Health Direct official NHS Blog- advice, news, information

Top-ups for drugs are fair says voters

2008-08-21T11:01:00.002Z

Patients should be given the chance to pay extra for the best available drugs in addition to their NHS treatment, according to a Sunday Times poll.

Nearly two-thirds of those surveyed said patients should be permitted to top up their treatment. The government is reviewing the issue after a Sunday Times campaign.

According to the latest YouGov poll, 73% believe that if treatments exist they should be available on the NHS. Only 21% think there should be a limit on treatment. Nearly a third said they would be prepared to pay extra taxes so the more expensive treatments could be available on the NHS.

Alan Johnson, the health secretary, has asked Professor Mike Richards, the cancer czar, to consider whether so-called co-payments should be allowed again. The labour government has previously argued such a scheme would create a two-tier service and has warned patients that care may be withdrawn if they pay for drugs privately.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4538256.ece

Health Direct asks why if labour allows the NHS to pay for the removal of 177,00 tattoos why don't they also fund cancer drugs?

Dental NHS copayments total £4.5bn since 1997

2008-08-20T14:00:00.002Z

NHS dental patients have paid £4.5bn in charges since 1997, while 2 million people have "lost" their dentist, the Conservatives have claimed.

The total paid in charges per year increased 22 per cent between 1997 and 2007, according to figures released to shadow health secretary Andrew Lansley.

New analysis by the Conservatives reveals that:

NHS dental patients have paid £4.5 billion in charges under Labour since 1997, despite 2 million people losing their NHS dentist.

Although spread between fewer patients, the annual amount paid in dental charges has soared by 22 per cent since 1997. Patients are now on average paying 35 per cent more for NHS dental treatment than they were in 1997.

Shadow Health Minister Mike Penning said: “Labour’s dental legacy is one of shameful failure.

“Not only are people now paying 35 per cent more when they see their NHS dentist, but Labour’s botched policies mean that millions of hard-working families have completely lost access to affordable dental care.

“Labour ministers need to own up to their mistakes, stop dithering and take action now to rectify the mess they’ve got the country into.”

From:
http://www.hsj.co.uk/announcements/2008/08/tories_report_dental_charges_rise.html

Drug companies face fresh action after trial failure

2008-08-19T13:40:00.001Z

Efforts to punish a group of drug companies allegedly behind one of the biggest price-fixing schemes to hit the public purse are being stepped up after the collapse of their criminal trial.

Frank Field, the former Labour social security minister, wrote to Alan Johnson, the health secretary, yesterday to urge further action against the businesses over a conspiracy that was allegedly taking place while prices of dozens of basic remedies rose as much as 800 per cent.

Mr Field made his intervention as lawyers acting for the National Health Service press for further "substantial recoveries" through a damages action against the companies that has already netted £34m. Many observers say the companies named have never been forced to account fully for their actions, bec-ause of weaknesses in the way Britain deals with financial misconduct.

Mr Field, a former member of the Commons' public accounts committee, said the companies should be "on their knees thanking their lucky stars" at the decision by Mr Justice Pitchford last month to stop their criminal trial on conspiracy to defraud charges.

Peters & Peters, the law firm acting for the NHS, is pressing ahead with a damages action founded on allegations that the companies were involved in a conspiracy to rig the prices of drugs including penicillin and warfarin, a blood thinner.

Jonathan Tickner, a Peters & Peters partner, said: "The obvious success of the civil proceedings . . . speaks for itself and we, on behalf of the Department of Health, fully expect further substantial recoveries to be made."

The main company still in the department's sights is Ashford-based Kent Pharmaceuticals, supplier of many basic antibiotics to NHS hospitals, retail pharmacists and dispensing doctors.

Kent declined to respond to questions on the case. All the other companies that faced criminal charges - Goldshield, Ranbaxy, Generics and Norton Healthcare - declined to comment when asked if they denied colluding with each other, saying they could not speak while the threat of criminal proceedings remained.

Mr Justice Pitchford last month scrapped fraud charges laid by the Serious Fraud Office against the companies after the House of Lords criticised the way the indictment was drafted but left open the possibility it could be amended. The SFO has launched an appeal against the judge's decision, arguing it should be allowed to reformulate the charges.

Since the trial collapsed, some senior executives - notably those at listed Goldshield, which is chaired by Keith Hellawell, the government's former drugs "tsar" - have gone on the offensive and complained £25m of taxpayers' money was wasted in mounting the trial. The companies have always argued that price-fixing was not a crime at the time of their alleged activities.

But lawyers said there seemed to be evidence of subterfuge to justify a prosecution, alleging companies conspired to defraud the government - and hence the taxpayer. Documents seized in the penicillin investigation included a presentation, known as "The Scenario", that contained a bullet-point overview of how to operate a price-fixing cartel.

The case could be picked up by the Office of Fair Trading, which has imposed fines totalling hundreds of millions of pounds over the past year or so on companies involved in cartels in industries such as aviation, supermarkets and tobacco.

Another possibility is that the NHS could launch a private prosecution. It declined to say whether it had plans to do so.

Health checks

2000 SFO starts probe into price-fixing in supply of generic drugs to NHS April 2002 More than 30 premises raided April 2006 Five companies and nine executives charged with conspiracy to defraud January 2008 Lords hear submissions from Goldshield and Ian Norris that price-fixing cannot be prosecuted under the common law offence of conspiracy to defraud March 2008 Lords rule in favour of Mr Norris and Goldshield July 2008 Judge quashes indictment against the five companies and nine executives charged

http://www.ft.com/cms/s/0/32776f1c-6806-11dd-8d3b-0000779fd18c.html

New prostate cancer drug hailed by experts

2008-08-18T07:32:00.000Z

A powerful new drug could transform the treatment of men with aggressive prostate cancer, according to London’s Institute of Cancer Research whose scientists developed it.

The drug – abiraterone – received an enthusiastic endorsement from the institute, Europe’s largest cancer research laboratory, and its associated Royal Marsden hospital, as the first clinical trial results were published online by the Journal of Clinical Oncology.

Ten thousand British men a year, diagnosed with the most aggressive (and normally fatal) form of prostate cancer, could benefit, says the ICR.

Johann de Bono, head of the abiraterone clinical programme, said: “This is the biggest step forward in prostate cancer treatment since the 1940s.”

The ICR and Royal Marsden are usually too cautious to enthuse about a new treatment, for fear of raising excessive expectations among desperate patients. But Dr de Bono said their confidence was based on a substantial amount of unpublished data, as well as the formal analysis in the Journal of Clinical Oncology of the Phase 1 trial with 21 men.

“The Royal Marsden patients have very aggressive prostate cancer which is exceptionally difficult to treat and almost always proves to be fatal,” he said. “They have been monitored for up to two-and-a-half years and with continued use of abiraterone they were able to control their disease with few side-effects.”

