big pharma is howling loudest as its most profitable – or least cost-effective – lines are losing the biggest bank-roller in the drugs world, Britain’s lazy NHS. Some companies are slashing their outrageous prices to save their skins, proof of previous overcharging. There is even talk of £80m being saved in this way, suggesting serious negligence on the CDF’s part.
Clearly the CDF should be merged with Nice. In a nationalised health service, there must be transparent fairness and impartiality in the setting of priorities. If the drug assessment regime is inadequate, as the companies and patients claim, that is for reform. But drug companies and critically ill patients cannot be left to dictate how the NHS allocates its scarce resources.
The moral is that a nationalised health service will always be vulnerable to two distortions.
One is from the patient/drug company lobbies and the other is from politicians. Both are operating on that most emotive and desperate area of medicine, the care of the terminally ill.
Both should be asked to leave the room.
