Lyndsay Moss: So many treatments and limited money builds in unfairness

Published on 02/03/2009 19:53

IN THE end, everything comes down to money. It's depressing, but true. Getting into the best schools, with the exception of the minority lucky enough to get financial assistance, depends on your family's ability to pay.

Being able to afford the best quality food in the supermarkets, rather than plumping for the 2p sausage, also depends on your wage packet. And whether you walk around in the latest designer gear or charity shop cast-offs also relies on the pennies or pounds in your pocket.

Given this, it probably shouldn't come as much of a surprise that the health care we receive also comes down to cost. But hang on a second … what happened to the National Health Service, with care free at the point of need?

Of course, this fundamental principle remains in place, and probably always will, but it would be naive to suggest that its interpretation has changed over the years.

The problem now facing the NHS, and society in general, has been raised by Professor John Smyth, a cancer expert from Edinburgh University.

At an Edinburgh Science Festival debate next month, he will encourage the audience to consider how the limited public resources available to the NHS can cope with the growing number of treatments now being created by scientists.

It is obvious we will never be able to afford everything that medical progress pops out at us. Some of the new treatments being created, particularly for cancer, cost tens of thousands of pounds and sometimes only buy patients a few extra months of life.

But to the families and patients these extra months are priceless, so how can the NHS put a price on this time? It does because it has to – the NHS would become bankrupt if it did not.

Bodies such as the Scottish Medicines Consortium (SMC) and the National Institute for Health and Clinical Excellence try to help the NHS by assessing new treatments and saying which are both clinically and cost-effective. In general, their advice is followed, and where a treatment is recommended, no matter where they live, patients have an equal right to get it.

But there lies the problem – health boards can still agree to fund drugs that are not recommended. They are, after all, licensed for use in this country. Here things become a little hazy. Each board has its own process to decide on what it deems to be an "exceptional" case – those patients who for whatever reason should receive a drug not recommended by the SMC. But patients have found it difficult to find out exactly what constitutes "exceptional" circumstances. This has led to a situation where some health boards seem to have more "exceptional" people living in their region than others.

While a non-recommended drug is prescribed on numerous occasions in one health board, it seems to not be used at all in another. Are we really to believe that people in Ayrshire are more exceptional than those in Glasgow?

To me, one solution would be to have a national group in charge of deciding on exceptional cases, rather than 14 boards. Of course, this would still mean cases where people are refused funding for a treatment, but it would remove a sense of unfairness that currently persists, despite all efforts to remove claims of "postcode lottery" from the NHS.

Whatever happens, we will continue to hear distressing cases of patients desperate for a drug that could give them more time with their families.

Last month, The Scotsman featured the story of kidney cancer patient Jim Reap who was denied the drug Sutent by his health board. After a mammoth fundraising effort, his work colleagues raised over 20,000 to pay for the treatment.

But not every patient will be able to do this, and why should they? The focus must now be on fairness.

Yes, the NHS will never be able to afford everything, but what it decides it can afford must be distributed on an equal basis. Each of us is deemed exceptional in the eyes of someone. The NHS must never be allowed to forget that.