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.


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