Top up fees- why equality is a cruel doctrine in the NHS

It has taken an inexcusably long time, but last week, the labour Government finally recognised that it was both cruel and unfair to deny NHS patients who decided to buy themselves drugs that the NHS would not purchase for them.

Linda O'Boyle is now dead, but she became the focus of the media campaign that forced the labour Government to change its mind. Her life was prolonged by the use of the anti-cancer drug Cetuximab.

She paid for it because the NHS would not do so. She was denied NHS care as a consequence, and had to pay another £11,000 to private hospitals for chemotherapy and nursing.

Mrs O'Boyle was one of many suffering from terminal illness who have gone through the same ordeal.

Nevertheless, there are plenty of people who continue to insist that, if the NHS cannot afford to pay for a particular drug, it is better that patients who need it die faster without it, and for them to be refused all NHS care should they pay to obtain it for themselves. Why would anyone adopt that cruel and irrational position?

No one is harmed when a patient like Mrs O'Boyle buys a drug which her doctors have recommended but the NHS will not fund. But there is a very obvious benefit to the patient. A policy which generates benefits without causing harm is obviously better than one which just causes harm. The choice between those two is a no-brainer.

Health Direct does not want to accuse those who advocate the policy of denying NHS treatment to patients who buy their drugs of having no brains. It is probably better to call them deluded. The villain is a misunderstanding of the ideal of equality: if everyone cannot have a benefit, it is better that no one should have it.

This implies that there should be no medical care at all if it is impossible to achieve the outcome in which that care is exactly the same for everyone. But that result cannot possibly be achieved, not least because doctors vary in their levels of competence and skill.

Those treated by the better doctors receive a higher standard of medical care than those treated by the less able and experienced. No egalitarian is so deluded as to believe that this means we should dismantle the NHS and make access to any kind of medical care illegal.

But that's the logical consequence of their doctrine that the most important value is not to provide medical care, but to ensure exact equality of outcomes for everyone.

The "harm" that the egalitarians claim is caused by allowing patients both to purchase drugs and to receive NHS care is, in reality, no harm at all. Someone who does not receive the best care possible from the very best doctors in the world is not harmed by the fact that there are people who do.

Professor Mike Richards, who wrote the report which led to the labour Government changing its policy, ties himself up in knots in an effort to both accept and reject that truth. He ends up recommending a compromise: patients who pay for drugs should not be denied NHS care, but they should not be treated in NHS hospitals. They should pay for any tests, scans and treatments to deal with complications arising from the additional drugs they pay for themselves.

The compromise will soon become untenable: differentiating between the tests and treatments that are made necessary because of the extra drugs, and those that are not, is often impossible. And what will happen if a patient is admitted into intensive care when they are due another dose of the drugs they pay for?

Will those drugs be administered in the NHS ward or not? Assessing such matters on a "case by case basis", as the Government proposes to do, is a recipe for precisely the outcome the Government says it wishes to avoid: patients being treated in wildly different ways, depending on the whim of the administrator who makes the decision.

The idea that medical care should be distributed according to need, and not on ability to pay for it, has one problem: doctors and nurses do not work for free, and drug companies do not give away drugs for nothing.

In 2003, the Wanless report on the funding of the NHS predicted that total NHS spending would rise from £68 billion to £154 billion in 2022. More recent estimates suggest that spending will increase to £184 billion. Such a huge sum won't come from general taxation: voters are not willing to pay taxes at the level necessary.

It means that "co-payments" - contributions from individual patients towards the cost of their own care - will inevitably have to increase.

Misguided egalitarians will try to prevent it. But they will only be able to do so by denying people medical care, and by going straight back to the situation in which someone like Linda O'Brien is pushed out of an NHS hospital because she makes a contribution to the cost of the drugs she needs. Is that the outcome they want?

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/09/do0903.xml

The last nail in the NHS coffin

Top up co-payments are the last nail in the coffin for the NHS as it opens the door to private providers.

On the face of it and from a moral perspective, a decision to allow “top-up” payments for cancer drugs seems the correct course of action to take to curb postcode lotteries for funding cancer drugs. However, this must be seen in the wider context of the future of the NHS and the fundamental principles of “universality” of care.

