Leader comment: What price a life? Time for tough health talk

Renowned journalist '“ and father-of-four '“ AA Gill who died at the weekend wrote movingly that if the NHS had been willing to give him a potentially life-extending cancer treatment it may not have been a cure but could have given him a considerable bit more of life '“ 'more life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth '“ but only if you can pay.'

Columnist AA Gill with his fiancee and partner of 25 years Nichola Formby.

The fact Mr Gill, a famous restaurant critic and columnist, was once described as “swimming through the gilded upper echelons of the world, knows absolutely everyone, lives in Chelsea” made no difference when it came to his dreadful lung cancer diagnosis and then the desperate search for a lifeline of treatment.

In his final column, Mr Gill, 62, who was born in Edinburgh, described being denied immunotherapy costing up to £100,000 a year which was not available on the NHS in England. Five months ago the same treatment, nivolumab, was approved for use in Scotland.

His words were powerfully evocative. For those who are dying and wish nothing more than to spend more time with their loved ones, or for family and friends fighting and campaigning to give someone more time, no expense is too great, the belief is always that the money should be there, what price a life?

For those tasked with making decisions on which drugs should be made available – Nice (National Institute for Health and Care Excellence) in England and the SMC (Scottish Medicines Consortium) in Scotland, a range of factors are taken into account.

It can be the cost effectiveness of the drug in question or doubts over long-term results which leads to their decision.

That Scotland has it own separate organisation making such decisions is right and proper considering Scotland has its own unique demography.

Today’s Scotsman reports on the anger of campaigners over the SMC’s decision to withhold a drug which can shrink breast cancer tumours before surgery. The self-same drug has been approved by Nice for those south of the Border. But while the SMC should decide what drugs should help Scotland and not just accept every drug which has come on to the market, it does show that we are not having a big debate on the cost of health care.

The time has come when we need to have some debate on how much the public is willing to pay, how much the state is willing to pay, and which bits of the National Health Service should no longer be provided free.No-one is having such a conversation because it is quite simply such a political “no-go” area.

Is there scope for some treatments – such as tattoo removal for example – to not be paid from the public purse? The decision to deny the breast cancer drug, Perjeta, in Scotland, was done so on grounds of results, not costs.

But the debate is not happening even when cost is the issue, as in the terribly sad case of AA Gill. Such discussions are long overdue but need to be done in the clear light of day rather than by those fighting for life itself.