Delays in access to cancer drugs scuppering healthcare reforms
TDxd. The range of drugs impacted includes some which are still entirely unavailable to public patients — despite European Medicines Agency (EMA) approval — and others which are available but for a narrower range of indications than now applies to privately insured patients.
Many of these medicines are highly expensive. But the hundreds of days or even years it takes for these medicines to be available in public hospitals can exceed the lifespan of some of the public cancer patients who could have benefited from the treatments involved. So, this is — in a very real sense — a matter of life and death.
Since the establishment of the National Cancer Control Programme in 2007, Ireland has been on an ambitious strategic journey to improve cancer incidence and outcomes.
As Professor Paul Redmond said in his foreword to the National Cancer Strategy published in 2006, it focused “substantially on reform and reorganisation of the way we deliver cancer services in order to ensure that future services are consistent and are associated with a high-quality experience for patients and their carers”.
He added: “There is evidence of considerable variation in cancer survival between regions and also significant fragmentation of services for cancer patients. These interrelated factors are of major concern to the National Cancer Forum.”
At the very heart of the plan was the establishment of a network of cancer centres within the public hospital system that would provide equitable access to the highest possible standards of care.
Readers may recall the political upheaval in some parts of the country as the plan was implemented, starting with symptomatic breast cancer services. With the strong political backing of Mary Harney, then health minister, the number of hospitals providing breast cancer surgery was rapidly reduced from 33 to nine. This move was underpinned by robust clinical evidence but nonetheless met with local opposition and even led to the resignation of a junior health minister from government. A similar process followed for each of the other tumours and the process of cancer reform has been continuous under a renewed strategy launch in 2017.
However, there is now a widely held view that this new two-tier access to cutting-edge therapies undermines the whole basis of the creation of the cancer control programme and — apart from driving a coach-and-four through the whole idea of equity for all — it risks fragmenting the organisation of our cancer services unless something is done quickly to allow the public system access new cancer therapies as soon as approved by the EMA as private insurers now do.
The creation of the designated cancer centres has been enormously good for patient outcomes, but now we are driving some patients away from these.
The cost of new medicines is a significant issue that cannot simply be ignored. But this disparity in access undermines so much of what we have achieved in the last 20 years and flies in the face of the aims of Sláintecare. Ironically the progress made on public-only consultant contracts combined with this new problem of unequal access to cancer treatment is the worst possible combination for public cancer patients.
If, as now seems certain, the former health minister Simon Harris becomes taoiseach, he has the opportunity to use his high office to re-engage with an issue he championed in health — the idea of Ireland joining other countries in the procurement of its medicines. He gets this issue and understands that we need to speed up and depoliticise access to new drugs and join with our neighbours to secure best value.
The role of the EMA has become much more prominent in the last few years and there may be an opportunity to secure real benefit for Irish patients by bringing new medicine approval, including purchasing decisions, within the competence of the EU so that all citizens of the EU can have equal access to new medicines.
The present position is untenable.
Simon Harris understands we need to speed up access to new drugs