NHS hospitals allowing top up cancer drugs payments

Health Direct has learned that payments to top up NHS care - supposedly banned - are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month. The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you're all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Separately another consultant at the same hospital writes a private prescription for the drugs that patients wants to keep them alive.

They are supplied at patients' homes by a private company called Healthcare at Home.

They pay the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

"Nowhere does it say that an episode of care is from diagnosis to death of your cancer" he said. "So we've just interpreted the rules in a way which is in favour of the patients."

Across the country

What is remarkable is that topping up, something the labour government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: "Top ups are happening today and they'll happen tomorrow. So long as they're done through us not using the auspices of the NHS I see no reason why they shouldn't continue."

A Department of Health spokesperson said: "We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

"Professor Richards is looking at how a consistent approach across the country might be best achieved."

Shadow Health Secretary Andrew Lansley said: "David Cameron and I have pressed the Health Secretary, Alan Johnson, to enter into a risk sharing scheme for the kidney cancer drug Sutent in order that patients will be able to access this life saving treatment immediately, but nothing has been done."

Norman Lamb, for the Liberal Democrats, said: "We are in an outrageous situation where patients are left in a lottery, dependent on a few hospitals which are bending the rules.

"This case makes the need for reform all the more urgent."

All Ian Jenkins wants is to stay alive as long as possible.

But his story does raise the question, why the need for a high level review of top ups if they are already happening all over the country?

From:
http://news.bbc.co.uk/1/hi/health/7668121.stm

Dying patient forced to pay £20,000 for NHS care

The grieving family of a woman who died last week tells why health service rules on top-up co payments for cancer drugs must be changed.

A mother of three has died from cancer after her family was forced to pay £20,000 for treatment she was denied by the National Health Service because she had bought a drug privately.

Carole Simmons, 59, died last Tuesday, the third person known to have died after suffering from the labour government’s policy of withdrawing NHS care from patients who buy top-up drugs.

Her death comes in the middle of a government review of top-up treatment, which was ordered after a campaign by The Sunday Times exposed the scandal. The review panel is due to report to Alan Johnson, the health secretary, later this month.

This weekend relatives of Simmons, who lived in Yapton, West Sussex, spoke out in the hope of sparing other families from suffering the same tribulations. Simmons’s husband Kevin, 59, a former divisional officer in the fire service, described what happened when she was diagnosed with bowel cancer last December.

“They more or less said that Carole had no hope, that she only had weeks to live,” he said. “They were sending Carole home to die.”

In an attempt to give Simmons more time, her family paid privately for a drug called Avastin, which was not available on the NHS. They believe it prolonged her life.

However, under labour government rules their NHS treatment was then withdrawn. As well as the cost of Avastin, the family had to pay about £20,000 for routine drugs, scans and consultant appointments that would otherwise have been available on the NHS.

“We got nine precious extra months with Carole which we may not have had if we didn’t have the money,” said Simmons. “We want Carole’s legacy to be that this policy will be changed so that this doesn’t happen to anyone else and top-ups are allowed.”

During the extra time she was given, Simmons, a former teaching assistant, saw a grandchild start school, enjoyed a family holiday in France and attended her sister’s 40th wedding anniversary in Jersey.

Simmons’s youngest son, Chris, 28, a solicitor, said: “Some people may be able to raise the money for the extra cost of the drug but they may not be able to pay for all the treatment, such as scans and consultant fees. Instead of ordering a review, Gordon Brown should have ended this immediately and allowed people to pay just for the extra cost of the drugs.”

He added that paying for Avastin had given “us time to put our affairs in order and to say our goodbyes”.

Simmons’s daughter Kate, 30, a civil servant, points out that her mother had paid for her NHS care. “Our mum worked all her life, apart from when she was bringing us up. She never claimed unemployment benefit and always paid her national insurance and taxes,” she said.

“Our mum really wanted us to speak out so that this would not happen to another family.”

The Simmonses paid for the drug and basic NHS care from savings and a loan. “This was my parents’ pension savings. They didn’t have the money lying around,” said the eldest son Colin, 35, a local government manager.

Simmons was treated at St Richard’s hospital in Chichester before her NHS care was withdrawn. She then paid for Avastin and her treatment, including scans using NHS equipment, at the Spire Portsmouth hospital in Havant.

The Royal West Sussex NHS Trust, which runs St Richard’s hospital, said it was following government guidance by refusing to allow Simmons to continue to receive NHS care while paying for the Avastin.

The government inquiry, which is being carried out by Professor Mike Richards, the government’s cancer czar, was ordered in June following the disclosure in The Sunday Times that another bowel cancer patient, Linda O’Boyle, 64, from Billericay, Essex, had died after her NHS care had been withdrawn because she paid privately for the drug Erbitux.

In May last year Sandra Baker, 62, from Walgrave, Berkshire, died of bowel cancer after being denied NHS treatment because she paid for a drug.

Simmons is the first patient known to have died during the government inquiry after being denied NHS treatment. She would have celebrated her 40th wedding anniversary today.