Patients showed big falls in levels of prostate specific antigen or PSA, the blood protein associated with prostate cancer activity. “A number of patients were able to stop taking morphine for the relief of bone pain,” Dr de Bono added.

Abiraterone works by blocking the generation of male hormones that drive growth of prostate cancers.

Cougar Biotechnology, a Los Angeles company, is funding extensive further trials, including an international study with 1,200 patients under Dr de Bono’s supervision. He hopes abiraterone will be available for general use from 2011.

From:
http://www.ft.com/cms/s/0/733f85e4-577a-11dd-916c-000077b07658.html?nclick_check=1

Health Direct ask s if this new treatment Abiraterone will be approved by the female biased NICE at the same speed with which they approved Herceptin?

Drug appeal procedures chaotic

2008-08-15T08:00:00.000Z

The pleas of cancer sufferers in England for drugs other than those usually funded by the NHS are not dealt with fairly, a patient group claims.

The Rarer Cancers Forum said the appeal system was chaotic and the result often depended on where the patient lived.

One in four appeals made in a 20-month period was rejected. But one primary care trust had no successful appeals, compared to 96% in a nearby trust.

"In the last 20 months, 5,000 cancer patients have been forced to plead for their lives. There has to be a better way." Penny Wilson-Webb of Rarer Cancers Forum

The recent decision by the National Institute for Health and Clinical Excellence (NICE) advising against the use of four drugs for advanced kidney cancer in England and Wales has thrown the spotlight on the patients fighting to receive them.

One of the routes a patient can take if the drug they believe they need is not funded by their local NHS is to lodge an "exceptional request" directly to the primary care trust, and put forward their particular medical or personal circumstances which they say means it should be funded for them.

The latest report, compiled using information obtained under the Freedom of Information Act, reveals that approximately a quarter of appeals are rejected. In total, 5,000 appeals were made, mostly by patients with advanced cancer, over a 20-month period.

There is no national guidance on how appeals should be run by individual primary care trusts, with some choosing to appoint committees including experts, while others do not.

The forum said there was not even a definition of what constituted an "exceptional case".

It is calling for the appeals to be handled on a regional, or even national level, rather than left in the hands of local NHS managers.

Its chief executive Penny Wilson-Webb said: "This audit shows that the exceptional cases process is in chaos and patients are suffering.

Expert criticism

Dr Steve Schey, a consultant haematologist at King's College Hospital in London, who has appeared before appeal committees, said that the process seemed to be a "lottery".

"We urgently need some standardisation and transparency in the decision-making process."

NICE guidelines cover England and Wales, where similar appeals process is in force.

Scotland and Northern Ireland have their own guideline bodies, and systems for patients to challenge decisions not to fund drugs.

A spokesman for the Department of Health said: "We have heard from patients that one of their major concerns is the perceived 'postcode lottery' in access to drugs - that there are too many variations around who gets access to prescribed drugs and that these variations are a lottery depending on where you live.

From:
http://news.bbc.co.uk/1/hi/health/7549564.stm

NHS drugs body NICE 'bullied, ignored and patronised' patients

2008-08-14T07:49:00.000Z

The NHS's drug-rationing body NICE has been accused of bullying, ignoring and patronising patients in consultation over the availability of life-altering medication.

The attack comes after the National Institute for Curbing Expenditure (NICE) ruled that drugs capable of prolonging the lives of kidney cancer patients by up to two years were too expensive to be made available on the NHS.

It coincides with the publication of a report which found that more than 1,000 patients have been turned down for cancer drugs in the past two years because of a postcode lottery.

Immediately after the decision on kidney drugs last week, campaigners denounced it as akin to a "death sentence" for thousands of people.

Now experts and patients' representatives invited to participate in the consultation process have claimed it was "flawed and irrational".

Charity Kidney UK is expected to make an official complaint that its advice was ignored, while three out of the four patient representatives asked to attend have registered protests.

One patient representative, Bill Savage, a retired management consultant who had a kidney removed, claimed that he and other patients were made to sit through a 101-page Powerpoint presentation focusing solely on the costing of the drugs.

"We were patronised and bullied by a process that marginalised us," Mr Savage, 61, said.

Kate Spall, who won treatment for 80 patients this year by challenging the priorities of local primary care trusts, drew up advice for Nice with the help of a large number of cancer sufferers, but was so appalled by the process that she declined to be named as a consultee and made a written complaint.

"We waited for our opportunity to contribute - and it never came," she said.

The four prohibited medicines include Sutent, which can prolong life in kidney cancer patients by up to two years. The draft guidance also rejected Avastin, Nexavar and Torisel.

Nice has said it has sent responses to all complaints but would not comment further.

From:
NHS-drugs-body-Nice-bullied-ignored-and-patronised-patients-say-charities.html

Cancer patients condemned to early deaths by NICE's cruelty

2008-08-13T07:44:00.002Z

Thousands of cancer patients have been condemned to an early death by labour's National Institute for Curbing Expenditure (NICE) as they blocked paying for cancer drugs which are widely available in Europe.

Patients with advanced kidney cancer are to be denied four life-extending treatments because the NHS says they are too expensive.

Charities expressed outrage at the decision, saying it left patients only one treatment option - interferon - to which many do not respond.

Professor John Wagstaff, from the South Wales Cancer Institute, said there was "no point" in him accepting referrals for people with advanced kidney cancer as around 75% of them "do not gain any real benefit" from interferon.

Broadcaster James Whale, who lost a kidney to cancer in 2000, said the guidance would "mean an early death sentence for many" if it were not revised.

" This is a reckless decision by people who have no idea of the consequences of what they are doing." Broadcaster James Whales tells Sky News.

The medicines do not cure the cancer but extend a person's life by a matter of months.

Patients already on the therapies should continue until they and their doctors consider it appropriate to stop, the guidance said.

Every year, up to 7,000 people in the UK are diagnosed with kidney cancer.

Professor Peter Littlejohns, clinical and public health director at Nice, said: "The decisions Nice has to make are some of the hardest in public life.

"NHS resources are not limitless and Nice has to decide what treatments represent best value to the patient as well as the NHS.

"Although these treatments are clinically effective, regrettably, the cost to
the NHS is such that they are not a cost-effective use of NHS resources."

Prof Littlejohns said there were no treatments that reliably cured advanced kidney cancer.

From:
Kidney-patients-denied-too-expensive-life-extending-drugs.html
Kidney-Cancer-Patients-Denied-Treatment/Article/

Health Direct finds it disgusting that cancer sufferers are being condemned to an early death by labour's pathetic cost cutting. They they find £80 million to fund a website and pay for the removal of 178,000 tattoos. Where's the logic and fairness in their dithering?

