How the Cancer Drug Fund is being used to attack the NHS


11:40 am - August 25th 2010

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contribution by Rosanna Singler

The Coalition knew just what it was doing when it announced its controversial £50 million Cancer Drugs Fund in July. It’s a significant milestone in the long-planned unravelling of the NHS

The essential role of NICE is to ensure that the NHS practices and more significantly drugs that it uses are effective, backed up by robust evidence and, perhaps controversially for some, cost-effective. It cannot buy drugs which gives only weeks of life and which cost more than drugs who can give years of extra life.

The NHS does not have a never ending budget, even in times of prosperity. This is why NICE has to play such a brutal role – who would want to control the purse strings where people’s loved ones lives are at stake?

A story in the BBC and the press yesterday and neatly exemplifies just what the £50 million Cancer Drug fund was set out to do – act as a divisive measure, giving the upper hand to drugs companies and painting the NHS as a mean old institution, denying life and happiness.

A neat and tidy personal story showing the life the drug had breathed back into one particular patient. There is no denying this is a great outcome, for this one individual. Buried underneath this was the fact that NICE had rejected this drug because under its robust assessment, for many, it would cost thousands and provide only a few extra weeks of life.

Stories like these undermine NICE and the NHS. We need to accept it must make tough decisions about what it can afford and more importantly, what it should afford, to make it a fair system for all. Personalised stories like this serve only to cloud the debate.

Where was the explanation of why NICE must make these tough decisions?

I was recently treated in an NHS hospital after a serious accident and I thought the services I received were fantastic. The nurses in particular did an unbelievable job. Sometimes I had to wait longer than I wanted for help. Sometimes the wards were hectic, noisy and stressful.

But because I believe so deeply in the NHS; because I understand that a service which serves so many on such a tight budget is going mean I am not going to feel like I am in a private 5 star hotel I didnt focus on these flaws. I didnt go running to the local papers to complain. But too many do, because there isn’t enough debate in this country about the NHS and what it stands for amongst ordinary people.

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Reader comments


1. the a&e charge nurse

Lansley’s play to the gallery has already been demolished by the Lancet who describe his new £50 million cancer fund as “intellectually bankrupt” and “a very modern triumph of political expediency over rationality”
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)61202-0/fulltext

Perhaps it would be much simpler if we abandoned NICE altogether and instead based difficult decisions about clinical effectiveness, or cost, on the most heart rending Daily Fail story?
http://www.guardian.co.uk/society/2007/aug/10/medicineandhealth.theissuesexplained

It’s “giving the upper hand to drugs companies”? More like giving a better hand to cancer patients!

We spend less on cancer drugs in the UK than elsewhere in Europe. Perhaps (just perhaps?), NICE have got some of their criteria wrong?

It’s easy to criticise decisions to buy drugs that “provide only a few extra weeks of life” (although, being strictly accuratem, it’s often months at stake) when you’re expecting decades of healthy life. Life’s quite precious when you’ve less than a year of it left.

The question is, how come other European countries can afford it? Does our health spending not equal theirs now?

The whole Avastin story is a very interesting one. NICE are refusing to recommend it for bowel cancer treatment on the grounds that it does not improve quality of life enough to justify its cost. In the case of treating bowel cancer this is the case because you are given large amounts of the stuff. However, it is extremely cheap when it is given in the tiny amounts needed to treat wet Age Related Macular Degeneration. The specialist at my local hospital told me that one injection of Avastin costs £1.

The problem is that it is not licenced to treat ARMD. The manufacturer has altered Avastin to make it no more clinically effective, just different, to create Lucentis. One injection of Lucentis costs £1000. Huh? Huh? Where did they get that figure from? The CEO is on record for saying that the cost is calculated from how much a patient would pay to save their sight. NICE reached a deal with the manufacturer where the NHS would pay for the first 14 treatments and if the patient needed more the manufacturer would pay for those. The eye specialist at my local hospital told me that he rarely has to give more than 10 treatments.

Lucentis is a significant cost at our hospital (about 1% of its income is spent on Lucentis). Patients are given the choice between the unlicenced Avastin or the licenced Lucentis. Half choose Avastin.

Why do I mention this? Well the Tories cite the Lucentis deal as the model for how they think that NHS drugs should be provided. They really are idiots.

@Mike

So if the NHS has a limited budget, where should the money for these drugs come from? What should they cut to pay for it? Why are cancer drugs more important than other illnesses? What would you cut? This 50 million fund is not enough to allow all cancer patients to use this drugs as standard on the NHS, it is so they can try it out, say ooh it works, create a big heart rendering story for the likes of the Daily Mail and undermine the decisions that NICE have to make to keep the NHS afloat.