“Top-up” payments will open the door to the insurance industry and private providers to deliver these treatments. This will become the norm for many new treatments, not only cancer drugs, and will lead to a system of “managed care” much like that in the US where it is the insurers and not doctors who decide who gets treated, where they get treated, how they get treated, who gives the treatment and how much it costs.

The universality of care provided by the NHS has already been eroded (eg, loss of the majority of NHS dentistry and eyecare) and this is the last nail in the coffin. The real tragedy lies in the fact that we should not even be having this debate.

The total NHS drug spend on cancer drugs in England is approximately £1 billlion per year, but, in the British Medical Journal last week, the chief economist of the King’s Fund, Professor John Appleby, stated that the NHS in England is projecting an underspend of £1.7 billion and foundation trusts are reporting cash balances of £2.5 billion.

Furthermore, it is painfully ironic that the huge cost of introducing a market based system to the NHS has actually helped to spark a debate that will lead to further privatisation and fragmentation.

From:
http://www.timesonline.co.uk/tol/comment/letters/article5091892.ece

Health Direct notes that one of the factors behind the current controversy about “top-up” drugs is the absence of any explicit recognition that vital moral issues are involved.

If an old person is trapped under a collapsed building late at night, people do not say: “She has not got long to live anyway, let’s leave it till the morning; it will cost a bomb if we get the cranes and crews out at this time of night.” They are more likely to say: “She is pretty frail; we had better pull out all the stops, and get cracking as soon as possible.”

The weakness of the NICE approach is to assume that life and death decisions about whether the NHS should buy new drugs can be based solely on an economic model. Common humanity comes into it too: even if it may involve paying higher taxes.

Labour U turn on NICE's cancer drugs postcode lottery killing policy

The rule preventing NHS patients from "topping up" their treatment is cruel and vindictive. Under just axed guidelines, anyone paying for drugs with their own money may be deprived of any further free health care.

This is a crude form of blackmail by the state provider that may have been understandable 60 years ago when the NHS was finding its feet but has no place in a modern healthcare system. It is to the credit of Alan Johnson, the Health Secretary, that he has finally acted to remove this barrier to patient choice.

Allowing a co-payment system to develop in healthcare is, however, more than just a humane decision that will allow seriously ill people to purchase life-saving drugs that may be too expensive for the NHS to prescribe. It is also a fundamental step towards diversifying healthcare in a way that will allow a better-funded and more patient-friendly system.

Health insurance companies will now start marketing policies for top-up payments only, as a supplement - not an alternative - to NHS provision, an attractive option to people who cannot afford full private health insurance.

That will help remove the barrier between state and private provision that has proved so restrictive, while opening up new revenue streams. A hybrid, public/private system could then emerge, without sacrificing the cardinal NHS principle that treatment remains free at the point of delivery to all who need it.

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/05/dl0502.xml

Health Direct points out that there is now a three tier NHS service. The top level is private health insurance for NHS services. The middle tier is part payment for drugs and services. With the base rate being access for patients only if whitehall edicts allow doctors to prescribe certain life saving drugs.

Top-up insurance is still essentially a means test - and works contrary to the concept of universal access on equal terms to the NHS at all points of contact.

There is no reward here for those who already self-provide, nor any consideration of what those seeking to claim contribute to our taxes, or to the costs of the NHS.

This is a bit like thanking the person, who has decided to refrain from beating you over the head with a baseball bat.

The magic formula, top up insurance- is routine in France. The plan does not call for genius; rather, its absence calls for rebuke.

I have just one question about this, Alan Johnson is claiming credit for changing this particular rule, but which minister was it who allowed the rule to be set in the first place- Health Direct suspects the bean counter Patricia Hewitt?

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

Lady Archer backs patients in row over top-up drugs

Lady Archer has backed demands for patients to be allowed to pay for additional medicines without losing their NHS care by releasing a survey showing that more than 80% of patients at the trust she chairs back the change.

The survey, of more than 800 patients, shows that 82% of NHS patients back the right to pay for top-up medicines.

