Cancer Hits Centre Stage – But At What Cost?
Cancer services have already been under the spotlight during the ‘pre-election’ campaign period, with Labour’s 2009 Conference pledge that patients will only have to wait one week for test results frequently cited and more recent promises of specialist care at home for all cancer sufferers the key differences between the two main parties. However, on the eve of the election being called, the Conservatives have grabbed headlines with a major announcement over the weekend that NHS cancer patients will no longer be denied cancer drugs that are widely available in mainland Europe. To pay for this increase in the medicines bill, the Party is claiming that its proposal to partially scrap Labour’s planned rise in National Insurance contributions for employers and employees will lead to £200m of savings for the NHS which will then be redirected to pay for expensive treatments. The proposed rise is due to come into effect in April 2011. Access to medicines has long been a contentious issue and whilst electorally appealing, the Conservative Party’s pledge leaves many questions unanswered.
Where will the money come from?
Some have already questioned where the £200m funding will actually come from as crucially this is not new money. In announcing the scheme, Shadow Secretary of State Andrew Lansley MP stated that Primary Care Trusts (PCTs) and other budget holders will have already planned for the rise in National Insurance in April 2011 and that it will simply be a case of re-allocating this funding. However, it remains unclear what will happen if budgets have not taken the rise into account or, even if they have, whether the budgets are currently within the tightening fiscal limits being imposed on the health service. Funding for the scheme has also been questioned by the King’s Fund Chief Economist John Appleby who described (and later retracted) it as a ‘sleight of hand’ because other services will inevitably and directly suffer. The reaction from Labour and the Lib Dems has been similar to that expressed at the wider policy of reducing the proposed rise in National Insurance payments – that the party has not got its sums right and is duping the public, businesses and institutions into believing that they can do more with less.
Why is cancer a special case?
Patient organisations representing those suffering from other chronic or long term diseases will rightly question why the party has put so much emphasis on cancer – what of the campaigners who have fought for access to drugs for conditions such as MS or Parkinson’s – does this render their efforts pointless? Those representing and indeed suffering from other chronic conditions will rightly feel nervous about the implications for the funding of other expensive treatments, especially given the tightening budgetary environment in which the NHS finds itself. We can therefore expect a backlash against the continued ‘special’ case made for cancer patients which will lead to more uncomfortable political debates in the weeks and months to come.
What are the implications for wider funding reform?
The pharmaceutical industry will need to study the proposals closely as it could have a significant impact on drugs pricing and the longer term reliance on the current health technology appraisal system. The Conservatives had previously committed themselves to introducing a value-based pricing system within the next Parliament – thought to be planned for 2014. However, the announcement that treatments for very rare conditions or for those that extend life by a matter of months will receive special funding could force this to be brought forwards – especially if the pot of available money isn’t as large as the party hoped. There are also implications for the Pharmaceutical Price Regulation Scheme (PPRS), with the current settlement potentially being difficult to honour in a pressurised spending environment post-election. Alongside the funding announcement, the Party has indicated its support for greater use of drugs outside existing NICE guidelines, raising the spectre of off-label use and greater doctor autonomy over indication, whilst risking the wrath of the industry who will see such a move as counter to the work of the Office of Life Sciences (OLS).
Is this a threat to the independence and the remit of NICE?
By effectively over-ruling NICE’s decision making process, the policy appears to challenge previous assurances from the Conservatives that, should they be elected, political interference in the health service and medicines management by Ministers will be a thing of the past and that a beefed up NICE is the way to ensure value and access for patients. Quite what role the proposed ‘independent’ NHS Board would have in implementing this policy is unclear and there could be negative consequences for NICE as a decision making body free of political pressure. This presents a major weak point for opponents to attack.
Given the often emotive and hard hitting press coverage that the non-approval of drugs by NICE for cancer patients creates, it is unsurprising that the Conservative Party has chosen to target policy at what is apparently a cast iron vote winner. However, industry will need to ensure it is prepared for potential conflicts over funding that may not be too far away in the future, given the bold pronouncements made on blockbuster therapies. Labour has already made it clear that cancer policy will be a central part of its attack on the Conservatives and their claim to be the party of the NHS, but this headline grabbing initiative could be a significant pull at the ballot box.