Dirty NHS hospitals report 20,000 pest infestations

2008-08-12T07:23:00.000Z

NHS hospitals have reported mice, rats, squirrels, bedbugs, fleas, cockroaches, ants, flies, silverfish and even foxes. Nearly 20,000 cases of pest infestations in NHS hospitals have been recorded over the past two years, the Conservatives have said.

Mice, rats, squirrels, bedbugs, fleas, cockroaches, ants, flies, silverfish and even foxes have all been reported by hospitals responding to Conservative freedom of information requests.

Responses from 127 trusts show that 70 per cent had to call out pest controllers 50 or more times between January 2006 and March 2008.

Examples include maggots found in patients’ slippers; rats in a maternity unit; wards “overrun” with ants; mice “all over” wards; cockroaches in a urology unit; fleas in a neonatal unit; and a store for sterile materials infested with mice.

Andrew Lansley, the Shadow Health Secretary, said: “Labour have said over and over again that they will improve cleanliness in our hospitals but these figures clearly show that they are failing.

“It is difficult for health service estates to maintain a completely pest free environment but the level and variety of these infestations is concerning.

“We need greater transparency in NHS infection control, and publishing data like this is one way in which we can drive up overall hygiene standards."

The data does not show whether infestations are increasing or diminishing, nor does it show that, unpleasant as they may appear, the pests found in hospitals have any clear implications for the health of the patients.

Few households can claim to be free of ants, mice, or silverfish all the time, and rats are never far away. Given the scale of the NHS, the size of its buildings, and the constant flow of patients in and out, the levels of infestation do not appear remarkable.

Malcolm Padley, a spokesman for Rentokil, which provides pest control for hospitals nationwide, said: “Pests are attracted to most buildings whether they are in the private or public sector. You are likely to see pests at some point in some form or another.

“There is a problem with large buildings, like hospitals, in particular and many buildings with a lot of grounds are also attacked.

“We have definitely seen an increase in the number of call-outs about bed bugs and rodents nationally. A lot of people could be going into hospitals with bed bugs on their clothing.

MOST PEST CONTROL VISITS
Nottingham University Hospitals NHS Trust: 1,070
Hull and East Yorkshire Hospitals NHS Trust: 898
Portsmouth Hospitals NHS Trust: 857
Pennine Acute Hospitals NHS Trust: 855
Guy's and St Thomas' NHS Foundation Trust: 813
Barts and the London NHS Trust: 801
York Hospitals NHS Foundation Trust: 690
Leeds Teaching Hospitals NHS Trust: 658
Southampton University Hospitals NHS Trust: 450
East Kent Hospitals NHS Trust: 416
Source: Figures obtained by the Conservatives for January 2006 to March 2008

A spokesman from the Patients Association was unconvinced, saying: "Such findings are truly revolting. How can patients be safe amid bedbugs, fleas and rats? These findings reveal what happens when money is taken away from where patients expect to see it spent.

"If these hospitals were restaurants they would be closed down and out of business."

From:
http://news.bbc.co.uk/1/hi/health/7542718.stm

NHS co-payment ban in disarray

2008-08-11T07:42:00.002Z

Labour's ban on NHS patients paying for medicines the health service does not fund is in disarray. Figures obtained under freedom of information legislation show that NHS hospitals were allowing dozens of patients to top up with private drugs before the government warned them it was not allowed under NHS rules in July last year.

The evidence that top-up payments have previously been allowed, apparently without difficulties, undermines the labour government’s claim they are contrary to the fundamental principles of the NHS.

At one trust, the Royal Cornwall Hospitals NHS Trust, 20 patients were allowed to co-pay for cancer drugs that the health service refused to fund before the labour ban was introduced.

The figures also provide further evidence that many trusts are allowing patients to top up with additional drugs without removing the remainder of their NHS care.

Freedom of information data shows that Nottingham University Hospitals NHS Trust has allowed patients to pay for drugs their consultant has recommended without losing the rest of their NHS treatment.

John Baron, MP for Billericay, who obtained the figures, said: “This undermines the case of those who argue co-payments cannot exist within the NHS.”

Other trusts that have allowed co-payments include the University Hospital Birmingham NHS Foundation Trust, ABM University NHS Trust in Bridgend, south Wales, and Weston Area Health NHS Trust in Somerset.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4449529.ece

Health Direct wonders whether NICE and labour would rather have people die than fund some treatments. Kill the quango, not the patients.

NHS managers get away with murder as MRSA superbug hospital escapes criminal charges

2008-08-08T08:01:00.002Z

The hospital trust at the centre of Britain's worst recorded hospital MRSA superbug outbreak which led to the death of 331 patients has escaped prosecution.

Clostridium difficile contributed to the deaths of the patients over two-and-a-half years at three Kent hospitals a health watchdog report found.

Appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene all led to the outbreak the Healthcare Commission found in a highly critical report in October.

However after studying that report, Kent Police and the Health and Safety Executive said there would be no charges over the deaths at hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust.

Assistant Chief Constable Allyn Thomas said: "Whilst the report makes for grim and at times distressing reading, our review has not identified any information that would indicate a need or duty to conduct a criminal investigation into the Trust at this time."

Relatives of those who died in the outbreak reacted angrily to the announcement.

Steve Stroud, whose 77-year-old stepmother Doreen Ford died in Maidstone Hospital said he was "disgusted" by the decision.

Mr Stroud, husband of former Bucks Fizz singer Cheryl Baker, said: "This is disgusting. Someone has got to be held to account over all these deaths and if it is not the hospital trust, then who the hell can it be?

"Someone really should have to carry the can over this... for no charges to be pressed is really disgusting. I can't believe it".

Baker, described the death of her mother-in-law as "legalised killing".

She said: "The Trust is to blame, I know that, everyone knows it and it makes my blood boil.

"Those patients didn't die by chance, they died because they contracted C diff at the Trust because of poor hygiene and care, so they are to blame, without a shadow of a doubt."

The Healthcare Commission had found the infection probably or definitely killed 90 people and was a factor in a further 241 deaths.

It also criticised the then chief executive of the trust, Rose Gibb, who left before the findings were published and is now reported to be fighting for a payout of several hundred thousand pounds.

But police said the report held no evidence that the deaths amounted to manslaughter.

For the trust or one of its employees to have committed gross negligent manslaughter, it would be necessary to identify a single act that was grossly negligent and caused a death.

Geoff Martin, of campaign group Health Emergency, said: "The decision not to bring charges over the catastrophic management failures at Maidstone and Tunbridge Wells sends out a signal that no matter how many people die, those at the top can bail out without taking the rap.

"Maidstone and Tunbridge Wells was possibly the worst single, corporate failure in the history of the NHS. It doesn't get any worse than 90 deaths and it's massive kick in the teeth to the friends and relatives of those who died that no-one will be properly called to account.