The survey also found that more than 90% of doctors and nurses favour patients being allowed to pay supplements for proven cancer drugs which are not funded by the NHS.

Archer, chairwoman of Cambridge University Hospitals NHS Foundation Trust, has submitted the results to Mike Richards, the government’s cancer czar, who is conducting an inquiry into the scandal of withdrawing NHS treatment from patients who pay for private medicines.
Private drug helps cancer man left to die

In a letter to Richards, copied to Alan Johnson, the health secretary, Archer described the policy of penalising patients who choose to pay privately for drugs as “illogical and unjust”.

Archer, wife of Jeffrey Archer, the disgraced Tory peer and novelist, also said the co-payments should be allowed, not just for cancer medicines, but for all effective procedures and treatments which are not funded by the NHS.

Christoph Lees, a consultant obstetrician and gynaecologist at the Cambridge NHS Trust, said the labour government should make “sensible provision for patients to exercise what should be their right, rather than penalise them for their choice”.

Meanwhile, nine professors of rheumatology at University College London Hospitals NHS Trust, in central London, and Leeds Teaching Hospitals NHS Trust have claimed British arthritis patients are less likely to get the medicines they need than those in Romania, Hungary and the Czech Republic.

In a letter to The Sunday Times, they accuse the National Institute for Curbing Expenditure (NICE) of making a “senseless decision” by ruling that arthritis sufferers who are not successfully treated by one of a group of medicines known as anti-TNF treatments can’t switch to another type.

From:
http://www.timesonline.co.uk/tol/news/uk/article4794836.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.

The King's Fund- labour's NHS top up payments strategy is untenable

The King’s Fund believes the current policy and practice on top-ups, which prohibits people from privately purchasing drugs not available on the health service while continuing a course of NHS care, is untenable.

There are areas of the NHS where there is inconsistency over patient charging, such as optical care and dental care, and current legislation does not provide clear direction to patients or the NHS about why these top-ups are allowed but others, for example the use of non-NICE approved drugs, are not.

In addition, the basis on which decisions are made locally as to whether drugs are available before they have received NICE approval or if NICE has rejected them, is not always clear.

The rules that do exist are differentially applied and result in significant variations between primary care trusts (PCTs) in the decisions reached - precisely the situation that NICE was established to avoid.

This situation is unlikely to be publicly acceptable and examples of the health service forcing vulnerable patients to lose out on their NHS funded treatment because they wish to pay for a drug themselves risks damaging the reputation of the NHS as a caring and compassionate service.

The difficult decision facing the government is compounded by the lack of available evidence on the numbers of people who could take advantage of any changes in the rules permitting top-ups, which we are assuming are small; the possible costs to the NHS; and the potential opportunity costs of using existing NHS resources in this way.

The absence of such an evidence base makes any recommendation we make more difficult. However, after much consideration of what is undoubtedly a complex issue, The King’s Fund believes that in certain circumstances patients should be permitted to pay privately for drugs that have been rejected on cost-effective grounds and retain their right to access the rest of their treatment on the NHS.

They should also pay for the associated treatment costs over and above the cost of treatment they would have received on the NHS.

The King’s Fund recognises there will be equity concerns raised by this as there will inevitably be some patients who can afford top-ups and some who cannot. This is an inevitable cost of this policy option. Therefore, if the government does take the decision to permit top-ups it should address the following issues and ensure safeguards are in place to minimise the risks of unfairness:

* Identify and specify the circumstances in which top-ups are allowed – the review is focusing on drugs only but there are other procedures and therapies that present similar if less emotive issues.
* Calculate the associated costs, such as the costs of administering a drug. If these costs were met by the NHS, this would mean resources being diverted from other NHS patients to support the delivery of a treatment that may have been judged to be not cost-effective by NICE. We propose that the patient should meet the associated costs over and above the NHS treatment they would already be receiving. These costs would have to be carefully calculated.
* Ensure that individuals understand the financial liabilities they may face if they top-up their care – individuals with a terminal illness may feel they have little to lose by risking their resources on an expensive drug with relatively low efficacy but if the drug proves to extend their life they may find themselves unable to finance payments in the medium or long term.

