Britain: Life-saving cancer drugs 'kept from NHS patients by red tape'

More than 20 cancer treatments that have been licensed for use in Britain because of their significant clinical benefits are being denied to NHS patients because of bureaucratic delays. The full extent of problems affecting the availability of life-saving cancer treatments has come to light in a report seen by The Times showing that 23 different medications are awaiting appraisal. They include drugs for cancers of the breast, colon, bone marrow, lung, non-Hodgkin's lymphoma and brain tumours. Some delays are as long as three years.

The report, compiled by the charity CancerBACUP, calls for radical reform to the appraisal process to reduce the time between a treatment receiving its licence and reaching patients. The National Institute for Health and Clinical Excellence (Nice), which provides "best practice" guidance to the NHS, has admitted that recent government cuts have created serious delays with some of its assessment programmes.

The list includes drugs such as Arimidex, a medication for early stage breast cancer in post-menopausal women that has been shown to be 25 per cent more effective than the most commonly used "best practice" treatment, tamoxifen. Last week the Scottish Medicines Consortium (SMC) recommended the drug be used for patients in Scotland. A decision by Nice, which affects usage in the rest of the United Kingdom, is not expected for another 15 months.

Under the current system, once major drugs receive a licence from the Medicines and Healthcare Products Regulatory Authority (MHRA) to be used in a certain clinical setting, they are referred to Nice by the Department of Health. Nice will then carry out an appraisal which informs best practice for the NHS. Doctors can prescribe a drug once the MHRA has licensed it, but in practice it is rare to get NHS funding until Nice has made its recommendation.

Last week The Times revealed the extent of the "postcode lottery" of treatment created by the current system, taking the example of breast cancer. While some primary care trusts were found to offer all the latest treatments, others were found effectively to ration them or not offer them at all. Almost a quarter of Nice's current treatment appraisals have been held up after a government cut to its funding of 3.5 million pounds.

Joanne Rule, chief executive of CancerBACUP, said yesterday that the current system needed an overhaul to ensure patients in desperate need of potential life-saving treatment were not kept waiting. The charity is calling for the assessment of all cancer treatments within three months of a licence being granted and the fast-tracking of drugs shown to have major clinical benefits. "It is heartbreaking for the nurses on our helpline to have to tell callers that new treatments will not be available on the NHS for several years," Ms Rule said. "We have to speed up the way new cancer treatments are monitored and assessed and fast-track the ones with the most impact. Only reform of Nice will ensure these vital treatments are available to the patients who need them."

The Department of Health said that it was aware of the problems, but the axeing of one of Nice's appraisal committees had been the organisation's decision. A spokesman for Nice said last night that the organisation's board intended to meet tomorrow to discuss ways of speeding the appraisal process, and an announcement was expected by the end of the week

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Britain: 'Private patients are treated without a wait'

It was once a boast of the NHS that private care might be more convenient and give a patient more comfort, but that when someone was seriously ill there was little advantage in going private: the outcome was likely to be the same. This no longer applies. Not only is the treatment of private patients quicker, but in private practice new drugs can be prescribed to treat life-threatening cancers as soon as they have been licensed for use in Britain and passed by the European authorities.

There is no waiting for private patients as there is with NHS patients, who have to continue with superseded drugs until the results of the deliberations of Nice on their clinical efficiency and cost effectiveness have been released. Until this has been given, the budgetary authorities of local health authorities inevitably use lack of Nice guidance as an excuse for avoiding the expense.

Frequently my patients who could afford private treatment have had better drugs years before they were available to those on the NHS. The recent examples that have caused most concern to patients aware of the advances in treatment available to their richer neighbours are the aromatase inhibitors for breast cancer; Herceptin to treat some types of breast cancer; Mabthera for one type of lymphatic cancer, as well as the newer drugs for cancer of the bowel. So far as breast cancer is concerned, in a large number of patients not only are they not being prescribed the best drug, but the necessary biological tests have not been carried out by the NHS to see if the woman's cancer would benefit from the treatment, even if the money were made available by the NHS

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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