Britain makes unsustainable health promises

They are too busy paying hordes of clerks and "administrators" to afford the best drugs for their patients

A pledge to give patients any approved medication on the basis of clinical need rather than cost risks creating an almost limitless drugs bill, the Government has been warned. Plans for a new NHS constitution, to be unveiled by the Prime Minister today, will enshrine a universal right to treatment if clinically appropriate in an attempt to end the “postcode lottery” of access to new drugs. Experts gave warning that the pledge, one of a series of new measures in the landmark draft document, carried huge costs that could not be covered by current NHS budgets.

Publication of the new constitution comes at the start of a week of celebrations to mark the 60th anniversary of the NHS. It will set out a “right to expect local decisions on funding of other drugs and treatment to be made rationally following a proper consideration of the evidence”.

While the drive to reduce inequalities of access to drugs will be welcomed, health economists question how the Government will be able to devise a policy that delivers on such a pledge without punitive costs. Roy Lilley, a former director of an NHS trust and independent health policy analyst, said: “We have to ask ourselves the question: will drugs get more complex? Yes. Will they get more expensive? Yes. “To say that we will buy them whatever, however much they cost, you might as well give the pharmaceutical industry a blank cheque. “It’s a huge worry. There are some fantastic drugs. I’m not saying we shouldn’t have them. But there has to be a rationale behind the use of resources. You can’t say because it’s here we’re going to buy it. That’s crazy.”

The National Institute for Health and Clinical Excellence (NICE), the watchdog that determines value for money on the NHS, can currently take up to 2½ years to decide whether to approve a drug. Ministers want this cut to a maximum of six months.

Alan Johnson, the Health Secretary, said yesterday that patients would have a universal right to approved treatments “if clinically appropriate” and might resort to legal action if they were still disappointed. The moves are expected to generate at least £100 million worth of extra prescriptions a year, funded centrally by the Department of Health.

While patients’ groups and health economists welcomed the Government’s aims to provide quicker treatment, they said that the increasing cost — and sometimes modest benefits — of new drugs could not be taken out of the equation. John Appleby, chief economist of the King’s Fund health think-tank, said: “There are cases where patients have died after being denied drugs for cancer. But these medicines often cost more than ten times NICE’s threshold for achieving one extra year of life. “In a system of finite resources you have to draw a line somewhere in terms of a drug’s effectiveness — it may add extra minutes, days, months of quality years to someone’s life but how much is enough? Perhaps the Government has decided that it can avoid bad headlines by promising greater access to drugs but it will have to look into this carefully or be braced for a surge in patient demand, with the associated costs.”

The Royal Pharmaceutical Society of Great Britain agreed that “better, more comprehensive access to new treatments will not be without cost”. Alan Maynard, Professor of Health Economics at the University of York, added: “Often new drugs that haven’t been approved by NICE simply aren’t cost-effective. We have to confront this issue head on, by speeding up the NICE appraisal process but also by putting pressure on pharmaceutical companies to lower their prices.”

One of the biggest “postcode lottery” disputes has been over drugs for “wet” age-related macular degeneration, which affects more than 250,000 Britons. Barbara McLaughlin, of the Royal National Institute for the Blind, said that NICE had been considering the drugs since February 2006 and that the slowness of the processes had threatened the sight of thousands of people.

Andrew Lansley, the Shadow Health Secretary, said that comparisons of access to emerging treatments between Britain and other countries was “frankly scandalous”. “We have some of the best cancer research in the world in this country but we have among the slowest uptake of new cancer drugs. So it is not just about a postcode lottery inside the UK.”

The Department of Health said the NHS constitution would be the first of its kind in the world and would state “what patients, public and staff are entitled to expect from the NHS”. It will be presented to Parliament this afternoon as part of the year-long review of NHS services completed by Lord Darzi of Denham, the surgeon brought in as a health minister by Gordon Brown.

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