Kindly old NHS decides not to let people go blind after all

Thousands have gone blind while the authorities spent over two years dithering, though

For the first time a drugs company will pay to top up patients' treatment where the level of care paid for by the Health Service is not enough. In a decision that marks a climbdown for the National Institute for health and Clinical Excellence (NICE), the first 14 injections of the sight-saving drug Lucentis will be paid for by the NHS. If the patient still needs further treatment then Novartis, the manufacturer, will pay for any additional doses.

The ruling overturns previous draft guidance that patients would have to go blind in one eye before receiving treatment with Lucentis, which costs more than $20,000 per eye, on the second. It also paves the way for other new drugs for which top-up doses may be required to be funded in the same way in future.

Richard Barker, director general of the Association of British Pharmaceutical Industry suggested other medicines the NHS cannot afford to pay for in full could be provided through cost sharing schemes between the NHS and the drugs industry. A similar approach has been suggested for kidney cancer drug Sutent, which costs $48,000 a year, and three other drugs after Nice issued draft guidance saying that they were not "cost effective" despite extending life by two months.

NICE has been severely criticised in recent months by health campaigners, who have accused them of condemning patients to "an early grave" by denying them the drugs. It has also been at the centre of a previous controversy over its decision to deny the $5-a-day drug Aricept to victims of Alzheimer's in the early stages of the disease.

Lucentis can stop the deterioration in sight caused by the condition wet age related macular degeneration (AMD), which affects about 250,000 people in the UK including 26,000 new cases each year. It can cause blindness within three months. Up until now around 40 per cent of primary care trusts have refused to fund the drug while others have approved its use only in 'exceptional cases' although the drug was approved in Scotland last year.

Nice has taken over two and a half years to issue its final guidance on the drug in which time many thousands of people have already gone blind as a result of the condition. The drug has no effect on the condition once the patient has gone blind.

Andrew Dillon, NICE Chief Executive, said the decision would be justified by both the improved quality of life for patients and cost savings in the long run. "Lucentis is an expensive drug, costing more than $20,000 for each eye treated," he said. "But that cost needs to be balanced against the likely cost savings. AMD results in reduced quality of life and increased risks of illness, particularly in relation to accidents - especially falls - and psychological ill-health. "Studies have also demonstrated that patients with visual impairment tend to have longer hospitalisations, make greater use of health and community care services and are more likely to be admitted to nursing homes.

"It has been estimated that the costs related to sight impairment for patients treated with Lucentis are around $16,000 cheaper than for patients who receive best supportive care over a 10 year period. Our guidance means that patients who are suitable for this treatment will have the same access to it, irrespective of where they live."

Steve Winyard, Head of Campaigns at Royal National Institute for the Blind, said: "We've been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country. Finally the torment faced by elderly people forced to either spend their life savings on private treatment or go blind, is over. "NICE's guidance will finally bring an end to a cruel postcode lottery." Primary care trusts in England and Wales now have three months to fund the treatment for all eligible patients....

The ABPI's Mr Barker said drug companies were being flexible and suggesting cost sharing schemes but Nice had to be flexible also.

The decision comes after Health Secretary Alan Johnson ordered an investigation into the policy of denying NHS services to patients in England who top up their care with private treatment. Currently, anyone who pays for any private care can be barred from receiving the normal package of NHS care but the review will look at whether such co-payments should be allowed in future.

In July, RNIB also backed three pensioners in landmark High Court action against Warwickshire PCT for denying them treatment. Tom Bremridge, chief executive of The Macular Disease Society said: "Those responsible for NICE should be aware that during the cumbersome two year review process 152 PCTs have individually had the power to decide whether to let patients go blind or to save their sight. The resulting stress and suffering has been cruel and unnecessary. "Many hundreds of vulnerable patients have been subjected to an appalling emotional rollercoaster ride for the past two years - during which many of them have lost their remaining sight."

He called for Nice to speed up drug appraisals in order to avoid primary care trusts around the country making different decisions on funding drugs that have not yet been through Nice....

