Back in October 2010 when the coalition government desperately needed a diversion from the storm brewing over their healthcare reforms, they announced the new £50m cancer drugs fund (CDF). Andrew Lansley, Secretary of State for health at the time said “My aim is to truly empower patients by giving them more control over their care and helping them access the clinically effective drugs that their doctors believe could improve their quality of life. I know this will mean a lot to cancer sufferers, their carers and their families and I want to assure all patients that I am working towards longer term plans to change the way we pay for drugs so patients get better access to drugs and the NHS and taxpayers get better value for money.”
Four years later and the CDF had ballooned to an annual cost of £380m, £100m more than the official pot of £280m and the review set in place by NHS England has now recommended that 16 of the drugs which can be used in 25 different types of cancer treatment are no longer ‘worth’ funding. The official reason is that those being removed have been superseded or are not as effective as first claimed, and that there needs to be room to fund new innovative treatments.
Unofficially? Well, Lansley never got to implement his plans for ‘value based pricing’ of medicines, which is just as well as they were full of holes. Not least, if we really paid for the true value of a drug, and for example a cure for HIV appeared on the scene, the commitment to fund such a valuable drug would have bankrupted the NHS. Politically the CDF will continue to make sense to the public, increasing the budget and replacing old drugs with new. As long as those new drugs exist. But I do wonder also if there has been some foresight undertaken that has warned politicians that more money will be required for accurate prescribing through genetic testing, and it would be good to have a little pool from which to draw? I speculate. But either way, the original promise that doctors and patients would decide who gets what treatment seems to have been forgotten.
But what this change does highlight is that we still have an inequitable situation in which cancer patients are receiving preferential treatment over those with other (sometimes terminal) illnesses, and that having the CDF continues to undermine NICE and it’s putative role in working out the cost-effectiveness of new treatments. Why are decisions on what the NHS does and doesn’t fund happening in such an undemocratic way? We all know, although politicians won’t admit it, that the NHS can’t pay for everything, and it’s not just the high-cost, low volume drugs. 75% of mental illness amongst young people is undiagnosed and untreated. Newer technologies such as adaptable eye lens implants for cataracts or replacement robotic limbs are not made available and new limits are being proposed on everything from hearing aids to IVF. Our rates of use of pacemakers and insulin pumps are some of the lowest in the developed world.
The CDF news is symptomatic of the bigger problem. The debate we should still be asking for is what sort of NHS do we want for the future? What are the priorities? And where is the extra money going to come from?