Don’t ‘economise’ on can­cer drugs

The Jewish Chronicle - - JC SPECIAL - BY PROF AN­THONY GOLD­STONE

THERE IS a myth t hat the NHS o v e r s p e n d s and is there­fore in­ef­fi­cient. This claim is de­lib­er­ately prop­a­gated. The fact is that the NHS is a high-qual­ity op­er­a­tion, led by car­ing staff, which sees a mil­lion pa­tients ev­ery 36 hours. The Com­mon­wealth Fund, a renowned US eco­nomic think tank, re­cently ranked the NHS best of 11 ad­vanced healthcare sys­tems in terms of value for money. Com­pared to the US health sys­tem (11th out of 11) the NHS, for 50 per cent less fund­ing per head, pro­vides bet­ter care in al­most ev­ery cat­e­gory un­der anal­y­sis.

The NHS is a vic­tim of the fail­ure to pre­pare prop­erly in the past 30 years for the needs of a pop­u­la­tion which has in­creased by 30 per cent. There have been two main strate­gies to avoid con­fronting the ba­sic is­sue of “how do we get more done for the same amount of Pro­fes­sor Gold­stone: ‘NHS is highly ef­fi­cient’ money?” Firstly, the sys­tem ex­presses ac­tiv­ity in “tar­gets” not vol­umes, and takes no cog­ni­sance of the fact that vol­umes of ac­tiv­ity are con­stantly in­creas­ing. For in­stance, GPs are car­ry­ing out 40 per cent more con­sul­ta­tions than 10 years ago. The sec­ond strat­egy is to blame staff: lazy GPs won’t work week­ends, con­sul­tants are mostly on the golf course and there are too many man­agers... The Com­mon­wealth Fund has shown that none of this is true.

So what has all this to do with delist­ing can­cer drugs? Many new can­cer agents are very ex­pen­sive and NICE (Na­tional In­sti­tute for Clin­i­cal Ex­cel­lence) is rightly mak­ing a stand against this. But some of the new drugs in myeloma, pan­cre­atic can­cer and other ma­lig­nan­cies are giv­ing pa­tients hope where there wasn’t any and the delist­ing is not tak­ing note that these drugs are ac­tu­ally ef­fec­tive. Cost/ben­e­fit anal­y­sis is all very well but delist­ing of ef­fec­tive drugs is another mat­ter.

Delist­ing is dev­as­tat­ing to pa­tients and is mak­ing UK can­cer care an ob­ject of de­ri­sion. Eight or nine of the drugs delisted in the UK two weeks ago (and there­fore not avail­able on the NHS from Novem­ber) are stan­dard treat­ment in the rest of the ad­vanced world.

The les­son is clear. Tell the public the truth about the NHS — that it is an in­sti­tu­tion of which Bri­tain should be proud but it is un­der­funded be­cause of de­mand — and al­low them to de­bate what they want from it. There are fun­da­men­tal choices to be made — “pay more” or “get less” — and the worst op­tion is to in­dulge in silly non­senses such as to fid­dle with the avail­abil­ity of ef­fec­tive can­cer drugs.

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