Her local MP, Nick Herbert, the shadow justice secretary, said: “I am horrified that my constituents have had to use their savings in this way. The awful situation at the moment is that if you do manage to scrape together the money to buy these drugs yourself, your NHS treatment is withdrawn. This puts patients in a terrible dilemma.”

Most leading health organisations, including the British Medical Association, the Royal College of Nursing (RCN), the NHS Confederation, which represents hospital managers, and the King’s Fund and Reform think tanks, have said top-ups must be allowed.

The Roy Castle Lung Cancer Foundation and the Patients Association have both backed top-ups in their submissions to the inquiry.

While the RCN accepts that allowing top-ups is necessary, nurses’ leaders warn that the change could create “business class” treatment for NHS patients who can afford it and thus potentially undermine the founding principles of the NHS.

Others argue that there is already a two-tier health service, as those who can afford to pay for all their care go to private wings of NHS hospitals.

The government inquiry, to be published at the end of this month, is expected to propose that patients should be allowed to pay for additional drugs without losing their NHS care.

Kate Spall of the Pamela Northcott Fund, which campaigns on behalf of patients denied drugs on the NHS, said: “Let us hope that Carole’s tragic story will bring about the end of this situation for patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/article4882645.ece

Cancer patient with months to live wins court order for last-chance drug on NHS

A cancer patient has won a legal battle against the NHS to be given a drug that doctors say could prolong his life by up to three years.

Colin Ross, 55, of Horsham, West Sussex, has multiple myeloma, a cancer of the blood cells, and was not expected to survive to see Christmas unless he was given a drug described as his “last chance”.

The High Court overruled the decision by West Sussex Primary Care Trust that treatment would not be cost-effective, and said that Mr Ross should receive Revlimid as an exceptional case.

Mr Ross had incurable cancer diagnosed in May 2004. In an interview with The Times last month he said that he was “sickened” that he was being denied the £30,000-a-year treatment even though the drug was available to patients living only a few miles away in East Sussex.

But despite the exhortations of doctors treating Mr Ross at the Royal Marsden Hospital, the specialist cancer hospital in London, the trust had, since March, repeatedly refused to fund the drug, raising the issue of a so-called postcode lottery for NHS treatments.

However, Judge Simon Grenfell, sitting in London, condemned the trust’s decision as “one which no reasonable authority could have made on the application before it”.

Revlimid is among the most expensive of new cancer treatments and is readily available to patients across Europe and in the United States and Scotland.

But it has not yet been granted approval by the National Institute for Curbing Expenditure (NICE) and, because of the cost, is likely to be rejected. It is provided by only some trusts in England and then only in exceptional circumstances.

The case is likely to encourage other cancer patients who may have been denied expensive drugs on the NHS, but experts emphasise that the case does not set a legal precedent and that decisions will be taken case by case in other areas.

The judge issued an emergency injunction to enable Mr Ross to begin treatment today, but the ruling was made on an interim basis pending a further appeal and not as the start of permanent treatment.

Mr Ross was too ill to attend court for the ruling but his long-term partner and carer, Wendy Forbes-Newbegin, 52, who has breast cancer, cried after the victory.

She said after the judgment that the family’s treatment by the NHS had been “appalling”.

“The mental anguish that we have been through has at times been unbearable, and wholly unacceptable in this day and age,” she said.

“Colin’s diagnosis and recent prognosis have been so awful in the first place, but to have to endure all the months of waiting for this life-prolonging treatment has been nothing short of shameful in the first degree.”

Mr Ross, who has two children and four grandchildren, told The Times that he feared that delays incurred by his appeals to the trust and ensuing legal action may have reduced the effectiveness of the treatment.

“Depending on what the judges say, I could start treatment with Revlimid, or the doctors will simply refer me to start receiving palliative care,” he said last month. “My bed in the hospice is already booked. I realise the drug is expensive for the NHS, but to think that I could have a few extra months or years to spend with my daughters and watch my grandchildren grow up – I’ve never wanted anything more.”

Before yesterday’s ruling he was taking a cocktail of painkillers and other drugs “just to keep my head above water”, and was advised that Revlimid was now the only option.

In March, Mr Ross’s clinicians asked West Sussex PCT to fund Revlimid for three to four courses at a cost of £5,000 a course and presented evidence to show that it could give Mr Ross up to three more years of life.

He had been unable to purchase the drugs privately, he said. “Even if I could, the law states that I would have to become a private patient and forfeit the rest of my NHS care.”

Richard Clayton, QC, acting for Mr Ross, told the court during a two-day hearing: “This application for this drug is the end of the road for him. Either he gets the drug and is able to have life-prolonging treatment, or he doesn’t and treatment ceases, with inevitable consequences.”

He added: “Were the claimant to live a mile and a half in either direction from where he does, he would have received the drug.”

West Sussex PCT said that it was considering whether to appeal.

