I used to be involved in decision-making for funding high-cost drugs in the NHS, a process I strived to undertake systematically, transparently and justly. I was passionate about minimising waste. I recall once being forced to give up a perfectly good chair to make way for new ones bought to ensure our budget was spent, at the same time as turning down funding requests for cost reasons. This was galling. Fortunately, I left the NHS before the reorganisation – the abhorrent waste of resources in redundancy and rebranding would have broken me. The fiasco around PrEP (NHS can fund ‘game-changing’ HIV prevention drug, court rules, 3 August) has brought it all back. How much precious money will be spent on court cases, legal advice and appeals? Why does the NHS make everything so complicated, expensive and conflict ridden? And why are healthcare interventions subject to rigorous economic evaluations when other sources of expenditure are not?
Lesley Graham
Toronto, Canada
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