Finally, The King’s Fund believes the government can use the opportunity created by the top-up debate to improve the way that new medicines – and by extension other forms of treatment – come into use.

The present system is overly dependent on trial data supplied by the pharmaceutical companies that do not necessarily reflect the realities of clinical practice. We need a more systematic and ongoing appraisal of new drugs in both clinical and economic terms.

The pharmaceutical industry has itself recognised that the introduction of new and expensive drugs must be handled in innovative ways. These measures might reduce the number of drugs that are excluded from NHS funding and would reduce the level of variation in the availability of non-NICE appraised drugs and treatments and reduce uncertainty for patients and the public.

From:
http://www.kingsfund.org.uk/media/top_ups_response.html

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.

Cost cannot be the only criterion for the NHS

Health Direct posts a stinging letter from senior health professional lambasting NICE and labour's financial accounting policies which favour tattoo removals over cancer sufferers.

WE WISH to support the eminent professors of cancer medicine who have called for a review of the way rationing decisions are made in the NHS (Letters, last week ). The Nice (National Institute for Health and Clinical Excellence) ruling to effectively ban four cancer drugs in England confuses cost-effectiveness with affordability.

These medicines have become the gold standard in the US and are more cost-effective than motorway crash barriers or air bags in our cars. Yet would society deny them?

The NHS has a budget of approximately £100 billion. If Nice applied its criteria to other parts of the health service, it might decide that many of them were not cost-effective. There is much waste in the NHS that should be addressed.

For example, many of the drugs prescribed on the £8 billion primary care drugs bill are not taken by patients. Savings in unnecessary prescribing could free up resources for cancer and other high-cost drugs.

Professor Salman Rawaf Director of Public Health,
Wandsworth Teaching PCT Norman Evans Consultant in Pharmaceutical Public Health

From:
http://www.timesonline.co.uk/tol/comment/letters/article4641096.ece

Subjective evaluation

Andrew Dillon and Sir Michael Rawlings of Nice are being disingenuous when they call for cancer specialists to say which acutely ill patients should be sacrificed to free resources for cancer sufferers. I suffer from breast cancer and I have had a mastectomy.

Like others in my position, I was offered a reconstruction on the NHS (I declined). The immediate and follow-on costs of this procedure can exceed the costs of new cancer drugs. Perhaps Nice could explain the basis of its valuation of one female breast?

Penny Smith Horseheath, Cambridge

Funds wasted

The NHS, as suggested, now spends comparable amounts on healthcare to the UK’s European neighbours, but less than two-thirds of the amount on cancer drugs, so where is the money going?

As a cancer patient I offer one observation on the differences in cancer care in the UK and France, which may indicate just one area where money is wasted. In France there are fewer staff in those meaningless roles so beloved of the NHS; no sign here of nurses employed to bawl out patients’ names over the noise of a television no one wants to watch.

A French oncologist greets patients and escorts them to his consulting room. I also believe wages for medical staff in France, even allowing for a reduced cost of living, are correspondingly lower than in the UK.

Sara Tait Carcassonne, France

Where the money goes

Do other health systems give priority to lives at high risk rather than funding Viagra, fertility treatments and antismoking and antiobesity campaigns led by commercial companies? Are their health management costs lower, in that they don’t fund two Nice bodies, one for Scotland and one for the rest of the UK?

John Allison Maidenhead, Berkshire

Case for co-payments

Surely, the only practical form of rationing that bypasses the Nice committee is for the patient to pay at least a proportion of the drug costs. The precept of “treatment free at the point of delivery” has to be abandoned; then we move into the complicated area of mitigating the costs to those who can’t afford to pay. Is that what the professors want?

Dr Richard Godwin-Austen Southwell, Nottinghamshire

Costly victories

You quote £15m as the cost of an Olympic gold medal, while Nice estimates the cost of anticancer drugs at £30,000 per patient annually? At those rates, one medal equates to 500 years of life.

David Diprose Saundersfoot, Pembrokeshire

NHS risks losing cancer drugs after NICE blights patients

One of the world’s leading drug companies is threatening to withdraw some of its new cancer treatments from the process by which they are approved for use in the National Health Service.