You mustn’t forget that the drug companies are very wise to the power of a small number of good stories have in the popular media to trump carefully researched and reviewed assessments of pharmaceutical effectiveness. Patients are used to tug at heart strings in order to release purse strings. Brutal, but true. Individual cases should not be used to make policy. And what will Lansley do when the money runs out?

@Rose,
I can think of lots of areas (many in cancer) where the NHS could work smarter and provide better care more cost effectively. Macmillan (and other patient charities) are working with the NHS to develop such services and remodel the care pathway. Just by example, many A&E visits and hospital admissions are eminently avoidable if cancer patients are supported in self-management as (to a greater degree) people with diabetes are.

Money is tight, so the spending of the public’s money should reflect the public’s priortiies. A (say) 2-3 month extension to life is pretty signifiant if you’re expected to live for 12 months. It’s not wrong if the press suggest that’s important. Many people might reasonably agree.

Either the NHS is efficient, or it’s miserly. Which is it, Dave?

9. alienfromzog

I cannot begin to describe how angry this kind of cheap politics and manipulation makes me.

The best bit of it is that Andrew Lansley believes we should remove “political interference from the NHS”

really?

I wrote a slightly long article for AngryMob on this issue a while back: http://www.butireaditinthepaper.co.uk/2010/03/15/sick-and-wrong/

The problem is that to explain what NICE does and how it does it is quite complicated whilst to say “we’ll put aside money for cancer drugs” is quick and easily understood and makes a good headline.

It’s just plain wrong.

AFZ

10. the a&e charge nurse

[3] “The question is, how come other European countries can afford it? Does our health spending not equal theirs now?”.

There are 40 odd european countries which one are you comparing the NHS to, and for which cancer?

According to this item rates for breast cancer, the fastest growing cancer, have fallen more sharply in the UK than anywhere else in europe;
http://www.guardian.co.uk/world/2010/aug/12/uk-lowest-cancer-death-rate

The NHS has always lagged behind France Germany and Switzerland on health expenditure (and still does) – the accumulative difference over the last 60 years must amount to many, many billions of pounds, yet compared to our big spending neighbours clinical outcomes (in the NHS) are not too dissimilar.

Why are the lie Dems allowing Clegg to destroy the NHS?

Is it now Lie Dem policy to finish off the NHS once and for all? We know that has always been tory policy, and they too lied in their joke sheet, (sorry manifesto)

Does Clegg think he should have run this passed his voters, many of which work in the health service. There was nothing in the coalition agreement about a massive reorganisation of the NHS. If Clegg wants to hide behind the austerity measures as a way of getting into govt fine, but he has no mandate to destroy the NHS. There is no need for all this change that is being rammed through, without scrutiny. All he has to say to Call me Dave is NO. Cameron can do nothing if has not got the votes.

Also ,have you noticed how the Conservatives refuse to put up a minister with each of these changes. When we had the reform of the military the cowardly defence minister refused to go on Newsnight. Last night the cowardly health secretary refused to go on and defend his policy. Instead we had Dorres trying to defend the lies of the this joke govt,.

“The best bit of it is that Andrew Lansley believes we should remove “political interference from the NHS”

If he has his way there won’t be any political interference in the NHS, because their won’t be an NHS left.

I blame Clegg for this, we know what the tory scum think of the NHS, but the Lie Dems?

2. Mike Hobday

I’ll tell you what, I will match your “cancer patients with a few weeks of life left” with my “elderly women who could live decades without pain by having a new hip”. It really is that black and white. I would urge you to do some reading about the role of NICE and read up about the QALY measure. The fact is the NHS always has been short of cash and always will be, Lansley’s changes will make the situation worse, not better.

(For the record I have experience of cancer treatment of relatives, so I am immune from the heart strings tugging arguments of “just a few more weeks is so special”.)

#12. Sally

If he has his way there won’t be any political interference in the NHS, because their won’t be an NHS left.

Exactly right. Lansley is removing all responsibility for public provision of healthcare. What a lazy bastard he is, legislating so that he will have no work to do.

If Labour had any sense they would call these NHS changes the Harold Shipman reforms. I’m sure people will be delighted that billions of un accounted for tax payers money will be handed over to GP’S and then they will have the power to waste that money without political interference.

Just think how may more lives Shipman could have killed if he had such a fund of money to help him.

@ 13 Richard

Totally agree!

