NHS policy on drug provision must be addressed

Published on Sunday 22 February 2009 22:25

NO TRAP is greater, or its solution more costly, than that which has ensnared the NHS. Every new medical breakthrough – from stem cell technology to cancer treatment – immediately raises expectations of instant access and universal application.

But there are just not the resources to satisfy on every front. That is the paradox of the NHS: vast though its budget has grown to be, it cannot hope to match the ever-rising expectations of the population.

Professor John Smyth, of the University of Edinburgh, says the huge number of therapies developed by scientists means that the costs to the health service could sky-rocket. In times when the economy and tax revenues were growing, there was some hope that these pressures would be mitigated by growing state provision for health.

But when the economy has slumped and when tax revenues are plunging, public expenditure on health cannot hope to grow at a rate sufficient to meet the increasing demands piled on the NHS.

The darkening outlook for health service expenditure throws into even greater light the concerns already evident about access to expensive treatments on the NHS in Scotland and fears that decisions about which patients should get access to drugs are not being made fairly across the country.

Some 30 per cent of drugs assessed by the Scottish Medicines Consortium are not recommended to NHS boards until full assessments are made of their efficacy and cost. Yet many patients still want to use these non-recommended drugs – and will apply pressure for funding.

As Prof Smyth points out, with 2,000 molecules already being tested for use in cancer treatments alone, the NHS is faced with the most difficult decisions on who gets treatment and who doesn't.

The funds of the NHS are finite when faced with the irresistible advance of medical progress. And indeed, even if substantial extra money was provided for the NHS, powerful arguments would be advanced for that extra resource to go towards Scotland's war against drugs and, in particular, alcohol abuse which, in many areas of Scotland, has now become the biggest killer.

Effective treatment, however, is highly labour intensive and costly. Thus, not only is the battle for resources intense across different government welfare priorities, but also within them.

How are these difficult conflicts to be reconciled? At present, the SMC is chiefly made up of healthcare professionals, managers and pharmaceutical and patient representatives.

Prof Smyth suggests there may be a case for bringing in a broader mix of people from different backgrounds – such as ethicists, philosophers and those from religious backgrounds. That may not make the final decision any less painful for those who lose out in the queue for treatment, but it may offer the prospect of more broadly based decision-making rather than one at the mercy of the better-resourced lobbyist.