Lyndsay Moss: 'Postcode lottery' on funding drugs must be addressed

Published on Monday 1 September 2008 20:16

"POSTCODE lottery" has become a bit of an overused phrase – not least, admittedly, by the media.

Whether it is in relation to rubbish collection, school selection processes or care-home places, "postcode lotteries" – which essentially means differences in services offered between different areas – always raise blood pressure and spark a sense of injustice among the public.

But in no area is the term more controversial than when it comes to the availability of life-prolonging – and usually expensive – drugs on the NHS.

Rarely a week goes by when there isn't a case reported of a patient denied a treatment because their local health authority does not believe it is cost-effective, and yet another patient who lives a few miles away is given the drug.

This issue, once again, seems to be coming to a head. Last week, patients and families protested inside the London HQ of the National Institute for Health and Clinical Excellence (Nice), the body, covering England and Wales, which assesses the cost-effectiveness of new drugs and advises the NHS on whether or not it should fund them. In Scotland, a similar job is done (often more quickly) by the Scottish Medicines Consortium (SMC).

But it would be wrong to think these bodies are not linked – while Scotland often benefits from speedier assessments, the SMC does consider what its counterpart is doing.

Both bodies rightly point out that the NHS does not have an endless pot of money to pay for every expensive drug. But this does not explain why patients in some areas find it easier to get exceptional funding for non-approved drugs than others, creating the postcode lotteries that Nice and SMC were supposed to eradicate.

It seems to me that politicians have been rather clever in creating these "rationing bodies" to make the difficult decisions. Telling cancer patients they cannot have a drug that could prolong their lives because it is too expensive is hardly a vote-winner – it's much better to gather a group of experts to say this for you.

I don't doubt the care and attention given to these matters by both Nice and SMC, but it is they who have to take the majority of the flak when the sums don't add up.

Increasingly, the processes they use to make cost assessments are being questioned. How can you put a price on a young mother with bowel cancer spending a few more months with her children and the benefits that will have for them in the years after her death? How can you quantify the improvements in the life of a carer if a dementia patient gets a drug that slows their deterioration?

Nobody is saying it is easy – these are difficult decisions in which society as a whole needs a say. If there is limited cash, maybe we need to ask people what they would rather have – a shiny new hospital in Glasgow or more money for cancer drugs?

It is clear the current situation cannot continue – patients are taking loans or remortgaging their houses to pay for drugs. I accept the NHS is not rolling in cash, but it is obvious that the current distribution of funding is unfair.

And let's not forget the drugs companies. Yes, they spend millions of pounds researching and developing new drugs, but pricing them out of the reach of the NHS hardly seems like the best way of recouping that money.

Soon the NHS will get more guidance on the issue of co-payments – whether patients should be allowed to pay for non-approved drugs and still receive other treatments free on the NHS. But this situation could just make the postcode lottery worse, treating patients with the cash for extra drugs alongside those having to get by on the standard NHS care.

Whatever the solution, politicians, health boards and clinicians need to involve the public in the debate.

Even so, the phrase "postcode lottery" seems destined to stay in our vocabulary for some time, ruining lives and breaking hearts until we find a solution.