From:
http://www.timesonline.co.uk/tol/news/politics/article4727613.ece

Health Direct applauds the judiciary. Having had their power over life and death removed many years ago, it is heartening that they are taking the same power away from labour's faceless health bureaucrats who are condemning thousands to premature deaths in the name of NHS cash shortages.

NHS's refusal to fund cancer treatment costs mother £21,000

For Barbara Moss, the photographs of this summer's camping trip to France will be particularly special.Two years ago, she was diagnosed with bowel cancer and given less than five months to live. After chemotherapy failed to slow the disease's progress, doctors said that her only hope was a drug called bevacizumab, marketed as Avastin, which her local NHS refused to fund.

When Mrs Moss, 53, cashed in her pension to buy the drug, she was also made to pay for other NHS care that previously had been free. Her story highlights a national debate on drug rationing that is about to reach fever pitch.

Next month, Prof Mike Richards, the Department of Health cancer tsar, will announce results of a labour government review into rules that deny NHS treatment to patients who want to "top up" their care by paying for some of it. The Government had to examine the issue after a public outcry over the death in March of Linda O'Boyle, a grandmother denied free NHS treatment after buying the bowel cancer drug cetuximab, marketed as Erbitux.

Mrs Moss was prescribed Avastin by her consultant at Worcester Royal Hospital, but the primary care trust refused to fund it. Instead, the former schoolteacher and her husband, Mark, a toolmaker, cashed in their pensions, and were given money by Mrs Moss's 86-year-old mother to pay for the drug.

It shrank a secondary tumour in her liver so successfully that she was able to have it removed. When the cancer returned, she was once again denied Avastin. The couple spent a total of £21,000 on the drug and on the chemotherapy and nursing that Mrs Moss had previously received free of charge.

Latest scans show she is tumour-free. The cancer is likely to return, but already she has survived for 17 months beyond her original prognosis. On holiday in France, Mrs Moss said: "All this extra time has been so precious. I have been able to spend time with my husband and two sons, and it has helped them and me to prepare for my death. Every day now is a bonus, and I am grateful for that. But I am angry that after paying our taxes we had to take on these battles, and I feel really aggrieved for those people who cannot afford these treatments which are available in so many other countries."

Mrs O'Boyle's widower, Brian, recently had a private meeting with Prof Richards to discuss the top-up review. Last night Mr O'Boyle told The Sunday Telegraph that he wants the entire system of drug rationing overhauled, so that every patient gets the treatment their consultant prescribes.

The father of three said his wife, who was an NHS occupational therapist, would have been amazed by the impact her death has had. Worcestershire PCT said it had concluded that there was not enough evidence to support the use of Avastin for bowel cancer.

Southend Hospital Foundation trust, which treated Mrs O'Boyle, said the charges for her NHS care followed Government policy, which meant only one organisation could be held accountable for a patient's care.

The charity Bowel Cancer UK campaigns on behalf of patients seeking both Avastin and Erbitux. The drugs' use is restricted by the National Institute of health and Clinical Excellence (Nice), the rationing body, on the grounds of cost.

The charity and many bowel cancer doctors are critical of the Nice guidance, but also say PCTs do not have proper policies that should allow some patients to be given the drugs if their cases could be defined as exceptional.

Ian Beaumont, charity's campaigns director, said: "We think the current system is totally broken. All over Britain we have got patients who are having to battle the NHS system at the same time they are fighting cancer."

From:
NHSs-refusal-to-fund-cancer-treatment-costs-mother-21000.html

Health Direct thinks that it is quite absurd that a quango like labour's NICE should have the power of life and death over patients when such powers were abolished years ago for the judiciary.

The problem for the NHS is that labour has blurred the difference between for example top ups for dental treatment and those for life saving cancer drugs- with no idea of the size of potential extra income for the NHS if labour was to see sense and allow extra personal funding.

Healthcare postcode lottery means patients losing out on cancer treatments

The level of healthcare inequality across the country is disclosed in a detailed report which shows some areas are spending twice as much tackling heart disease and cancer as others.

"Postcode lottery" prescribing means some patients are not getting the same access to vital drugs and treatments as their neighbours.

In Knowsley, Merseyside, healthcare bosses spend £118 per head on cancer treatments, but in Ealing, west London, they spend just £47.

Middlesbrough spends £167 per head on circulatory diseases, including heart disease, compared with £76 by Southwark, central London.

The spending variations were "almost certainly not justified", warned Nial Dickson, the chief executive of the King's Fund, the influential health think-tank, which compiled the report.

The wide variations in how much the National Health Service trust spends on these diseases has remained unchanged for three years.

This despite an extra £9billion investment by ministers.

The spending variations were branded "unacceptable" and there were calls on the labour Government to investigate whether they were leading to higher death rates in some areas.

It comes amid increasing concerns over healthcare rationing with several high profile cases where patients have been denied drugs because they were deemed "too expensive" for a particular Primary Care Trust (PCT).

Last week, Colin Ross, a cancer sufferer who has been told he will not survive the autumn unless he receives the cancer drug Revlimid, took his case to the High Court.

