Over the last few weeks, we have attempted to arrange an interview with local MP Ann Keen, who is the health minister responsible for cancer treatment.
She has now declined, saying it would be inappropriate because the Department of Health is awaiting the outcome of a recent policy review into the issue, but a DoH spokesman agreed to answer some of our questions.
Why does spending on cancer drugs account for less than 1% of the NHS budget when survival rates for the disease are among the lowest in western Europe?
We know that cancer survival rates in England have been lower than some other European countries. However, they have been steadily improving and we are on course to meet our target of a reduction of at least 20 per cent in cancer deaths in people under 75 by 2010.
We believe we can further improve our cancer survival rates by diagnosing patients as early as possible. Raising awareness and earlier diagnosis is a major feature of the Cancer Reform Strategy, published in December 2007, and the Government is committed to driving this forward.
Expenditure on anti-cancer drugs is also increasing. In 2006, around £729 million was spent on drug treatment for cancer compared with around £450 million in 2002.
Why is there such a variation in the amount of money different trusts spend on cancer drugs? Are there any plans to make access to drugs more uniform across the country?
There is no right or wrong amount to be spent and different trusts will spend according to different needs. However, we are not complacent. Variations across the country are reducing as shown in the National Cancer Director’s (Professor Mike Richards) report published in 2006. The Cancer Reform Strategy sets out improved planning and tracking of chemotherapy at local levels.
In addition, the Strategy makes a commitment that all new cancer drugs and significant license extensions will, by default, be appraised by NICE.
Why is more advice not available to cancer patients appealing against decisions by their health trusts?
The proposed NHS Constitution makes clear patients’ right to expect local decisions on funding for all drugs for which NICE guidance is not available to be made rationally following proper consideration of the evidence. Where the local NHS decides not to fund a treatment, the patient and clinician can expect an open and honest explanation. To underpin this, the Government is developing a set of principles and guidance to support local decision making in the absence of NICE guidance.
We are currently considering the responses received to the recent consultation on the proposed NHS Constitution.
Why were some trusts allowed to get into such debt and do you accept their claim that this doesn't influence their decisions on cancer drugs?
There were many reasons why some Trusts found themselves in financial deficit. However, what is important is that the NHS has turned this around and the proportion of NHS organisations in deficit continues to fall, with only 3% of organisations forecasting a deficit at Final Accounts 2007-08, compared to 22% at 2006-07, and 33% at 2005-06.
Decisions on cancer drugs should always be made on the basis of their clinical and cost effectiveness and I do not believe that Trusts in financial deficit allowed this to influence their decisions.
What is the Government doing to try to persuade drugs companies to lower their prices?
We are already doing much to secure best value for money from the £10 billion a year spent on medicines in the NHS in England. We are in advanced negotiations with the pharmaceutical industry on a new Pharmaceutical Price Regulation Scheme. The outline package agreed so far recognises the importance of achieving value for money for the taxpayer whilst also ensuring that patients continue to benefit from innovative products at a reasonable price.
Why does NICE take so long to make its decisions?
NICE’s technology appraisal guidance is based on a rigorous assessment of the best available evidence and involves wide consultation with stakeholders and an independent appeals process. These aspects of NICE’s processes are vital to both maintain the transparency of NICE’s processes and ensure that NICE’s guidance is legally robust.
We are building on improvements already been made and the Next Stage Review final report, High Quality Care for All, included a commitment to achieve consistently fast NICE guidance on significant new drugs by making improvements to the topic selection and NICE appraisal processes.
Does the Government know how much is spent on NICE and on different trusts' exceptional circumstances panels making these decisions?
Year on year, the Government has increased the amount of money allocated to NICE from just over £12 million in 1999/2000 to over £31 million in 2008/09.
There will be significant new investment in NICE to fulfil the role outlined in the Next Stage Review final report. We envisage that over the next four years the Department of Health will more than double the resources it puts into NICE.
We do not collect information on expenditure on individual Trusts’ exceptional circumstances panels.
Does the Government expect the situation to get worse as more cancer drugs become available in coming years?
We know that the number of new drugs licensed for use in different cancers is likely to grow considerably over the next decade. Industry sources indicate that drugs to target cancer account for over half of all new drugs currently being developed.
NICE therefore plays a vital role in ensuring that all patients have access to clinically appropriate and cost effective treatments. If it recommends that a treatment should be used in the NHS, then a PCT must fund its use for eligible patients within three months.
With total funding of the NHS now at record levels, having trebled since 1997, we expect PCTs to plan ahead and to consider the implications of introducing all cancer drugs that may be recommended by NICE in the future.
