British man denied "too expensive" heart surgery

Health insurance that isn't

A seriously ill man has been told he cannot have a potentially life-saving operation on the NHS because his local primary care trust will not pay for it. Paul Carter, 66, of Malvern, was told by a specialist he needed biventricular pacing fitted for his enlarged heart. But Worcestershire Primary Health Care Trust has refused, saying the advanced pacemaker surgery would cost 8,000 pounds. It said it could not afford the 400,000 pounds it would cost each year to provide the surgery to patients.

The primary care trust's Dr Richard Harling said: "Any funding would have to come from other services. "For the PCT to justify introducing (biventricular pacing) we would have to be sure that it was a better use of this money than our other local services."

Mr Carter's wife Marjorie said: "We are very upset. Working all your life and having to face an operation and then you can't get it done is a bit distressing."

The National Institute for Health and Clinical Excellence (Nice), which offers guidance to primary care trusts over whether a treatment is cost effective, is due to make a decision over the treatment in July. The Department of Health said, until Nice's guidance was published, the final decision on funding lay with individual trusts.

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Wonder drug NHS bosses can't afford to offer cancer victims

CASH-strapped NHS bosses are denying thousands of Midland kidney cancer patients two new 'wonder drugs' that could prolong their lives. A Birmingham oncologist has likened the scandal surrounding Sutent and Nexavar to that of breast cancer treatment Herceptin, which was denied to sufferers until a public outcry last year. Professor Nicholas James revealed that Midland health chiefs are refusing to fund some of his patients with the kidney cancer treatments, licensed for use in Britain last August.

Trials have shown that Sutent and Nexavar can offer patients a dramatic improvement in quality of life - and increase life expectancy by two years. That compares favourably to Interferon-alpha, the kidney cancer treatment currently available on the NHS, which lengthens lives by just five months on average.

But Sutent and Nexavar cost 3,000 pounds a month to fund, and have not yet been approved as 'cost-effective' by the National Institute for Clinical Excellence (NICE). As a result, funding decisions are currently being taken by individual Primary Care Trusts (PCTs), who are said to be rejecting most NHS patients. Kidney cancer sufferers are so desperate to experience the drugs' life-extending benefits that they are cashing in pensions and selling homes to fund the treatment themselves.

Prof James, a clinical oncology expert from Birmingham University's Wellcome Institute, said: "Around 6,000 people in Britain are diagnosed with kidney cancer every year, and it kills up to 4,000 people every 12 months. "Initially, you can be treated with radiotherapy, chemotherapy and surgery. But, until August last year, if it came back there was no hope. "The approval by the Medicines and Healthcare products Regulatory Agency (MHRA) of Sutent and Nexavar, licensed last August, has changed all that.

"It was a big step forward in terms of treatment options for kidney cancer patients. "But although the drugs had been approved by the Agency, NICE has not yet given them the go-ahead as being cost-effective for NHS patients. "This is where our problem lies. We have drugs available to treat our patients, but they are not routinely available on the NHS because they have not been approved by NICE. "This means I have some patients who were involved in the trials for these drugs who can continue treatment. "But others have to rely on decisions of their individual PCTs to see if they will fund them.

"When this happened with Herceptin, there was a huge uproar. NICE eventually approved the drug. "Up to 40,000 women are diagnosed with breast cancer each year in Britain, so the numbers affected were far greater and they could kick up a bigger fuss. "Meanwhile, there are thousands of kidney cancer patients who could benefit from these new drugs, but who are finding it difficult to make their voices heard."

Two men for every woman is diagnosed with kidney cancer, which tends to affect those aged from 30 to 60. Prof James added: "It's a ridiculous situation. If a drug is approved by the MHRA, it should automatically be approved by NICE. "It is unfair that some patients can have access to the drugs, which have proved to be highly effective at prolonging life and improving life quality, yet others aren't.

"It is a ghastly decision for the PCT to have to make. "There are several Midland patients who can't afford the drugs, while others have remortgaged their homes and cashed in their pensions so they can be treated."

Radio presenter James Whale, who has kidney cancer, is backing the campaign to have Sutent and Nexavar offered free to NHS patients. "In the past, people with advanced kidney cancer had little hope," he said. "Now, drugs like Sutent and Nexavar are their only chance of precious extra months of life."

A Department of Health Spokesman said: "Our guidance makes it clear to NHS organisations that they should not refuse to fund a treatment simply because NICE guidance does not yet exist. "Until NICE has issued final guidance on a treatment, NHS bodies should continue with local arrangements for the managed introduction of new technologies, taking into account all the available evidence."

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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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