Health committee concerned about ‘two-tier NHS’ for expensive drug treatments

May 12, 2009 at 2:41 pm 2 comments

The Health Committee has published a report into patients buying additional end-of-life drugs outside the NHS.

Kevin Barron MP, the Chair of the Committee, said:

“This is a highly complex issue and it is clear from the considerations undertaken by Professor Richards that the option of separating NHS and private care is the only one likely to address most effectively the confusion which has surrounded the debate about purchasing additional treatment.

“Other options, such as a voucher scheme, appear to be unworkable or would undermine the fundamental values of the NHS. Nevertheless, there are real concerns which will need to be carefully monitored.

“It is vital that patients receive clear information, quickly, about the reasoning behind panel decisions.”

The committee of MPs said they were “not convinced” by arguments that dismiss the threats of establishing a two-tier system or that separation of patients is practicable for only a part of their treatment.

“We can see no transparent way of rapidly alleviating the problem other than Professor Richards’ proposals that NHS and privately purchased drug treatments are administered separately,” the committee said.

In recent years the NHS has been criticised both for not funding certain drugs and for withdrawing treatment for patients who chose to purchase privately additional drugs which the NHS refused to fund.

In June 2008 the Secretary of State for Health asked Professor Mike Richards, National Clinical Director for Cancer (the Government’s “Cancer Tsar”), to examine the availability of NHS medicines and to provide guidance on “if, when and in what circumstances patients should be able to purchase additional drugs that are not funded by the NHS”.

Professor Richards’ report, published in November 2008, Improving access to medicines for NHS patients, concluded that there had been a loss of confidence in the system for making drugs available on the NHS and made fourteen recommendations to the Department of Health.

Professor Richards made two significant recommendations.

First, the NHS should make more expensive drugs more widely available to NHS patients.

Secondly, the NHS should allow the purchase of additional drugs privately as long as they were administered separately from NHS treatment—even though Professor Richards estimated that there were only 18 cases where NHS treatment had been withdrawn because the patient had purchased drugs privately.

The Department accepted all Professor Richards’ recommendations. In late 2008 and early 2009 the Department and NICE (National Institute for Clinical Excellence) made three important decisions, designed to implement them. These were:

* NHS trusts were told to end immediately the practice of withdrawing NHS treatment from patients who purchased drugs privately;

* Where patients continued to purchase private drugs, the Department published draft guidance to NHS trusts about how to separate NHS and private treatment. Final guidance was implemented on 23 March 2009.

* Supplementary guidance was issued to NICE Appraisal Committees to make available a greater range of more expensive drugs to a greater number of NHS patients and thereby reduce the need for patients to buy drugs privately.

“The Department’s instruction to NHS trusts that they should immediately cease the practice of withdrawing funding for NHS patients who had purchased additional treatment was generally welcomed,” the committee said.

“However some of our evidence expressed concerns about the risks, consequent on the Report, of potential disadvantages to NHS patients including the formation of a “two-tier” system.

“While we welcome the Department’s proposals for separating NHS and private treatment we are concerned that separation will be hard to achieve in practice.

“We believe it would be wrong for very seriously ill patients to be moved from an NHS ward to a different location so as to administer a privately paid for drug separately.

“This undoubted disruption to a patient’s quality of life just to meet some bureaucratic requirement would not only endanger the patient’s care but would be unjust.

“There is also a danger under the proposed arrangements that two patients with the same condition on the same NHS ward might receive different treatments because one patient could afford it and the other could not.

“This must not be allowed to happen except in the circumstances described in the Department’s final guidance.

“In addition, for the new arrangements to work it is essential that there is a good continuity of care between the NHS and the private sector in this area.”

The committee also expressed concern that the the guidelines regarding the separation of NHS and purchased drugs will establish a precedent that would open up the possibility of a “core service” emerging in the NHS obliging patients to co-fund aspects of their treatment or to go without.

The Department and NICE have introduced two initiatives aimed at increasing the availability of expensive drugs so that patients will be less likely to purchase drugs privately, these are: the provision of supplementary guidance for end-of-life treatments to NICE Appraisal Committees and the introduction of a new Pharmaceutical Price Regulation Scheme.

“In setting this new guidance, NICE said that it was important to place clear limits on the numbers of patients who would benefit from it because the NHS could not afford to apply the guidance for all conditions,” the committee said.

“Given that increasingly new drugs are ‘designer’ technologies for small subgroups of patients many new products can be viewed as treatment for ‘rare’ diseases.

“We consider the definition of subgroups of patients suffering from rarer cancers as “small populations” is too woolly and needs more clarity.

“We consider there is a clear danger that the new arrangements will lead to the system becoming unaffordable as pharmaceutical companies target new drugs on subgroups of diseases.”

Click here to read the report.


Entry filed under: Committees, Commons. Tags: , , , , , .

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