David Nicholson, NHS chief executive, said: "Whilst criminal proceedings have not been brought in this instance, the Trust's failure to protect and care for patients during the outbreaks of Clostridium difficile between 2004 and 2006 was wholly unacceptable."

From:
http://www.telegraph.co.uk/news/2474303/Superbug-hospital-escapes-criminal-charges.html

Private hospitals to follow NHS in publishing patient outcomes and death rates

2008-08-07T07:51:00.000Z

Private hospitals will have to publish an annual "quality" report outlining how their patients have fared, David Nicholson, the National Health Service chief executive, has disclosed.

The move means that for the first time it will be possible to make direct comparisons between the quality of treatment in the two sectors.

Another side-effect should be more information than has previously been available on how many patients the private sector treats.

The requirement for private hospitals, like their NHS counterparts, to publish figures on death rates and other quality measures was revealed by Mr Nicholson to MPs on the Commons health committee. It follows the decision to bring the two halves of the system under the same regulatory umbrella from next year.

David Worskett, director of the NHS Partners Network, which represents private providers of NHS care, welcomed the move. He said yesterday that his members, which include Spire, Care UK, Nuffield Hospitals and General Healthcare, were commissioning "an independent sector-wide approach to collating and presenting patient outcome data".

"Independent sector providers live or die by their quality," he said, "so we have no problem at all with that. There may be some arguments over the technicalities of what is presented in annual quality reports and how. But there will be absolutely no argument about the principle."

In a separate development, Mark Britnell, the health department's director-general of commissioning, has written to the independent sector laying out more than a dozen areas where it can play a role in NHS care. The move is aimed at reassuring the providers that their role in supplying public services - apparently under threat last year - is assured.

He lists policy changes that could lead to business for the private sector, including the patient's right to choose both treatment and providers, providing more information on the quality of care in both the NHS and private sectors, and piloting new integrated care organisations in which the private sector could play a role, along with opportunities to support NHS staff who leave the NHS to sell their services back through social enterprises.

In addition, the jobs of chief executive and chairman of a new competition and co-operation panel have been advertised at what are understood to be attractive salaries. The panel will act as an appeal body for the NHS, private and voluntary sectors if primary care trusts fail fairly to tender new or significantly changed services.

All these and more offer "real potential for private sector involvement", Mr Britnell says in his letter.

Mr Worskett said his members had reservations about one or two of the items. But the private sector's fear last autumn that its potential role in the NHS was shrinking as independent treatment centre contracts were being cancelled had diminished sharply.

"The feeling that it is all going backwards has gone away. A framework [for the independent sector] is now being put in place that looks much more robust for the future. There is still some uncertainty about the best way to achieve change. But there is absolutely no doubt now that the process is continuing and the position has stabilised," he added.

http://www.ft.com/cms/s/0/88ee15b0-5d04-11dd-8d38-000077b07658.html

NHS Choices £80m price tag- another IT disaster?

2008-08-06T11:05:00.006Z

NHS Choices website- more bad news. Health Direct posts NHS has signed another massive IT contract, this time an £80m deal to create the biggest, most erudite, cradle-to-grave healthcare website in the world. Ever.

The site is called NHS Choices, and it occupies the URL nhs.uk. The site already combines the roles of medical encyclopedia, NHS guidebook and users' forum.

The interactive health guides are as readable as commercial handbooks, and presumably as authoritative. My personal favourite feature is Behind the Headlines, inherited from the old National Electronic Library for Health, which sets out the facts behind those "Two cups of tea a day can cure dementia" headlines you see in the red tops.

NHS Choices is also gatekeeper and evangelist for labour's government policy of encouraging patients (in England) to be picky about their hospitals. As labour rightly stresses, choice must be based on information. Thus the site publishes patients' (moderated) comments about care they receive in individual institutions, as well as official data such as survival rates from some surgical procedures.

What, then, is the worry? The answer lies in the scale of the undertaking and what it means for the rest of the e-health economy.

In the words of a vision paper published earlier this year, NHS Choices is to become "the digital wing of the NHS". This is in keeping with the government-wide strategy of rationalising the number of official websites down to a handful of "supersites", both to save money and make life easier for users.

The trouble with being a supersite is that it tends to make you slow, bureaucratic and a big fat target. Every time an NHS organisation says it can't afford a new drug or procedure, you can guarantee the cry will go up: "But you can afford £80m for a website?"

Especially as some of the services - collecting patients' feedback, for example - seem to duplicate those of independent ventures such as Patient Opinion (patientopinion.org.uk) and the newly launched Iwantgreatcare (iwantgreatcare.org).

And, busy as it is, the current NHS Choices site is just the start of the project. This autumn, under the new contract, it will integrate with the online element of the NHS Direct health helpline.

Next year it will take on information about social care, which is provided mainly by local authorities rather than the NHS. And all of this is just a preliminary for the real challenge - becoming the front end of HealthSpace, the ambitious system of personal electronic health records being created by the NPfIT white elephant NHS National Programme for IT.

Any one of these initiatives has the potential to become labour's next IT-enabled public relations disaster. Let's hope the Department of Health and its supersite contractor, Capita, knows what it's doing this time.

NICE blights 40,000 people with Rheumatoid Arthritis access to life changing drugs

2008-08-05T08:59:00.002Z

The National Rheumatoid Arthritis Society (NRAS) has reacted angrily to the National Institute for Health and Clinical Excellence (NICE)'s decision will deny approximately 60,000 people with Rheumatoid Arthritis (RA) access to a range of Anti-TNF drugs and could blight them facing high levels of pain, the possibility of more surgery and long term disability.

NRAS is preparing itself for a flood of calls from distressed patients who are effectively seeing their future quality of life taken away from them.

Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, comments:

“This decision is another nail in the coffin for the treatment of RA in England and Wales. NICE are re-writing the rules of RA treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians.”

NICE are refusing to let patients have access to a second Anti-TNF if their first attempt at Anti-TNF therapy fails. Moving from one TNF therapy to a second and even a third has been established practice in the UK for some years, so this is not ‘new’ treatment which is being banned.

Together with the NICE decision in April to reject abatacept, they are effectively reducing clinically effective treatment options for people with RA from five drugs to just two. Patients diagnosed with the disease in their 20’s and 30’s could face 40-plus years with increasing disability and be forced out of work if access to these drugs is denied.

Ailsa continues:

“NICE is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to Anti-TNF treatment.”

This decision flies in the face of the recommendations in Dame Carol Black’s recent report – Working for a healthier tomorrow – about supporting people to remain in work and the Department of Work and Pensions’ aspirations to have 80% of working age population in work by 2010/11

Ailsa, an RA sufferer herself for 28 years and who is on her third anti-TNF treatment which enables her to work 50-60 hours a week and run an organisation employing 14 people, is concerned that the views of patients have been totally ignored by NICE:

“The involvement and views of patients and patient groups in the NICE process is just a token gesture and is not taken seriously.”