Dr Rafiq Hasan, Director of Market Access and Ophthalmics at Novartis said the new agreement was "an innovative approach which shows how pharmaceutical companies can work together with Nice and the Department of Health to ensure patients do get access to treatments on the NHS." He said: "Wet AMD is a debilitating eye condition that can result in a rapid loss of sight if left untreated. Lucentis is a treatment for a key unmet medical need and it has the potential to save many peoples' sight. "Rapid implementation of the guidance is now needed to ensure that patients receive the treatment they need as soon as possible."

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FOI investigation into Sydney public hospital conditions

A Seven News investigation has revealed hospital blunders have led to dozens of serious injuries or deaths. Secret internal documents detail the errors in Western Sydney hospitals, and outline a two year review of investigations into blunders that can mean the difference between life and death. 61 people have died following serious mistakes over the past two years. The reasons for these deaths have until now been kept under wraps, because the information is not made public. Those reasons include surgical material or instruments left inside patients, procedures performed on the wrong patient or wrong body part, and incorrect diagnosis.

Furthermore, a report in 2006 led to a raft of recommendations, but 40 percent of them were ignored, and 20 percent were implemented after serious delays.

Warren Anderson's 16 year old daughter died after a bungled treatment for a fractured skull. "Vanessa should have been walking out of that hospital totally healthy," he said. He added, "Change the system that killed my daughter to make it a safe system. That's the apology I want from Reba Meagher." Health Minister Reba Meagher wouldn't comment, but she apologised to Mr Anderson.

Shadow Health Minister Jillian Skinner said, "I'm shocked with the extent of these deaths, given the government has denied them, is not reporting them, is failing to come clean with the extent of problems in our hospitals."

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Tasmanian hospitals festering, warns doctors' boss

ACUTE staff shortage in the Launceston General Hospital's emergency department is part of a problem festering across the entire hospital system, the Australian Medical Association says. Outgoing AMA state president Haydn Walters said hospitals appeared likely to suffer across-the-board staff shortages, making them extremely expensive to run - and warned that the state's health bureaucracy needed to become more doctor friendly.

Prof Walters said the department was about 10 years late in realising that doctors were not ratbags who needed to be kept in line. He said the LGH risked following the Mersey and Burnie hospitals, reliant on $2500 a day specialist locums and overseas-trained doctors - and parts of the Royal Hobart Hospital were also at risk. Prof Walters said doctors were voting with their feet.

His criticism of the department's "can't-do culture" was rejected by Health and Human Services Department secretary David Roberts. Mr Roberts, who was lured to Tasmania from the UK in January, said he was impressed by the department's innovative "can-do culture". He said he had witnessed a long hard slog of reform in the UK that enabled its hospitals to get a grip on similar emergency department problems. He said a key innovation in emergency departments - already embraced by LGH doctors - was a new acute physician's role where doctors were trained to deal with a broad range of medical problems, not unlike a general practitioner.

Mr Roberts said he had an open door policy, regularly meeting with doctors and nurses: "Doctors are coming with ideas on how we can reform ... I'm pleased to back them." Mr Roberts said Prof Walters' gloom and doom scenario - and his view that North-West hospitals had become dependant on locums - was wrong, but conceded the Mersey hospital had struggled. "It will pick up," he said.

Mr Roberts said apart from some hard-to-fill posts, Tasmanian hospitals were not having major difficulties recruiting doctors. "Our doctor shortage is not as severe as some of the mainland states," he said. [THAT'S a consolation!]

Prof Walters said the ranks of doctors who were committed to living and working in Tasmania for the long term, continued to thin. He said among those bearing the brunt of the LGH crisis were interns - doctors just out of medical school who were feeling exposed and vulnerable - as a growing number of experienced professionals who supervised them voted with their feet. Prof Walters, also from the UK, said he had nothing against overseas-trained doctors, but for the sake of stability and cost control, they needed to be balanced by local doctors.

He will step down in two weeks to begin a sabbatical.

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