Mr Ross, 55, who suffers from multiple myeloma, a cancer of the blood cells, was denied the drug, which costs £4,000 a month, by West Sussex PCT, Despite a leading cancer expert describing him as ``eminently suitable" for treatment. It could prolong his life by three years.

If he lived a mile-and-a-half away from his home in Horsham, West Sussex, Mr Ross's case would come under a different PCT where he would have been more likely to receive the drug.

Jane Tomlinson, the cancer campaigner who died a year ago, was denied a drug that doctors believed could prolong her life although neighbouring PCTs provided it. She eventually received it as part of a clinical trial.

The Government argues that rationing within the NHS is necessary to ensure that resources which could be spent elsewhere are not wasted and that patients receive only treatments which have real clinical benefits.

The new report show that while some PCTs spent more than nine per cent of their budget on cancer care, including drugs, some spent just 3.6 per cent.

The proportions ranged from 5.7 per cent to nearly 11 per cent for circulatory disease.

It also showed discrepancies in treatment for mental health problems. while some trusts spent 8.7 per cent of their budgets on treatments others spent 25 per cent.

Mr Dickson said: "This report raises questions rather providing answers.

"It does not mean that any one PCT's spending is necessarily wrong but it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations - some of these are almost certainly not justified."

Norman Lamb, the Liberal Democrat health spokesman, said: "This analysis points to an unacceptable postcode lottery of care with Primary Care Trusts totally unaccountable to the communities they serve for these funding decisions."

He added: "This report begs urgent questions as to what extent these extraordinary variations in spending are affecting patient care and leading to higher death rates. The Government must investigate whether the funding allocations are fair."

The Tories have called for a system under which ministers would negotiate with drugs companies to bring down the cost of treatments which have proved effective, allowing them to be offered to greater numbers of patients.

David Stout, Director of the PCT Network, which represents most Primary Care Trusts in England, admitted that some of the differences could not be easily explained.

"While this may be due to inconsistencies in the data, it may reveal unacceptable variation in clinical practice or unexplained variation in investment," he said.

"While this analysis does not in itself provide the answers, it will help local primary care trusts to continue to ask the right questions about how they can best manage their resources."

Last month cancer charities and patients groups reacted angrily to a decision by the Government's drugs watchdog, the National Institute for Health and Clinical Excellence (Nice), that four life prolonging kidney cancer medications, costing around £24,000 a year, were not "cost effective" on the NHS.

The organisation has previously faced controversy over its advice that Herceptin, a breast cancer drug, could only be used for advanced cases.

Only after patients groups launched a campaign and legal fight was the drug allowed for early stages of the disease.

Nice has also stoked outrage by refusing to allow an anti-dementia drug, Aricept, which costs around £2.50 a day, in the early stages if Alzheimer's disease, meaning that thousands of patients have to wait for their condition to worsen before they can receive the drug.

The Government has ordered a review into whether to allow patients to buy their own drugs, under controversial "top ups", without having to pay for the rest of their NHS care, as the current system demands.

From:
Healthcare-postcode-lottery-means-patients-losing-out-on-cancer-treatments.html

Top doctors slam NHS drug rationing

Britain's top cancer consultants have accused the labour government’s drugs rationing body of ignoring the plight of patients forced to sell their cars and remortgage their houses to pay for cancer treatments freely available in Europe.

Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to “get its sums right”.

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain’s two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: “We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can’t be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely.” They say: “The time has come for a radical change in how the NHS makes rationing decisions for cancer.”

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers.

They said: “There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups – lacking powerful lobbyists – will be denied cost-effective care for miserable conditions like schizophrenia, Crohn’s disease or cystic fibrosis.”

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.

Health Direct asks if National Insurance was brought in so that we could pay for our medicine . was NICE was brought in so there would be some money left in the kitty for "drinks at Christmas "?

Top-ups for drugs are fair says voters

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?

Banned cancer drugs better than NHS ones

Privately bought cancer drugs are proving to be up to five times as effective as NHS treatments, Health Direct reports on the suffering the co-payments ban is inflicting on patients.

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4138237.ece

Tories plan a bonfire of the NHS targets in bid to save 100,000 lives

David Cameron has set out his vision for the health service, with a promise to save 100,000 lives a year by giving patients more information and more power over their own care.

Labour’s internal NHS targets will be ditched and patients simply told which hospitals get the best results, under the radical Tory plans.

“How long will my dad survive if he gets cancer? What are my chances of a good life if I have a stroke? What are my chances of surviving from heart disease? This is the kind of information people want and need,” Mr Cameron planned to say.

He was also listing a series of goals - reminiscent of New Labour's 1997 pledge cards - so that voters could hold a Conservative Government to account over its handling of the health service.

These include:

* raising cancer five year survival rates to above the EU average by 2015

* cutting early deaths from stroke and heart disease to below EU averages by 2015

* cutting early deaths from lung disease to below EU averages by 2020

* annual improvements in survival rates and quality of life for patients living with long-term conditions.