“As a patient expert for many years now, I have attended at least 6 NICE Appraisal/Appeal meetings. I can confirm that with the exception of the Chair of the Appraisal Committees only on one occasion have I or any other patient expert with me ever been asked a question by any other member of the Committee – they seem fundamentally uninterested in the patient quality of life issues which matter to real people.

Any patients concerned about this decision can contact NRAS on 0800 298 7650 or visit the website: www.rheumatoid.org.uk.

From
http://www.rheumatoid.org.uk/article.php?article_id=535

NHS spurns gift of free cancer drug

2008-08-04T07:50:00.003Z

Bosses in the National Health Service have refused to administer a drug to a patient with advanced kidney cancer even though the medicine is being provided free.

Barrie Clark, 61, was told in May that he could receive a free supply of a new kidney cancer drug on compassionate grounds from the pharmaceuticals company that makes it.

Clark was then astonished to be told by the NHS that he could not take up the offer at his local hospital because it was against management policy.

He could receive the drug, which has been approved as safe, only by paying for nurses to administer it privately.

Cancer patient sent home to die by the NHS sees health improve after cashing in pension and paying privately for drugs

Linda O’Boyle was denied free treatment in her final months because she had gone private to try to prolong her life

Clark is in a similar predicament to patients being denied NHS care if they choose to pay for drugs that the health service does not fund. Campaigners are outraged that the ban on allowing NHS patients to pay for private drugs has now extended to letting them receive additional medicines for free.

In a letter of complaint to NHS Grampian, which runs Aberdeen Royal Infirmary where Clark is being treated, the father of four said: “I have been denied a free drug for a long time when there was no alternative treatment.

“We find this appalling and demand that the drug be offered free of charge immediately. How many other people has this happened to? You have jeopardised my life and caused great anguish to me and my family. That is disgraceful.”

The medicine, temsirolimus, which has the brand name Torisel, was granted a licence for the European Union in November. The European Medicines Agency (EMEA) has ruled that its benefits outweigh the risks. Dozens of NHS patients have received it on compassionate grounds from Wyeth, the manufacturer, in advance of its commercial launch in Britain.

The National Institute of Health and Clinical Excellence (Nice) is assessing whether Torisel is cost-effective enough to be prescribed on the NHS.

Managers at NHS Grampian told Clark that he could not receive it because it was not yet on its list of prescribed drugs, known as the hospital formulary. The trust says it will not be placed on the formulary until it is assessed by Nice or the Scottish Medicines Consortium.

Clark, a manager in the oil industry, has been helped by Kate Spall, a cancer drugs campaigner with the Pamela Northcott Fund.

Spall said: “I have never heard such rubbish. They are saying this medicine cannot be given because it is not on a drug list, but patients elsewhere across the country are getting it. Are we now in a position where a terminally ill patient is denied a free medication?”

Cancer professors dismissed the explanation as “bureaucratic nonsense”. Will Steward, a consultant oncologist at Leicester Royal Infirmary, said: “I really do not understand the decision not to allow a free drug to be administered from the hospital. We do this frequently.

“Many trusts have allowed this in the past and this decision is perverse.”

Jonathan Waxman, a consultant oncologist at the Hammersmith hospital in London, added: “This is an effective treatment. This shows the mess we are now in.” After Clark told the hospital he was going to speak to the media, managers said he could pay to have the drug administered privately. He would need to pay about £1,000 a month as it is taken intravenously.

Clark said that, although appalled at his treatment by the NHS, his own oncologist had done his best. NHS Grampian declined to comment on the individual case.

The Sunday Times has been campaigning to end the ban on NHS patients paying for private drugs that the state does not fund. Last week two patients won appeals to receive cancer drugs on the NHS after they featured in the Sunday Times Right to Pay campaign.

Sheila Norrington, 59, a cancer patient from Maidstone, Kent, was denied NHS care after paying privately for Erbitux, which costs about £3,000 a month. After the paper highlighted her case, the Peggy Wood Foundation, a charity, agreed to pick up the bills, but last week West Kent Primary Care Trust reversed its decision.

Barry Humphrey, 59, from North Walsham, Norfolk, was told that if he paid for Nexavar, the only available treatment for his advanced liver cancer, he would be billed for his NHS care. His local trust refused to fund the drug but neighbouring Suffolk Primary Care Trust has recommended that the NHS should provide it.

The British Medical Association and the NHS Confederation, which represents hospital managers, support a patient’s right to co-pay for cancer drugs without losing NHS care.

From
http://www.timesonline.co.uk/tol/life_and_style/health/article4364419.ece

Clostridium difficile rates still rising

2008-08-01T08:31:00.002Z

The number of infections caused by Clostridium difficile are continuing to rise.

Graham Tanner, chairman of National Concern for Healthcare Infections, said: “It should be remembered that over four years, more than 20,000 patients have suffered an MRSA infection, and in excess of 200,000 contracted C. difficile.”

In 2007-08 the number of MRSA cases fell to 4,438 - 588 above the target, Health Protection Agency data show. However, in the first quarter of this year a trend of falls in C. difficile bloodstream infections was reversed, with a 6 per cent rise: there were 10,586 cases of C. difficile blood infections in patients aged 65 and over.

A total of 966 cases of MRSA were reported - an 11 per cent drop on the previous quarter and an average of 322 cases a month. In 2004 John Reid, as the Health Secretary, said that infections of methicillin-resistant Staphyloccocus aureus should be cut to a monthly average of 321. At the time that was said to be unachievable. Even within the Department of Health, leaked documents last year showed there was serious concern it would not be met.

But the recent fall in cases suggests that high-profile initiatives such as the “deep clean” of all hospitals and introduction of a mandatory “hygiene code” may have had the desired effect.

MRSA and C. difficile are carried by some healthy people, but the bacteria can cause illness when they grow unchecked, elderly hospital patients being particularly at risk. Annual figures showed a decline for both infections.

Alan Johnson, the Health Secretary, described the decreases as a remarkable achievement.

“Our strategy is clearly having an impact, with our challenging target now within touching distance, but this is not an issue we can be complacent about and we will continue to focus our efforts on reducing infections further,” he said.

Andrew Lansley, the Conservative Shadow Health Secretary, said that the Government would not have met its MRSA target had it measured the yearly rates to March.

To achieve half of the 7,700 MRSA infections in 2003-04, the NHS would have had to limit rates to just 3,850 cases this financial year, he said.

“Every case of a hospital infection is one too many, but in four years Labour hasn't even been able to halve MRSA rates, he said. “They have only got round to admitting they have missed the target by moving the goalposts. This shows just how much they've dithered and delayed over tackling hospital infections.”

