Whilst it will not mean a disaster in differential outcomes for the population, this post-code differential highlights the anomalies of our 4 regional health services. It reinforces the WHO opinion that there is no longer an NHS. It brings back fear when we should be reducing it, and it makes it clear that rationing overtly is the pragmatic answer. I too would exclude Kadcyla for terminal patients. The main beneficiaries of the Scottish decision are Roche shareholders.. The Times leader advocates rationing, but not necessarily “overtly”.
A life-extending breast cancer drug rejected as too expensive for England and Wales is to be made available to Scottish patients.
Scotland has also become the first part of the United Kingdom to offer a pill that cuts the risk of HIV infection by 90 per cent after NHS England fought a court battle to avoid paying for it. Campaigners warned that English taxpayers would not put up with subsidising treatments in Scotland that they could not get themselves.
Scottish public spending is £10,500 a head against £8,800 in England, with the NHS getting £2,100 and £1,900 per person respectively. English and Welsh taxpayers contribute more to Scottish health spending through the Barnett formula.
The drug Kadcyla can offer an extra nine months of life to patients…
The Times leader encourages rationing – a policy denied by all politicians. “Drug Frontier” – It is wrong that a cancer drug is available in Scotland and not in England or Wales – 11th April 2017:
adcyla is an advanced breast cancer drug that prolongs the life of patients for an average of nine months and in some cases for much longer. It is also, at £60,000 to £90,000 a patient, one of the most expensive cancer treatments ever brought to market. Despite this the drug is readily available to women in 18 European countries, including Germany, Austria, France and Scotland. But it is not available in England or Wales.
An important cause of this disparity is health spending per head that is significantly higher in Scotland than in England, thanks largely to the generosity of the Barnett formula by which block grants from Westminster to Holyrood for public service subsidies are calculated. For the 1,200 women in England and Wales who could benefit from Kadcyla, and who help to fund both their own and Scotland’s health services through their taxes, this is not merely back luck. It is an unconscionable injustice.
These women and their families may ask what can be done to fix such blatant unfairness. Experience suggests an answer, but not a satisfactory one. Recent pricing battles between pharmaceutical companies and the National Institute for Health and Care Excellence (Nice) involving other cancer drugs have shown that when Nice and the NHS bring to bear the full force of their leverage as one of the world’s biggest drugs buyers even the biggest companies can be persuaded to lower their prices.
“The system is working,” Sir Andrew Dillon, Nice’s chief executive, claimed last month. If so, it is working in a way that leaves patients in limbo and desperately anxious while the regulator and the drugmakers bargain with each other. In the case of Kadcyla, it has so far not worked at all. Roche Pharmaceuticals, the drug’s Swiss manufacturer, has been under pressure to lower its cost for three years and has not budged. There is still hope, since the company may decide that discounted sales to such a big customer are better than none, but as the two sides haggle, patients die.
The gap in per-capita health spending between England and Scotland is narrowing but still conspicuous. It roughly halved from £213 a person a year in 2010-11 to £103 a person four years later. The difference is not funded by any underlying strength of the Scottish economy, which has contracted as world oil prices have fallen by more than half in the past six years. It is funded chiefly by Westminster, as shown by the overall gap in per-capita public spending between the two countries. Even as Scotland’s national income has fallen with its oil revenues, its total spending per head has remained at least 18 per cent higher than in England.
The two countries’ health services are independent of each other and can set their own priorities. Simon Stevens, chief executive of NHS England, has admitted that certain costly cancer drugs once available either as a matter of course or through the Cancer Drugs Fund will no longer be because he has prioritised GP surgeries and mental health. The fund is in any case overspent and being wound up. The list of drugs not available on the health service will lengthen.
This newspaper accepts that as people live longer and treatments get costlier the NHS must ration its services or find more sources of funds. The case for a new funding model is only strengthened by the fact that a world-class treatment is available in Scotland but not in England. The case for Roche to cut its prices is even stronger.