Julia is Director of 2020health.org, a web-based, centre-right Think Tank for Health and Social Care and uniquely focuses on bottom-up policy development by front line professionals. She also blogs at CentreRight.com.
‘The promise of happiness has created an epidemic of depression’ says Tobias Jones in the first chapter of his brilliant book ‘Utopian Dreams’. It’s not a book about health but his statement could equally apply to feelings about the NHS today. We have been promised so much, firstly by Frank, then Alan M and John, Patsy and now Alan J. We have spent unparalleled sums. Yet we have an NHS that is falling in productivity. We have a crisis in inner-city nursing that means the most vulnerable newborns are getting no attention. And innovative new drugs that save sight or give a few more years of life to those who already know they won’t reach three score years let alone the extra ten, are denied or delayed leaving anguish and anger instead of hope or healing.
It was to this last betrayal that 2020health turned it’s attention in our latest report, ‘Our health, our money, our say’, available on our website. Now I want to make clear from the outset that I am a realist. No health service in the world can meet the demands of its population; there is an infinite illness burden and finite therapeutic resources. However we believe that Labour’s consultation on ‘top-ups’ is premature as it is partly based on a false premise, which is that there isn’t enough money to pay for new drugs. The consultation doesn’t question the status of non-NHS drugs but asks for opinion on whether to allow them alongside NHS care.
Our assertion is that this avoids the fact that many of these non-NHS drugs should be available on the NHS. We clearly demonstrate that in the light of wasted NHS resources to the tune of (currently) £800m a year on unused medication, a budget surplus of £1.7bn and anticipated savings due to drugs coming off-patent run into the billions, denying some of the superb new drugs to NHS patients is scandalous. Now I don’t believe that we should have a carte blanch situation of automatic acceptance of all new medications as soon as they get a license. Spending thousands on a drug that extends life by three months is clearly a waste of NHS resources. But rejecting a drug that would extend the life of a 55 year old by three years as in the Ross case? Delaying Lucentis by 18 months, condemning people to irreversible blindness? These are not contentious lifestyle enhancements, but effective, transformational, therapeutic interventions that are at the core of the philosophy of the NHS. The NHS should be in the business of treating and preventing illness and that should be the main criteria for NHS funded care.
While some of the drugs rejected by NICE have gone on to become ‘gold-standard’ treatments elsewhere in the world, there are wider economic ramifications of them not being available on the NHS. Clinical trials for new drugs depend on having the existing ‘gold standard’ to compare to. Individuals are recruited for trials on the new, licensed product and compared to those on current therapy regimes. This is an essential part of the appraisal process and vital to demonstrate any increase in efficacy of new products. However if these new drugs are not being widely used in the NHS, the trials cannot take place in the UK. Whilst it may still be popular to diss the pharmaceutical giants, the reality is that we jeopardize their future investment in our health if our drugs appraisals routinely reject their new products.
However in the light of the wasted millions on unused prescriptions, we do go on to assert that we all have a responsibility to the NHS to only obtain medication that we actually need. Over 80% of people pay nothing for their medicines. We feel that the introduction of a flat fee of £1 for all prescriptions would be enough to encourage each of us to think about whether we need any more pills, and we are thinking particularly here of people on repeat prescriptions. In a country where 90% of people earn less than £40k per annum and inflation is eating into everyone’s household budget, a small transaction that makes the majority ‘stop and think’ we believe is a worthy incentive. We make other suggestions too, recognizing that there needs to be a renewed sense of responsibility on all sides. However the principle remains. The NHS was created to treat illness, not generate happiness. There is money in the system to pay for new, effective drugs. It is vital that these are made available through the NHS, as to deny them to the majority who could not afford them privately is divisive, unjust and negligent.