Murray Devine, Safety Advisor for the Healthcare Commission, the NHS regulator, added: “This is great news for patients. There's no question that there has been a very significant turn around, but the challenge isn't over. This improvement has got to be sustained and infection rates brought down further.”

From
http://www.timesonline.co.uk/tol/life_and_style/health/article4353861.ece

Litany of surgical blunders revealed

2008-07-31T08:08:00.004Z

Cases of 14 brain surgery patients who were the victims of catastrophic errors when neurosurgeons operated on the wrong side of the head are to spearhead a government drive to make operations safer.

Sir Liam Donaldson, the Government's chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate "wrong site" mistakes.

About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.

In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the "burr-holes", were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.

Sir Liam told The Independent: "The procedure of drilling burr-holes can be life-saving and you could say that it is a low number [drilled on the wrong side] in the context of all neurosurgical cases. But many people would be incredulous that it could happen at all, let alone be repeated. It is a challenge to our ability not just to reduce error but to ensure these sorts of error do not happen. They should be 'never events'."

In all, almost 130,000 errors involving surgical procedures were reported to the National Patient Safety Agency. In most cases involving operating lists, the error will have been detected before the surgery was done so the true number of errors is likely to be under-reported.

Sir Liam said: "Most surgery is safe but errors do occur. Many are minor but some are serious. Some should be 'never events'. We really should be able to consign wrong-site surgery to the history books."

In a second example highlighting a different problem, he will describe 14 deaths and nine serious reactions among patients having hip replacements related to the cement used to fix the artificial joint.

Hip replacements are among the commonest operations in Britain but in rare cases the cement causes globules of fat to be forced out of the bone into the blood, triggering a heart attack. In the UK, half of all hip replacements are performed using cement; in Canada just 3 per cent are. Guidance about the risks of cement had been issued to surgeons in the UK, but practice had not changed as quickly as it had in North America.

Sir Liam said: "No one knows what causes this reaction."

Two weeks ago, NHS Review by Lord Darzi, the surgeon and Health minister, called for the safety and quality of health care to be placed at the heart of the NHS and said urgent steps should be taken to eliminate "never events", serious incidents which harm patients and damage public confidence in the service.

The new clinical board will be established by the National Patient Safety Agency and include the Royal Colleges of Surgeons and Anaesthetists and patient organisations. Its first task will be to tackle wrong-site neurosurgery and fatal reactions to cemented hip replacements.

Sir Liam will also call for safety tests based on a checklist to be piloted in all UK hospitals. Surgeons and nurses will run through the checks before each operation in the same way pilots check their aircraft before take-off. The Surgical Safety Checklist was launched by the World Health Organisation last month.

About 20,000 patients die after surgery each year in the UK but it is not known how many were preventable. An estimated 2,000 NHS patients die each year as a result of errors in treatment, and an inquiry by the National Audit Office in 2005 concluded that half of all incidents could have been avoided if staff had learnt the lessons of previous errors.

Although serious errors are rare, a study of 38 surgeons in 14 NHS hospitals in the British Medical Journal in 2006 found "most" had experience of operating on the wrong site.

"We should be able to make major in-roads into reducing surgical errors," Sir Liam said.

From:
litany-of-surgical-blunders-revealed-866894.html

Ban on NHS top up is cruel rationing, says BMA

2008-07-30T08:55:00.003Z

Doctors believe patients should be allowed to pay for drugs that are not available on the NHS as they called for an independent inquiry into the controversial problem.

They warned that not allowing patients to top up their NHS treatment with private medication was a "cruel form of rationing".

In a close debate, doctors at the British Medical Association conference in Edinburgh voted in favour of a motion saying patients should have the choice to purchase non-health service treatments and medications if they wish and still receive the rest of their treatment free. The motion was passed with 62.8 per cent of the vote in favour.

The debate comes after a woman dying of cancer was denied free NHS treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle, 64, from Billericay, Essex, was receiving chemotherapy on the NHS, but she paid for the drug cetuximab to boost her chances of fighting bowel cancer. She was banned from free NHS care and died in May.

At present, patients who want a drug or treatment that has not been through an appraisal system or has not been licensed can have NHS funding refused by their primary care trust.

If they choose to pay for the treatment they have to have all their care privately. Many trusts are flouting the rules and allowing patients to purchase drugs which are administered within the NHS and continuing with their health service care.

But in a second motion, members of the BMA stopped short of demanding top-ups be introduced now by the narrowest of margins, 154 to 153, and have called for a Royal Commission to look at the issue further. The labour government has already ordered Prof Mike Richards, national director for cancer services to review the position and the report is due in October.

Some labour ministers claim that allowing private top up treatment would bring about the downfall of the NHS by allowing richer patients to pay for improved treatment, while drugs available to poorer patients may be limited.

At the highly charged debate, one doctor, Gordon Matthews, spoke movingly about his own wife with end stage cancer who wants to buy drugs. He argued that it was not ethical to exclude patients from the NHS because they had chosen to pay for drugs when they are 'clinging to their lives'. Another doctor said the worst moment of his medical career was hearing women screaming while undergoing abortions because they could not afford the anaesthetic.

Proposer of the motion Stephen Austin of the BMA consultants committee said the current rule is "healthcare rationing in its most brutal and cruel form" and that it placed patients in an "impossible" position.

But Dr Jackie Davis of the BMA Council said pharmaceutical companies would put pressure on vulnerable patients and insurance companies would be lining up to offer cover for drugs that the NHS will not pay for. Dr Kevin O'Kane, from the London region, said the motion was 'poisonous' and a 'nail in the NHS coffin'.

He added that the review of the NHS carried out by Lord Darzi meant the appraisal of new drugs by the National Institute for health and Clinical Excellence (Nice) would be speeded up and the postcode lottery in treatment ended, so there was no need for the motion.

Just over 70 per cent voted in favour of a Royal Commission to look into the issue and then supported supplementary motions that co-payments must not be a route to extension of NHS charges.

Commenting after the debate, Dr Hamish Meldrum said: “In principle doctors believe that patients should have the choice to buy additional treatment that is not available on the NHS, without being forced to pay for all their treatment privately.

“However, they stopped short of asking for co-payments to be introduced until there has been a wider debate with the profession and public and the evidence has been collected and examined. Doctors recognised that there were many potential problems with introducing co-payments and suggested a number of safeguards they would wish to see considered were they to be introduced.”

Ian Beaumont, Director of Communications, Bowel Cancer UK said: “We are concerned that while co-payments will enable some patients to receive treatments privately, those who can’t afford to pay will not be able to access them. Co-payments also give the Government, NICE and Primary Care Trusts an excuse to deny patients access to new, effective treatments on the NHS.”

From:
Ban-on-NHS-top-up-is-cruel-rationing%2C-says-BMA.html

Health Direct posts that people who can afford to opt out of the NHS completely and purchase private health care should be able to do so, and they do.