17. Flowerpower

Don’t you see anything grotesque in the chief executive of NICE (salary: £180k +), who presides over a quango that spends £35 million, telling kids that their daddy has to die because the NHS can’t afford the drugs he needs (drugs available to cancer patients in every other civilized country)?

And isn’t it especially grotesque that in at least one year recently, NICE spent more on spin (press officers and fees to Weber Shandwick) than it did on testing drugs.

I wouldn’t shed a tear if the whole lot of them were made redundant and the money spent on treating sick people.

Flower power – If we did not have an organisation such as NICE robustly assessing which drugs are bought by the NHS then the NHS would not have any money to treat sick people. Avastin, the drug in question, does not save people from Bowel cancer, it provides a few extra weeks of life – something the NICE has to assess whether it is worth it or it would not have any money to pay for actual live saving drugs and treatments.

As for the £180,000 salary – you might want to investigate what the drugs companies behind such drugs as Avastin pay their Chief Executives and also what they spend on press and marketing before you cast aspersions on how NICE spends its funds. You have to fight like with like. And you will probably find that they money spent by NICE is small potatoes compared to giants such as GSK and the like.

19. the a&e charge nurse

[17] “Don’t you see anything grotesque in the chief executive of NICE (salary: £180k +), who presides over a quango that spends £35 million, telling kids that their daddy has to die because the NHS can’t afford the drugs he needs”.

Unfortunately with certain types of advanced cancer poor old “daddy” cannot be saved because the NHS has simply been too lazy to find a drug that will cure everybody of everything.
I dare say some patients MIGHT live a few weeks longer, or even months (with certain expensive drugs) but needless to say this sort of expenditure, in the absence of any proven evidence that a population as a whole will benefit, means there is less to go round in other spheres like palliative care, for example, a setting where it is already known that supply is falling way short of demand.

Perhaps it’s rather unreasonable that our every health expectation is not speedily fulfilled, and at the drop of a hat for very low cost – personally, I blame Quangos like NICE for having the temerity to evaluate if proposed treatments are effective in terms of clinical outcome or cost.
Wouldn’t it make much more sense if we left it to the relatives of dying cancer patients to decide how best to spend the money?

20. Flowerpower

Rose

Flower power – If we did not have an organisation such as NICE robustly assessing which drugs are bought by the NHS then the NHS would not have any money to treat sick people.

NICE was established in 1999. The NHS somehow managed without it fot many years before that. Perhaps it did seem a good idea at the time, when it had a more modest role and budget. But when an organization established to get value for money ends up spending > £35 million per annum, one wonders how much it is really saving.

A&E Charge nurse

Re: your snarky remark about patients’ kids deciding which drug to use…. hey, why not let doctors decide the clinical treatment issues rather than statisticians and bureaucrats? Might even allow us to catch up with the rest of the civilized world’s cancer survival rates.

Richard Blogger:

Thanks for posting that – just the sort of story that will NEVER reach the pages of the national press simply because there is no-one paying for it to be promoted.

That sort of waste of public funds – profitable waste – is almost never reported, even less ever cracked down upon. Those profiting have good PR and lobbying departments, and plus as major corporate players they have the ear of ministers and civil servants (and might be able to offer them a very nice job one day).

As the Daily Mail’s article demonstrates, they can easily sell any resistance from NICE or any other public body to their profiteering at taxpayer expense as ‘evil bureaucrats killing off innocent people’ (a PR line which Mike Hobday above has apparently bought, hook, line and sinker).

The fact is that these emotive stories are usually promoted to the press by the PR departments of the drug companies, or via astroturf patient groups they fund. They figure that by kicking up a public controversy, they can drive up the price NICE might be willing to pay. If they do particularly well at demonising government drug buying practices, they might even get NICE abolished – if every hospital bought independently from them (‘a free market’ – except with them as the monopoly supplier) they could name their price even more freely than today.

Flowerpower: “NICE was established in 1999. The NHS somehow managed without it for many years before that.”
They did, but in previous decades monopolies were less powerful in the drugs market, and there were fewer high-cost drugs to deal with.

The NHS (or any other healthcare provider) needs serious bargaining power, or it will pay more. Those holding monopolies would simply name their price without any connection to the cost of research/manufacture. It would be politically unacceptable for any drug to disappear from any one hospital, so they would have to buy at any price named or face public rage.

The drugs companies are quite wise to the fact that NICE reduces the price they can charge where they hold a monopoly on a drug, which is why they keep up a continuous media campaign to demonise NICE. This isn’t because they are evil: it is because they are required to do so as part of their duty to shareholders.