The Tories chose the 60th anniversary of the creation of the NHS to unveil their “Green Paper” on health policy, ‘Delivering some of the best health in Europe’, before an audience at the Royal College of Surgeons in London.

Mr Cameron has been eager to stress his commitment to the service, and neutralise Labour claims that a Tory Government would downgrade it.

He argued that Labour has strangled the NHS in red tape, “testing to destruction the idea that the NHS can be improved by more bureaucracy, more central control and more initiatives from the Department of Health”.

According to the Tories, raising NHS standards to the European average would save around 38,000 lives every year, but their “ambition” is to lift performance to match the best systems in the world, which would save at least 100,000.

Mr Cameron insisted that outcomes are the only thing that matters for patients: “What matters is the result itself, not how it is achieved.”

Niall Dickson, chief executive of the King’s Fund, welcomed the plans.

“(The Conservatives) are right that what matters to patients is whether their quality of life has improved following surgery or any other procedure rather than whether top-down targets have been met," he said.

’But the Conservatives’ plan to abolish central targets needs to be considered carefully. Before we drop central targets altogether, we must be sure that there are appropriate safeguards to ensure standards and aspirations are in place.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4204107.ece

Health Direct- top up health service care is fair

Health Direct points out that when some complication arises after private surgery, many patients land in the NHS and are treated, not sent away. Equally NHS dental services- when one can find them, require additional payments from patients.

The labour government has deemed that NHS cancer patients cannot pay for an additional anticancer drug without losing their entitlement to state-funded care at that time. It says a patient cannot be a private and an NHS patient in the same “episode of care”.

But we already have a mixed economy in healthcare with private contractors providing NHS-funded care and with those patients who run into problems in the private sector ending up in the NHS at varying stages of their treatment.

The past decade has seen a seismic shift in the NHS, as private contractors provide services, which they do for profit. We use NHS funds to pay agencies for temporary staff, despite the exorbitant cost. Why not allow NHS and personal funding to be integrated if that is what the doctor thinks best for the patient?

The National Institute for Health and Clinical Excellence (Nice) provides important boundaries to what treatment is paid for and what is not by the NHS, but individuals sometimes fall outside the norm. They deserve to be allowed to help fund their care.

When the consultant assesses that a patient is likely to benefit from a drug, yet the drug is not funded by the NHS, what do they do? Do they tell the patient, knowing that the patient has a right to know about their condition and its treatment, or do they keep silent to avoid distress?

Professional codes of conduct demand disclosure. Without that honesty, the patient and their family are left unsupported to surf the net in the vain hope of finding something to help.

The labour government also objects to allowing NHS cancer patients to pay for additional medicines on the grounds that this would create a two-tier NHS with patients on the same ward being administered different drugs based on their ability to pay.

We already have multi-tiered healthcare in this country, however. Those who can afford to pay for their care privately do so.

The labour government is adamant that an “episode of care” is either in the NHS or funded privately by the patient. Yet there is no clear and consistent definition of “an episode of care”.

Is it just the standard course of a drug, including or excluding background investigations and potential but not expected complications? Or is it everything associated with a treatment, even if life-threatening complications occur? We have different definitions of an “episode of care” around the country.

If, for example, a patient has a hernia operation, then suddenly has a massive heart attack immediately after the operation and is shipped into the local NHS coronary care unit, the patient’s dressings relating to the surgery have to be attended to – the NHS does not wash its hands of the patient just because the surgery was done sooner but privately.

When some complication arises following private surgery, many patients land in an accident and emergency department and are treated, not sent away. The episode of care is deemed to be over in the private sector and the patient reverts to the NHS.

There is a provision for the NHS to charge the patients or insurer but this happens rarely, even when the complications arise directly from the privately funded intervention. We have patients in nursing homes paying for their social care, having been means-tested.

This includes care from trained nurses although the rest of their care is rightly provided on the NHS. Yet the boundary between some aspects of health and social care is very blurred.

At present, different NHS trusts take individual decisions in conjunction with their local commissioners over individual high-cost drugs. Often the difficulties arise when high-cost drugs are licensed for one indication but the clinician wants to prescribe it for an individual with another condition.

This can either be because the patient wants to buy the drug but have NHS care, or it may be that the patient wants to top up their care, or wants to self-administer the drug (perhaps purchased via the internet) but remain treated by the NHS. The danger is that if the NHS does not know what the patient is taking, the consultant is unable to advise if the drug is likely to do more harm than good. And the NHS still has to treat the patient when problems arise.

No patient can expect a clinical team to administer a treatment that is unlikely to be of benefit – on balance the benefits must outweigh the risks and burdens.

There will always be patients getting funded drugs but not responding as hoped for. Similarly for unfunded treatments, there will be a small number of patients who might have benefited if they had had the treatment; predicting that can be hard.

But why should we pretend that the lines around NHS episodes of care are clear? They are not. Without clear national definitions of what the NHS does and does not do, can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?

