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


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

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