It can be a difficult fact to face, but the National Health Service has a limited budget. This sometimes means that there is not enough money to allow doctors to provide every patient with every drug they wish to prescribe. Mark Pownall looks at what the NHS is doing to ensure that budgeting for drug treatment is based on the best available evidence.

The variations in the availability of cancer drug treatments in the UK have long been a source of great controversy. Different drug treatments may be available in different hospitals. What has seemed most unfair to people with cancer has been when a certain drug treatment is available in one health authority and not another.

Some of the difference arises from what different doctors in different hospitals choose to use – cancer treatment is not an exact science, so it is natural that there is some variation from one hospital to another. But, in some cases, variations arise from the reluctance of certain health authorities to fund specific types of treatment, which tend to be newer and possibly more effective – but which are generally more expensive than some of the previous treatments. According to a CancerBACUP survey, Living with Ovarian Cancer, published last year, ‘short-term issues of affordability… dominate much district level decision-making’. This may result in what has been called ‘postcode prescribing’ – where you live determining what treatment you receive.

Hard-pressed health authorities, which have many demands on their budgets, may have their own plans for cancer treatment, including the drugs that a patient with a particular type of cancer will receive. It may take time for these plans, or ‘protocols’, to be updated as information about new drugs becomes available. Cancer specialists have the greatest influence on which drugs are used, but they may not have the final say. Many hospitals have Drugs and Therapeutics Committees that determine which drugs can, and which cannot, be prescribed by the hospital’s doctors. Effectiveness is the key factor taken into account by these committees, but they also consider costs.

Specialists may have to make their case to ensure new drugs are put on the hospital’s approved list of drugs (‘the formulary’). But they are not always successful, even when the clinical evidence of the benefits of a new drug seems to be obvious. The CancerBACUP survey carried out last year found that only one in five health authorities were committed to the provision of what experts considered to be the most effective first-line treatment for ovarian cancer.
Improving the fairness of drug provision

The Government is taking steps to remove the element of chance from cancer care and other treatments. It has established a National Institute of Clinical Effectiveness (NICE) – a committee of experts with access to a huge amount of information – that will, over the next few years, make recommendations to health authorities and to doctors on the most effective treatments available. NICE will publish guidelines based on the latest evidence, and will prioritise looking at new drugs.

Reassuringly, cancer treatment is already ahead of many other types of illnesses in taking steps to address differences in the provision of care around the country. A report published in 1995 (the Calman-Hine report) set out national standards and ways of organising cancer care. It is being used to help set up a National Service Framework – to provide ‘greater consistency in the availability and quality of services, right across the NHS’. This is being developed for a wide range of conditions, and will provide national standards, including the treatments that should be available to everyone, no matter where they live.

CancerBACUP will continue to play a key role in ensuring that all cancer patients receive the same high quality care, including the most effective drugs, throughout the country. It will also be identifying the standards of care that all NHS patients should have a right to expect.