Cancer patients in Britain will consequently be denied more effective drugs that are available to sufferers in other countries.

Roche, the Swiss pharmaceutical giant, has already refused to supply economic data on its drug Avastin for treatment of lung and breast cancer to the National Institute for Health and Clinical Excellence (Nice), the authority that evaluates the cost-effectiveness of medicines for the NHS. This means Avastin will not be available on the NHS for those diseases.

Avastin is said to double the time a breast cancer patient’s condition remains stable when compared with existing treatments. Studies have also shown improved survival rates for lung cancer victims.

Roche said last week it will consider withdrawing from other evaluations rather than submit products only for them to be rejected by Nice as too expensive.

The statement is the latest twist in the growing row over decisions by Nice. Earlier this month Nice caused an outcry in a preliminary decision when it rejected the use of Avastin (also known as bevacizumab), Sutent (sunitinib), Nexavar (sorafenib) and Torisel (temsirolimus) as too expensive to treat kidney cancer.

“The alternative to these drugs for many patients is death,” said Jonathan Waxman, professor of oncology at Imperial College, London. “Nice is making terrible mistakes.”

The survival rates for cancer in Britain are already among the lowest in Europe — on a par with Poland, Slovenia and the Czech Republic, according to data published last year.

However, cancer charities acknowledge there has been significant improvement in rates since the government made the issue a priority with its NHS Cancer Plan, first launched in 2000.

Some consultants argue, however, that Britain already spends less on cancer drugs than many other European countries and that it is “crazy” to reject drugs proven to prolong life.

Richard Barker, director- general of the Association of the British Pharmaceutical Industry, which represents the drug companies, said: “Nice does a tough and necessary job, but is making errors because of a very mechanistic approach.

It relies too much on arithmetic and not enough on clinical judgment.”

Nice was created in 1999 with the aim of ensuring that decisions on the best and most cost-effective drugs for the NHS were made at a national level, were transparent and could be challenged.

When the drug companies scrutinised the economic modelling used by Nice, they realised that the estimated costs of their drugs and effectiveness could vary widely.

Even more seriously, some of the calculations were wrong. There was an outcry in the medical community in February 2006 when Nice stated that Temodal (temozolomide) — declared as the biggest breakthrough in treating brain tumours for decades — did not offer value for money.

Temodal had won approval from the European regulator in 2004, but many British patients were denied treatment as Nice wrangled over costs.

Peter Davison, 48, a manager for Cambridge University Press, was among the few British patients who received the drug — because he was diagnosed with a brain tumour while working in Singapore.

“I was lucky to be abroad,” said Davison, who is now in remission. “Four months after I had the operation to remove the tumour, I was running and climbing mountains.”

When Schering-Plough — the pharmaceutical company which markets Temodal — prepared its appeal against the Nice decision, it identified an error in the modelling. Once corrected, the model showed the drug was cost-effective — and as a result it was ultimately approved for NHS use.

Not surprisingly, the drugs companies now want full access to the economic models, with the chance to check the accuracy of the calculations. In May, the High Court ruled that Pfizer and Esai, the companies which market the Alzheimer drug Aricept, should be given full access to these models.

“We believe this modelling might not be fit for purpose and we want to check it,” said a Pfizer spokesman last week. Nice said it was seeking leave to appeal to the House of Lords after the High Court decision.

Even where the models are correct, consultants and patients’ groups say Nice fails to give proper weight to the evidence from clinicians and patients’ groups.

The Sunday Times has highlighted the fact that NHS patients do not even have the option of paying for the drugs privately because of government ban on “co-payments”. The labour government has said it will review the issue.

Professor Sir Michael Rawlins, chairman of Nice, said the evaluation process was recognised internationally and Nice had been commended by the World Health Organisation for the quality of its work. He said: “We have a finite amount of money to spend on healthcare and we have to divide it up in as fair and as equitable a way as we can. We can’t say to yes to everything. It’s awkward, it’s difficult, it’s unpleasant.”

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

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?

Dental NHS copayments total £4.5bn since 1997

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

NHS co-payment ban in disarray

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 spurns gift of free cancer drug

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

Ban on NHS top up is cruel rationing, says BMA

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!

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

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