Any one who could afford to top up should be alowed to do so. People who can afford neither will still benefit from free health care from the NHS. Yes this is a multi-tiered health care system , but what is so wrong with that?

The idea that this would spell the end of the NHS is laughable, unless some factions of the BMA are so worried that all their members will do as dentists did and dump NHS practice all togethar.

Pharmaceutical companies cannot pressurise poor people because they are not permitted direct patient advertising as they are in the US. They could pressurise GPs, but you have to hope that the unscrupulous fat cat, pound chasing, sloppy GPs who would in turn pressurise patients are struck off.

Insurance companies will queue up to offer potential NHS blacklisted treatments, but again if someone chooses to invest in their future health provision why shouldn't they? It is no different than buying critical illness insurance. You buy it or you dont it depends on what value you put on it.

Maybe it is about time that people started to take more responsibility for their own health. The current government think it is a dirty word, but perhaps people should ASPIRE, to be in a better position when benefiting from healthcare; rather than aspiring to own a car they cannot afford or sinking 20 pints and smoking 40 fags that weekend.

It is these people, with skewed notions of aspiration i.e. to appear wealthier and more important that they actually (just like a celebrity) are who will ensure the demise of the NHS, not the ones who have chosen to invest in their health!

Gordon Brown is always battering on about choice, why not put your money where your mouth is then Gordo, give people the choice!

Innovation needs cost benefit treatment

2008-07-29T08:35:00.000Z

Will technology break the NHS bank? The question preoccupies health experts across the developed world, who have universally identified medical innovation as one of the main forces propelling costs upwards.

“Technological change is the predominant reason for medical cost increases in the past half-century,” says David Cutler of Harvard University, an expert in the field. “Studies of aggregate medical spending, and of particular medical conditions, show that at least half of all cost growth is a result of increased use of technology.”

For Mark Sculpher, professor of health economics at York University, what counts is cost-effectiveness. “It may be appropriate to devote considerable additional resources to new technology if it is good value,” he says.

Joe Hogan, head of GE Healthcare, one of the world’s leading diagnostics and imaging companies, says: “I scratch my head when people say technology adds costs. It’s not the way economics works. In what other industry in the world has it not increased efficacy and efficiency?”

He highlights the surge in the power of diagnostic devices and the extraordinary accompanying drop in costs of scanners in recent years. “There will be an increase in capacity and an unbelievable decrease in costs,” he says.

That view is shared by a group frequently demonised by those who excoriate rising healthcare costs: drug manufacturers. Asked how he responds to fears that the medicines bill will rise too high, Chris Brinsmead, president of the Association of the British Pharmaceutical Industry, the UK trade body, says bluntly: “The evidence points otherwise.”

While the prices of some new drugs – notably for cancer and certain extremely rare diseases – have risen sharply in recent years, he says that the overall proportion of the UK National Health Service budget spent on medicines is not only modest, at less than 10 per cent, but has declined.

That is partly explained by generic competition once patents expire for drugs such as proton pump inhibitors, which have all but eliminated expensive ulcer surgery, and statins, which have helped ease cardiovascular problems.

Most academic attempts to measure cost-effectiveness of new technology conclude that it more than pays for its keep. Last year, for instance, Prof Cutler published an extensive study of “revascularisation” (bypass surgery or angioplasty) to restore blood flow after a heart attack. Analysing 17 years of data, he concluded that the procedure was associated with more than a year of extra life expectancy at a cost of about £20,000 – making it “highly cost-effective”.

But it is important to use technology sparingly rather than seeing it as a panacea that can be indiscriminately applied to all patients. The majority of technology is cost-effective and valuable, according to Paul Ginsburg, president of the Centre for Studying Health System Change in Washington. “But the benefits are diminished when the technology is applied beyond those patients most likely to benefit from it,” he says. “We have a tendency to apply new technologies to too many people.”

For example, “arthroscopic”, keyhole operations on the knee were a boon for the original patients, who had a clear-cut requirement for such surgery, but it was extended too far, to people who did not really need it.

In the same way, the painkiller Vioxx undoubtedly benefited many patients with arthritis but Merck withdrew it from the market in 2004 after side-effects emerged when it was used by a far larger number of patients to whom, critics argued, it should never have been marketed.

Booz Allen Hamilton, a consultancy, found “substantial evidence that overutilisation and misuse of technology is leading to spending that exceeds its value for patients”.

If the technology is available, there is a propensity to use it as extensively as possible. Diagnostic imaging, a £50bn business, is a good example of increases in spending being “driven to a large extent by the growth in the number of machines installed in hospitals, as well as in doctors’ offices and at imaging centres”, the consultants said.

The result, according to Booz Allen, is a strong incentive for doctors to prescribe unnecessary scans that provide little help in getting closer to a diagnosis.

“Healthcare is littered with examples of technologies that have not delivered on their initial promise,” says Prof Sculpher. Even in the more restrained UK environment, there are doubts that imaging technology is being used cost-effectively.

Health systems throughout the world are facing up to the need for better evaluation of the costs and benefits of new technologies before they are introduced on a large scale.

“There is great potential in developing a lot more information about effectiveness,” says Dr Ginsburg.

From:
http://www.ft.com/cms/s/0/9342d5a4-47bb-11dd-93ca-000077b07658.html

NHS at 60- Growing ranks of elderly add to costs dilemma

2008-07-28T07:43:00.004Z

NHS at 60- Technological change, ageing populations and rising expectations: for health ministers and executives worldwide they are the three furies that bedevil attempts to contain the spiralling cost of care.

“In my experience,” recalls Kenneth Clarke, the highly regarded former health secretary, “at international meetings of health ministers, all they and the other people there ever talk about is how to control costs and they never really seem to find a way to do it.”

All western countries have seen their populations age significantly and the three pressures combined have pushed up costs during the past half century and more.

Nicolaus Henke, head of the London health practice for management consultants McKinsey, flourishes a graph showing that during the past 50 years health spending has outstripped growth in the economy by 2 per cent a year on average in every country in the Organisation for Economic Co-operation and Development.

The trend, he says, is “startling”. Countries occasionally manage to roll back the rate of increase. The US did so briefly in the mid-1990s by putting tighter controls on treatments doctors could use in a drive to raise quality and constrain costs. Other countries have from time to time squeezed budgets or cut them. But the trend always reasserts itself.

If it continues, says Mr Henke, “by 2050 most countries will spend more than 20 per cent of gross domestic product on healthcare. The US will be spending well over 30 per cent”. By 2100, the US health spend would take 97 per cent of national income, the UK’s two-thirds.

“That is difficult to conceive,” says Mr Henke, “but in 1960 most observers would have said that 40 years on it would have been pretty inconceivable that western Europe on average would be spending 9 per cent of GDP on health. But that, of course, has happened.”

