Karen Reissmann | ukwatch.net

The NHS and cancer drugs: what price on life?

JamieSW — Thu, 13 Nov 2008 22:54:09 +0000

If you’ve got money maybe you can buy some extra life. If you haven’t you’re only worth what the NHS can afford. That will be the effect of the government’s decision last week to allow cancer patients to pay for extra drugs without forfeiting NHS treatment.

Previously, those who decided to pay for care which the health service said it could not afford were deemed to have opted-out of the NHS into the private sector. They would then have to pay for all their treatment.

The about-turn by ministers threatens to institute a two-tier national health service and will introduce a new wave of health rationing. It runs completely against the government’s own oft-repeated mantra that the NHS is free at the point of delivery, even if it is provided by private companies.

Of course the previous system was also unsatisfactory – the only fair solution is for all clinically proved drugs to be available to all on the NHS.

Many patients have already spent a fortune trying to extend their survival chances by buying “non-NHS” drugs.

The new rules mean that cancer sufferers no longer have a universal NHS – with prescription charges no longer the standard £7.10 but effectively running into thousands of pounds.

This system will mean many will end their lives in debt, while many more who cannot afford treatment will die early.

The government argues that the NHS would be bankrupted if it was allowed to prescribe all it might want to.

But for many cancer patients, access to certain drugs is a matter of life and death. Such people will be angry at the sight of the greedy bankers lining their pockets with public money. Just who has decided upon this set of priorities?

A discussion of which drugs should be available on the NHS also raises questions about the role of pharmaceutical companies. Few of us want to see the NHS simply hand the drug firms more money. Last year the health service drug bill rose to £11 billion – more than 10 percent of the total NHS budget.

In the same year, Pfizer – the multinational drug firm that manufactures the Sutent kidney cancer drug that the NHS says it cannot afford – recorded profits of £9.8 billion.

Drug companies don’t exist to find cures but to make money. Companies choose which drugs to invest in on the basis of expected long-term returns.

So they tend to chase the anti-arthritis and anti-depression markets – which are huge and often require a lifetime of medication – but have little interest in the illnesses where there is little chance of such regular profits.

The firms say that their huge profits reflect the risks they take when spending on research.

Yet they spend a similar amount – about a third of their total costs – on marketing, including launches, gifts, sponsorship, and conferences abroad to try to persuade doctors to prescribe their medicines. Stop this practice and the prices would plummet.

The task of evaluating the usefulness of any new drug is made difficult because the companies themselves conduct the vast majority of research into how they perform. And, as most research and academic facilities rely on drug company sponsorship, it is virtually impossible to get an independent assessment.

The government-run National Institute for Clinical Excellence (Nice) was created to provide genuine independent research. But Nice doesn’t just use clinical evidence about how well a drug works when considering whether it should be available on the NHS, it also assesses “economic evidence”.

So, for example, when Nice looked at drugs for dementia, it did not just assess how the medication impacted on patients and their carers, but whether or not it delayed the need for “expensive” residential care.

The fact that so many effective cancer drugs are denied to NHS patients partly explains why survival rates in Britain are so much lower than comparable countries such as France.

Nice says that many effective treatments that are excluded from the NHS offer “demonstrable and substantial survival benefits over current NHS practise but are deemed not to offer a good use of NHS resources”.

Nice values every extra year of life at £30,000. So if you are faced with a diagnosis of cancer, you cannot expect the NHS to simply prescribe the best treatment – you can expect it to consult its balance sheet.

Until healthcare and drug companies are taken out of the equation, it will be impossible to know what drugs are best in any given situation.

I believe that all clinically proven drugs should be available on the NHS, but that we should not allow the pharmaceutical companies to carry on fleecing us.

If the government can see its way to nationalising banks in the public interest, why not nationalise the firms with the power of life and death too?

Karen Reissmann is a nurse and a member of the Unison union’s health executive. She writes in a personal capacity.

Unity in Action

Ellie Keen — Fri, 07 Dec 2007 03:23:50 +0000

On 5 November I was sacked after 25 years from the job I loved as a community psychiatric nurse. Three days later 150 community mental health workers went on strike indefinitely for my reinstatement.

I might have felt a bit of shame and embarrassment if any of the trumped up charges were true, but I was even sent a letter on the day of my suspension promoting me to senior practitioner. My crime was speaking out about government plans to transfer NHS care to the voluntary sector and publicly protesting my innocence.

As a result my colleagues are taking 14 days of strike action. Their amazing commitment of time and energy is not just about freedom of speech and myself; it is driven by the frustration of working in services being cut to ribbons.

For a long time our trust has been underfunded, but it came to a crunch in 2003 when one of our NHS hospitals closed and moved to a private finance initiative (PFI) hospital. The beds cost four times as much in the new hospital, so we only had half as many. We lost 45 beds across the city.

This means that even if a patient has section papers completed they can wait up to three weeks before admission. You end up with a 20 bed ward for 27 patients. Patients are reluctant to go home because when they come back they might have nowhere to sleep.

The trust also managed to turn a £4 million budget increase into a cut for the ten community mental health teams. We used to have 16 nurses, but they reduced it to four, with support workers cut from seven to four. Despite this we only had 10 percent less patients.

All this made people furious, so we went on strike earlier in the year, stopping the redundancies and downgrading. You’re not allowed to strike about cuts in services if you have a job at the end of it but we carried on campaigning regardless. I think they suspended me for continuing to campaign. If I’m a leading trade unionist in the branch and they discipline me, where does that leave individual nurses?

I went to see a junior minister for mental health the other day and I was the sixth person to see him that day about services or my case. It’s on a scale I’ve not seen before, but the trust has been digging a bigger and bigger hole for themselves, upping the stakes when they should be backing down.

In our first set of strikes they closed three wards rather than discuss emergency cover with us. They sent some people home for two weeks, some to a private hospital where people couldn’t leave for the five or six days they were there, they sent another 20 acutely mentally unwell patients or so to Darlington, for three weeks, with no idea when they were coming back, 100 miles from their family and friends. I just think that’s cruel.

They’ve employed private investigators to investigate my case on a couple of hundred pounds a day. They’ve employed a private HR person for my disciplinary hearing. They’ve taken on 20 private beds for the duration of our strike as a contingency plan.

We lost 20 beds when we moved to the PFI hospital and suddenly they turn up in the private sector and we can afford them, but only for the duration of the strike. Now they’ve got a private PR firm employed. The money, time and energy they have squandered trying to get rid of me and break the union could have been spent trying to solve the problems of our service.

What’s so inspiring is the way nurses, occupational therapists, senior support workers and the service users themselves continue to speak out about cuts despite what’s happened to me. People still go to committees, write to MPs, do press interviews, organise lobbies, petitions and demonstrations: all the things my victimisation was intended to stop.

Our strike headquarters is a hive of activity. Over half the strikers are actively involved. Users of our services have been incredibly supportive despite the huge impact our strike action has had on them. They regularly join our pickets and protests, and speak out.

For years our union branch has supported campaigns by our users. We fought for free bus passes and daycare, and to stop Job Centres threatening people about work. People often ask me if I was offered my job back would I want to work there again. Well I couldn’t ask for better people to work with – users, carers and staff alike. We have a passion for what we do, a sense of justice and a laugh. It’s not just about me.

More information is available at the Reinstate Karen Reissmann website.