Interestingly, the opinion of Nigel Griffin QC is that there is no bar in law, and no reason in principle, for NHS and privately paid-for care to become more integrated so that treatment runs concurrently, providing that nobody else is excluded from treatment in the process.

It cannot be beyond the wit of managers to ensure that those who fund their own treatments integrated with the NHS do so in a way that allows a small fund to be generated to subsidise the odd patient who cannot pay but really would benefit from that rare off-licence treatment.

Surely this would be more equitable than restricting access to potentially life-prolonging treatment to those able to pay for everything included in the “whole episode of care” – whatever that means.

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article4087623.ece

NHS scandal: dying cancer victim was forced to pay

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian O’Boyle’s husband said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but \ we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

NHS at 60- NICE roadblock deprives patients as big drugs companies shift trials from UK

NHS at 60- leading pharmaceutical groups are cutting back on clinical research in the UK, claiming insufficient commitment by the labour government and the National Health Service to support new drug development.

Pfizer of the US, Roche of Switzerland and Merck-Serono of Germany are among the companies which have told the Financial Times they have, or will, reduce the number of British patients enrolled in trials to test experimental medicines for life-threatening diseases such as cancer.

The drug companies are increasingly frustrated by the National Institute for Health and Clinical Excellence, the labour government’s medicines advisory body, which last week handed them fresh setbacks by advising against NHS use of Pfizer’s Avastin and Merck-Serono’s Erbitux.

The result, the companies claim, is that few patients in Britain are receiving “gold standard” treatment so there is too small a group against which to compare their experimental drugs.

Chris Brinsmead, head of the UK arm of AstraZeneca and newly appointed president of the Association of the British Pharmaceutical Industry, the trade body, said a sample of just four companies had revealed that more than 20 trials had failed to get off the ground since the start of last year because they could not recruit patients.

“Two or three years ago, this would have just been hypothetical,” he said, stressing that the UK’s relative share of global clinical trials was already in decline although absolute numbers were stable. “It would be a great shame if the trend continued.”

The warnings are a fresh embarrassment for the labour government, which has stressed its commitment to pharmaceutical research in the UK while imposing a fresh 5 per cost cut after unilaterally scrapping the existing price contract with industry only halfway through its five year term.

Denise Richard, head of the UK oncology business division at Merck-Serono, the German drug company, said a large cancer trial her company had supported three years ago with free medicine and a grant of several million pounds was “the last time we will invest such a massive amount until we see a better return”.

She said that if her company had previously allowed her to include about 20 British centres with cancer patients as part of international clinical trials, it was now willing to permit only four or five “to provide a bit of data from the UK”.

Pfizer has already recently cancelled UK participation in four clinical trials, including one for cancer, because it could not recruit sufficient patients who were taking the existing international “gold standard” approved drugs against which to compare with Avastin, its experimental treatment.

Harpal Kumar, head of Cancer Research UK, said: “In the long-term there is a serious risk that if we get to the point where none of the new drugs are being used in the UK, the trials won’t eb done here.”

From:
http://www.ft.com/cms/s/0/f0e08f2a-42ee-11dd-81d0-0000779fd2ac.html?nclick_check=1

Cancer victim told to pay for his own drugs by NHS

A cancer patient who was sent home to die by hospital doctors but then discovered a cocktail of drugs that stabilised his illness has now been told that the NHS will not pay for his medicine.

Jack Hose, 71, a retired engineer, was receiving a chemotherapy drug called irinotecan on the NHS, but it was failing to halt his bowel cancer.

NHS doctors told Hose, from Bournemouth, that they could do no more for him and that he should go home and make the most of the rest of his life while taking painkillers.

Hose was not prepared to die and sought a second opinion from a private doctor who recommended trying another drug, called cetuximab, in combination with irinotecan.

The mix of drugs appears to have stabilised Hose’s cancer. However, cetuximab is not funded by the NHS.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, which is treating Hose, has told him that, if he takes the drug, he will need to pay for all his care, including the cost of the medicine he initially received on the NHS.

Hose is the latest victim of the labour government’s policy of denying NHS treatment to patients who pay for an additional private drug.

Alan Johnson, the health secretary, says such an arrangement, known as “co-payments”, would lead to a two-tiered NHS.

“It seems outrageous that, having paid National Insurance contributions for 50 years, they are now asking me to pay for my care,” said Hose.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999216.ece

Prostate cancer services subject to wide postcode lottery

Prostate cancer services must be improved to help tackle the wide variations in care seen across England, say health experts in Prostate Cancer week.

The Prostate Cancer Charter for Action found death rates from the cancer were twice as high in the London borough of Lewisham than in nearby Southwark.

The group said patients needed more encouragement to seek help earlier.

About 35,000 men are diagnosed with prostate cancer each year in the UK, and 10,000 die from the disease.