The triple pressures prompt apocalyptic predictions. Jonathan Anscombe, head of health of A. T. Kearney’s European health practice, says they create “a perfect storm”, one that will “test the limits of collective funding mechanisms” all around the world.

He predicts that countries will have to restrict tax and social insurance systems to a “core” offering. It will consist chiefly of preventive and primary care services that help restrain costs, along with emergency services and support for the poor, he suggests.

Everything else – most non-emergency care, let alone costly end-of-life cancer drugs – will have to be covered by private individual insurance or by out-of-pocket payments. This, he declares, is “inevitable” and “it is hard to see how this can be achieved without making care more unequal”.

But there is another view. For a start, many of the dire predictions rely on believing that existing trends will simply continue. But that assumption ignores the disruptive effect of the unpredictable, which can lower costs as well as raise them.

Dangerous and costly surgery for gastric ulcers, for example, has disappeared, killed off first by a drug that treated the ulcer then by an antibiotic that cured it.

John Appleby, chief economist at the King’s Fund health think-tank in London, illustrates the dangers of extrapolation with a graph showing that if the steady decline in mortality rates in the UK continues, “by about 2039 the UK will be spending about 10 per cent of GDP on health care and nobody will be dying. Somehow, I don’t think that is going to happen,” he remarks drily.

Many analysts are now much less worried about the impact of ageing than they were. For a start, says Richard Saltman, professor of health policy at the Rollins School of Public Health, as with pensions, “you can fundamentally reduce the costs if people work even one, two or three years longer to pay in rather than take out”.

And there is a growing body of evidence that the older generation, on average, is living longer and healthier, not longer and sicker.

Martin McKee, head of research policy at the European Observatory on Health Systems, says there is good evidence from countries including Canada, Germany and the US Medicare system that the high cost of care for the elderly is chiefly the cost of dying.

“A large part of lifetime expenditure on health care occurs in the last year of life and indeed in the last few weeks before death: and it does so regardless of the age at which you die,” he says.

Added to that is tentative evidence that the costs of dying are lower for those who live longest. “This may be because the old are treated less intensively and so incur fewer costs,” Prof McKee says. That may not be entirely explained by age discrimination.

Raymond Tallis, former professor of geriatric medicine at Manchester University, has argued that even healthy old people’s bodies become frailer. “So it is possible that the stroke or heart attack that you might have survived with a disability at age 70 will kill you at 90.”

Furthermore, any breakthrough in the treatment of dementia – although none is on the near-horizon – could lower long-term care costs

As people live longer, costs will rise, but not necessarily catastrophically. There are, Professor McKee says, “many myths and misunderstandings” about ageing and technology.

But can nations afford the rising bill? Mr Henke of McKinsey has his doubts, although he notes “the most convincing graph in the whole of social science” is the one that shows the richer a country is, the more it spends on health care.

“Healthcare is a wonderful product,” Uwe Reinhardt, professor of political economy at Princeton, says. “So as we get richer we have bought more of it. And if you ask ‘Can we afford the elderly?’ I say – give me a break. Of course we can afford the elderly.”

From:
http://www.ft.com/cms/s/0/85202166-47bb-11dd-93ca-000077b07658.html

Tensions grow over cancer treatments as NICE blocks drugs

2008-07-25T08:24:00.003Z

The new generation of cancer medicines raises delicate and potentially explosive issues for the labour government’s medicines advisory body National Institute for Curbing Expenditure (NICE).

In the past decade, the NICE has recommended an overwhelming majority of the 251 drugs it has reviewed. More recently, however, Nice has rejected half a dozen cancer therapies and forced the manufacturers of others to develop more imaginative, and cheaper, alternatives.

Already the agency has encountered difficulty obtaining some of the information it needs to make its assessments. Now, two manufacturers – Roche and Merck Serono – have raised the stakes.

They are explicitly refusing to co-operate with requests for cost-effectiveness data on their medicines Avastin, for lung and breast cancer, and Erbitux, for late-stage colorectal cancer, respectively.

“Roche did not consider it a good use of either public sector or indeed Roche’s own resources to produce a full submission ... for a year-long appraisal which would have resulted anyway in negative guidance,” Roche said.

Professor Michael Rawlins, chairman of Nice, has a different explanation: “They’re saying that they felt they could not substantiate the high prices they expected to command in relation to the benefits of the product.”

Nice’s role is to assess both clinical and cost-effectiveness, based on the principle that it is unjust to expect the National Health Service to buy expensive medicines that offer little benefit.

The agency does not scrutinise all medicines, nor does it or the NHS refuse treatments simply because they are expensive – developing effective but costly treatments for rare conditions has fostered an entire sub-sector of companies.

But cancer affects a vast and growing patient pool. While a few new medicines, some linked to diagnostic “markers” such as Herceptin for breast cancer, are providing breakthrough treatments, many others have so far shown far less impressive results, extending life by a few months at best in some patients. Yet prices remain high.

The Association of the British Pharmaceutical Industry, the trade body, stresses the costs of developing cancer medicines and the fact that many fail and never come to market.

The body says medicine prices overall in the UK are below those of a number of other European countries and represent a small and declining proportion of total health spending – below 10 per cent of the NHS budget.

There is debate over the need for Nice both to accelerate its review of new drugs and to review its criteria, as well as for similar levels of scrutiny to apply to other parts of the NHS.

Denise Richard, head of the UK oncology business unit for Merck Serono of Germany, which has failed to win Nice approval for Erbitux for late-stage colo-rectal cancer at £2,700 ($5,330) a month, argues that Nice needs to review its criteria, speed up its reviews and change its procedures.

She says that few cancer specialists are involved in Nice technical reviews because of possible conflicts of interest; that companies cannot update Nice during long appeals, despite fast-changing data on drug efficacy; and that the thresholds for cost-effectiveness should be raised for patients with late-stage cancer, since they rarely lived more than a few extra months.

Pharmaceutical companies are reluctant to cut prices. While the UK represents only 3-4 per cent of the global market for medicines, it punches above its weight, in part because Nice’s assessments are closely followed internationally. Price reductions in the UK would likely trigger copycat actions by purchasers elsewhere and encourage “parallel trade”, by which medicines sold in countries at lower prices are exported by arbitrageurs to higher priced ones.

The result has been a series of hidden discounts, such as on Velcade for multiple myeloma – the nominal list price stays the same, but the company will reimburse the cost to those patients in whom it proves ineffective.

Ultimately, the best hope for better value might be that, as drugs are used for earlier stage treatment in many more patients for a wider range of cancers, falling prices will be compensated by rising volumes. But for now, the industry remains cautious.

From:
http://www.ft.com/cms/s/0/fc9fa62a-42e4-11dd-81d0-0000779fd2ac.html