Prostate Cancer Support Group

 

Meeting on 8 Sep 2006 at Calow, Derbyshire, UK
 

NHS funding for cancer treatment : recent trends and future prospects

Media attention has focused on the financial crisis in the health service.  Mr Mike James (Consultant urologist at the Chesterfield Royal Hospital) explained the reasons for this crisis so that the audience (prostate cancer patients and spouses) could reflect on current trends and contribute to the debates on the way forward. 
 

Mr James started by posing the question:
Should expensive treatments/medications for cancer treatment be means tested?
Members of the audience were concerned that it was becoming very much a postcode lottery with significant variations in funding policies in England, Scotland and Wales and felt that there should be a consistent policy across the UK.

 

Trends over the last 20 - 25 years.
Mr James said he qualified in 1983 and had witnessed how treatments for cancer had changed since then.  In the early days, there were a limited range of treatments.  There was now a higher incidence of cancer with people living longer and developing various diseases.  The new treatments are also expensive.  Historically, drugs were derived from plants.  Modern gene-based drugs are studied and tested on cell activity and result in new molecules which are targeted at specific cancers.  They are costly to develop and companies need to recuperate their R & D costs.  Surgery will play a small role and treatment will be largely drug-based.  These drugs are expensive.  For example, the most successful kidney-cancer drug in self-administrable tablet form increases life expectancy significantly but at a cost of £80 per day over several years.

 

Who decides?

Budget holders have limited funds and are forced to make difficult decisions.  In future, most people will not be able to get the best cure for cancer.  So, patients need to become involved in the debate and decision-making process.

 

At present the National Institute for Health and Clinical Excellence (NICE) decides whether a treatment is effective and cost-effective.  Its decisions are often challenged by doctors and patients.  If NICE approves a treatment, patients can demand it and the funds have to found from somewhere.  There is no time to plan for the financial consequences. This is just one reason for the current financial crisis in the health service.

 

Other factors contributing to financial crisis in the NHS

Health funding is continually changing.  Most of the funds come from a payment-by-results scheme.  The tariff (money) for providing a specific treatment (eg to remove prostate cancer) is the same across the country.  So, if the the procedure can be made cheaper, it is possible for a hospital to re-invest the savings in other areas of care.  However, the government ignored advice and got the sums wrong in its contracts with consultants, General Practitioners (GP) and other non-medical contracts.  The GPs were able to reach almost 100% of their potential income since the targets, such as immunisation and blood pressure and other monitoring, were relatively easy to achieve.  So, within three months of the initial contract, the tariffs were altered resulting in a 10% cut in budget.
 

The health trusts have to somehow balance the books since the government will not bail them out.  It is hoping that market forces will sort things out and even out provisions across the country.  Some hospitals, especially in the London area, may go under.

 

Consequences for Chesterfield

Fortunately, Chesterfield Royal Hospital made a surplus last year and is able to balance its books better.  Some other hospitals are having to make redundancies of nurses and medical staff.  Even in Chesterfield, each section has to suggest means for a 10% reduction in costs.  The biggest costs are in jobs and senior nursing grades have had to move or be removed.  The basic medical care will continue to be provided since the remaining staff will be re-organised to cover more responsibilities.

Some Q & A

1. Elderly members of the audience recalled their experience of the development of health care in Britain and hoped that the NHS would continue to provide the excellent service they have come to expect.
    

2. Several members pointed out that there should be a review of the current practice of a) National Insurance contributions going into the Exchequer, and b) funding for health coming out of general taxation.  There was some support for the LibDem idea that there be public contributions which are ear-marked for the NHS.
    

3. A member of the audience pointed out that continually changing, knee-jerk, short-term target-driven policies were typical of the current government and in his experience had undermined the quality of provision in higher education as well.
    

4. Another member pointed out that the financial pressures could have been eased if UK foreign policy was different.
    

5. It was pointed out that people are going to find it difficult to take out medical insurance for best available treatments when they were also expected to provide for their pensions, etc.  If drug companies continued to over-price treatments such that the NHS and the general public could not afford it, is this likely to stifle future R & D anyway? 
    

6. Someone else noted that our Prime Minister's boast that Britain was the fourth richest nation was not helping since it was attracting a lot of in-migration, stretching limited resources even further.

The audience thanked Mr James for his succinct and informative talk on matters affecting all of them as cancer patients, and for provoking their on-the-spot contributions. 

Report by Mahes Visvalingam, 18 Sep 2006