"Prostate cancer sufferers report worse care, lower awareness and poorer outcomes than other patients. More than any other cancer, the story of prostate cancer remains a story of inequalities." Frank Chinegwundoh, of Prostate Cancer Charter for Action

One of the key problems is that men are often diagnosed late.

The group said there was much the labour government could do to tackle this and eradicate the postcode lottery.

The report said men should be provided with better information about the disease, including how to recognise the symptoms, in a bid to encourage them to seek a medical opinion at an earlier stage.

The lack of awareness about the cancer was illustrated in a separate report by the Prostate Cancer Charity.

The poll of 1,000 men over the age of 45 found one in three thought it was normal to get out of bed many times a night to go to the toilet - one of the key symptoms of prostate cancer.

Staffing levels

But Prostate Cancer Charter for Action also called for an increase in the numbers of specialist nurses for the disease as staffing levels vary widely across the country.

The figures, obtained from the Office for National Statistics, highlighted particularly stark contrasts in parts of London.

Deaths from the disease in North Southwark and Bermondsey stood at 15 per 100,000 compared with 38 per 100,000 in Lewisham West.

From:
http://news.bbc.co.uk/1/hi/health/7288088.stm

Health Direct highlights the plight of prostate cancer sufferers as being both the result of labour's postcode lottery, but also the result of sexism whereby breast cancer sufferers are regarded as being a higher priority.

Please also read Health Direct's post on Dec 18, 2007- Prostate Cancer- a health disservice

As 2007 draws to a close it is sad to contemplate that during the year another 10,000 men in the UK will have lost their lives to prostate cancer, and that 10,000 families this Christmas will be grieving the loss of a loved one as a result.

Cancer patients fight to stop NHS withholding care

Cancer patients have launched a legal action to prevent the NHS from withdrawing care if they seek to improve their chances of recovery by paying privately for an additional drug.

The patients say the NHS will be breaching their human rights if it withdraws the treatment they are receiving.

Two of the patients, Colette Mills, 58, a former nurse from near Stokesley, North Yorkshire, and Debbie Hirst, 56, from St Ives, Cornwall, who both have breast cancer, have been told they will be made to foot the entire £10,000 monthly bill for their care if they attempt to pay privately for an additional drug, Avastin.

Ministers claim that to allow patients to pay for top-up drugs would be unfair to those who cannot afford them and lead to a two-tier NHS. The health department has issued guidance to NHS trusts warning that such co-payments are not allowed.

However, the patients’ solicitor, Melissa Worth of the Manchester law firm Halliwells, said NHS trusts would be breaching several articles of the 1998 Human Rights Act if they withdrew chemotherapy treatment. Worth also argued that in withdrawing treatment NHS trusts would undermine the National Health Service Act of 1977.

She said: “In light of the indisputable obligations of the trusts to provide life-sustaining treatment when there is a known, real and immediate risk to life, there is no legal justification for the trust threatening to withdraw all free treatment should our clients wish to maximise their chances of survival by complementing the treatment they are receiving by receiving Avastin.”

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the overfifties, have all backed Mills and Hirst since The Sunday Times highlighted their plight last month.

This weekend they were joined by one of Britain’s leading breast cancer consultants. Professor Ian Smith, head of the breast cancer unit at the Royal Marsden NHS Foundation Trust, said: “I am very sympathetic to the case of these patients. We are looking after patients with life-threaten-ing diseases and it is difficult enough telling them they cannot get the drug on the NHS without needing to then say: ‘Even if you are prepared to pay for it, you still cannot have it.’ This creates a very emotionally fraught situation and seems very harsh.”

Politicians have also pledged to campaign for a change in policy. John Baron, a Conservative MP and former shadow health minister, said: “It is absolutely wrong for the NHS not to allow tax-paying patients to top up their treatment if they so wish. Why shouldn’t patients make that extra payment for a drug that could be life-saving? This is unfair and the government should be ashamed.”

The health department said: “It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3137669.ece

Health Direct asks Why shouldn't patients pay for any "extra" treatment? If we have money it is because we worked for it and are entitled to spend it as we wish. Why the big brother attitude of fairness?

Why should all suffer for the few as usual who have spent their earning on other things and have ensured that "the state must now keep them". Isnt that a selfish attitude? Having cancer isnt selfish and I bet the people who created this silly philosophy haven't got cancer.

If they eventually get it, as statistically twenty five per cent of us will, Health Direct wonders if they will turn to private treatment to help save their lives! Cancer patients should be allowed to spend their OWN money exactly as they choose.

NHS U-turn on prostate cancer treatment by NICE

A life saving treatment will be denied to tens of thousands of victims of Britain's most common male cancer after a U-turn by the NHS rationing body NICE.

The groundbreaking ultrasound therapy has been shown to kill nine out of 10 prostate tumours, and five years after treatment, 80 per cent of patients show no sign of the cancer recurring.

Compared with surgery or conventional radiotherapy treatment, it is not invasive and is far less likely to lead to devastating side effects such as impotence or incontinence.