23. the a&e charge nurse

[20] I’m not really sure you understand the issues if you think doctors are NOT involved in decisions taken by NICE or cancer care in the NHS lags behind “the civilised world”.

Here is a wilki item which claims NICE “has acquired a high reputation internationally as a role model for the development of clinical guidelines. One aspect of this is the explicit determination of cost-benefit boundaries for certain technologies that it assesses. NICE also plays an important role in pioneering technology assessment in other healthcare systems through NICE International, established in May 2008 to help cultivate links with foreign governments.
http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence

You seem to be advocating a return to the post code lottery method of resource allocation?

24. alienfromzog

@20 Flowerpower, I’ve been meaning to respond for a couple of days, I’m sorry it’s taken me so long.

However, you are completely wrong. Basic philosophy states that to construct an argument you need two premises leading to a conclusion. An argument fails if either premise is shown to be false or if the argument lacks logical consistency (logical fallacy). Your argument – if I understand it correctly, please tell me if I’m wrong – fails because at least one of your premises is false and the other one may well be too and the logic might have some problems also.

Let me put it like this:

Premise 1. Cancer survival is lower in the UK than the rest of the ‘civilised world’ (by which I presume you mean Western Europe).

Premise 2. Spending more money on ‘Cancer drugs’ will improve survival

Therefore;
If Britain spent more money on cancer drugs that NICE denies to people, cancer survival would improve in the UK.

I’ll start with premise 2 as that’s the easiest, the whole point is that the research done by NICE shows that these drugs are not cost effective because they have very little clinical effectiveness. (By the way, the panels that NICE uses are a mixture of experts, many of them clinicians in the field as well as statisticians and NICE takes submissions from the drug company (in the case of new drugs) and from relevant charities). Therefore the amount of money needed to be spent to make the cancer survival gains you have in mind is far far more than the difference in spending between countries.

Premise 1 is quite interesting. It is widely reported that cancer survival in the UK is worse than Europe. There are two things to say about this; firstly it is not necessarily true and secondly, if it is true, the reasons and multifarious and complex.

The cancer survival rates are calculated by very different methods in each country. Hence the change in survival rates within a country are much more informative. (Recently it has been shown that UK breast cancer survival has improved the most rapidly across Europe in the last 25 years). The calculation of cancer survival depends on many things – primarily time of diagnosis and inclusion of data within the figures. If you are interested, I can provide links but the short(ish) answer is that the UK has a national register and arguably the most robust data in the world thus essentially all cases of cancer are included in the calculations. In other countries the data is collected much less effectively.

It is therefore controversial whether Britain actually has worse survival. Of course this is far too complex a concept for a newspaper to report.

So premise one probably isn’t true. Premise two, certainly isn’t. And the logic might have some problems also, as we all know in the real world it is not as simple as spending the extra money will result in the expected result.

You complain about NICEs £35m budget. (I have no idea if this is the correct figure or not). And that NICE spends a lot of its budget on advertising. NICE has been shown to improve cost effectiveness across the NHS and thus saves far more than it’s £35m budget out of the NHS’s £100bn budget. Furthermore, NICE’s primary function is to improve quality of care, it does this by constructing clinical guidelines. Having written them it needs to distribute them to thousands of clinicians (like me). How do you propose they do this?

Dr AFZ

P.S. Ben Goldacre is (unsurprisingly) very good on this issue yesterday:
http://tinyurl.com/2a4rof4 [yesterday’s bad science].


Reactions: Twitter, blogs
  1. Liberal Conspiracy

    How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No

  2. carrie JS

    Good Article: RT: @libcon: How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No

  3. Carrie Sherlack

    RT @CJSherlack: Good Article: RT: @libcon: How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No

  4. Seff

    “@LibDemPress How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No”

  5. Danny Yee

    an attack on NICE and NHS cost-effectiveness http://tinyurl.com/325tkrg (LibCon)

  6. Dawn Foster

    Ace piece by the fantastic @Rosannablabla RT @libcon How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No

  7. Jim Jepps

    RT @libcon: How the Cancer Drug Fund is being used to attack the NHS http://bit.ly/9h16No

  8. Rosanna

    I love the fact that when you search for cancer drug fund my story on liberal conspiracy are the top 12 results #vain http://bit.ly/9h16No

  9. Carrie Schneider

    How the Cancer Drug Fund is being used to attack the NHS | Liberal …: A story in the BBC and the press yesterday… http://bit.ly/aWKeFq

  10. ryesen

    How the Cancer Drug Fund is being used to attack the NHS | Liberal …: A story in the BBC and the press yesterday… http://bit.ly/99tQ6V





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