Suitable for treatment in the early stages of the disease, when it is not known how quickly it will spread, the ultrasound therapy is regarded by doctors as a vital new weapon in the battle against prostate cancer.

The UK's most prevalent cancer among men, prostate cancer kills 10,000 a year, with 35,000 more cases diagnosed annually. A third of men over 50 contract it.

Three years ago, the National Institute of Health and Clinical Excellence (Nice) said men across the country should be offered the treatment, called High Intensity Focused Ultrasound (Hifu), free on the NHS.

But The Sunday Telegraph has learnt that Nice has now decided to reverse that decision. In the New Year, the controversial rationing body will massively restrict the use of the HIFU treatment.

Instead of it being available to all prostate cancer sufferers, it will now be restricted only to those who have already failed to respond to conventional treatment and whose cancer has returned.

The decision, set to be made in February, means Hifu will not be available to the vast majority of prostate cancer sufferers.

Cancer charities and senior doctors last night attacked the move as a U-turn.

Mark Emberton, a consultant urologist at University College Hospital, London, said he was worried that patients would be forced into the private sector, "which would be a disaster", if they wanted the treatment.

He also questioned the logic of only offering Hifu to men whose cancer had returned, while denying it to patients in the early stages of the disease.

Meanwhile, Stephen Brown, a consultant urologist at Stepping Hill hospital, Stockport, said: "We think Hifu is a really good option for patients who want a lesser procedure."

Prof Roger Kirby, who chairs the Prostate UK charity, also decried the decision. He said: "Restricting the treatments available will have a massive impact on the patient."

Since Nice made its original ruling, permitting the use of Hifu, just 300 men have been given the treatment on the NHS.

Primary care trusts have so far been slow to foot the bill for the treatment, which is one-off but costs about £13,000.

This amount compares with £3,000 for radiotherapy, which takes six weeks, and £5,000 for surgery.

It is understood that Nice, which has refused to comment on its new guidelines, will rule that there is insufficient evidence to prove that Hifu has long-term value.

The U-turn comes despite the research published last month in the European Journal of Urology which found that eight out of 10 men were healthy five years after being treated with Hifu.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/12/16/ncancer116.xml

UK among Europe's worst for cancer funding and cancer deaths

The UK is lagging behind "nearly every other" European country when it comes to investment in cancer services and has some of the poorest survival rates for the disease.

The labour Government came under fire yesterday after its wide-ranging report into cancer services revealed its woeful under-investment in tackling the problem compared to other Western countries.

In England, just £80 per head of population is spent on cancer compared to £121 per head in France and £143 per head in Germany. Just 5.6 per cent of the total health budget is spent on cancer compared to 7.7 per cent in France, 9.2 per cent in the United States and 9.6 per cent in Germany.

The Cancer Reform Strategy, published yesterday, showed the UK ranks 22nd out of 28 European countries for mortality rates among women with cancer, and is ninth for mortality among men.

The figures from 2006 show women in Estonia, Slovakia, Lithuania and Slovenia are all more likely to survive cancer than women in the UK.

For men in the UK, mortality rates are better than in eastern Europe but still lag behind Iceland, Sweden, Malta, Finland, Cyprus, Switzerland, Norway and Germany.

The Conservatives attacked the labour Government for reneging on its promise seven years ago to make England's cancer services the best in Europe, and said cancer survival rates in the UK were still lagging far behind "nearly every other" European country.

Mark Simmonds, the shadow health minister, said: "Gordon Brown and Alan Johnson [the Health Secretary] have been forced to admit their failure to achieve the best cancer survival rates in Europe, despite the huge amount of money they've spent on trying.

"What is saddening is that if the UK achieved European best levels of cancer survival rates then 95 lives each day could be saved."

Cancer programmes currently cost £4.35 billion a year and costs will increase by an extra £70 million a year under the strategy which was announced by Mr Johnson and Prof Mike Richards, the labour Government's "cancer tsar", yesterday.

Norman Lamb, the Liberal Democrat health spokesman, declared the strategy was at risk due to the Government's "inability" to secure value for money in the NHS.

He said: "The sad truth is that too much investment has been wasted on organisation upheaval and top-down bureaucracy."

Andrew Lansley, the shadow health secretary, said: "While the Government has spent so much of taxpayers' money, the UK is still lagging behind the rest of Europe in cancer survival rates. Sadly, today's updated cancer strategy fails to clearly set out how we will turn that round."

Spending on cancer has increased by 27 per cent over the last three years, making it the third-highest funded disease behind mental health and circulatory disease - despite being the biggest killer.

There has also been considerable variation on spending among primary care trusts in England. Even after variations in the population are taken into account, the amount spent ranges from 3.6 per cent of the budget to 9.1 per cent, the report said.

According to the Conservatives, each cancer patient in Oxfordshire, where David Cameron has his constituency, receives just £5,182 per year, but cancer sufferers in Nottingham receive £17,028, which is more than three times as much.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/12/04/ncancer204.xml

Labour's nanny state wants us to stop eating and drinking