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Rationing/ Resource Allocation

Top hats and top-ups: better health for the better off

The health secretary announced today that patients in the UK who choose to buy medicines not funded by the national health service, will no longer be excluded from receiving public health care. This announcement follows controversy about expensive cancer drugs that are available in other countries, but may not be available under the NHS.

Given that private healthcare is available in the UK (and overseas) for those who are able to pay for it, it seems unreasonable to punish patients who choose to spend their money on cancer drugs by denying them access to the public health system for part of their care. (See here, and here for previous blogs on this topic).

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Travelling for Treatment

A BBC report today suggests that “many” UK couples are going overseas to choose the sex of their children. What seems most odd about this is that in some cases they go to places where sex selection is illegal.

What is interesting here is the fascination with what people do when they go overseas or why they go overseas. There are a whole range of stories about Britons going overseas to get things that they cannot get in the UK – or cannot get in the UK as cheaply. The obvious examples are sex selection, assisted suicide or treatments not available on the NHS.

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Saving pennies and saving premmies

According to a report in the Guardian today, premature babies in the UK
are being put at risk because of a shortage of suitably qualified
staff. It is usual in newborn intensive care units in the UK for nurses
to have to look after more than one baby at a time. There is usually
one nurse per two sick babies, whereas in adult or paediatric intensive
care there is almost always one nurse per patient. This is contrary to
the recommendations of British specialists in newborn intensive care.

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A Nasty Dilemma for NICE

After a prolonged disagreement with patient groups, the NHS’s funding guidance body, NICE, has approved the £10,000-an-eye blindness treatment, Lucentis. The drug has been shown to halt the progression of wet age-related macular degeneration (AMD), the most common cause of blindness in developed countries. But as the BBC  note, in approving it, NICE may have unwittingly deprived the NHS of a much cheaper alternative.

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Doctors or Resource Allocators?

A recent survey by Myeloma UK, and reported on the BBC website, suggests that many doctors do not tell patients about drugs that may be beneficial and which are licensed in the UK. The trouble is that the drugs have not yet been approved by NICE and so may be difficult to obtain on the NHS. This seems to suggest that something is wrong with the way in which NICE functions with respect to licensing and that doctors are in some way complicit.

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Postcode lotteries

In its just-published report Taking Exception on the allocation of cancer drugs by UK Primary Care Trusts, the Rarer Cancers Forum (http://www.rarercancers.org.uk)  provides further evidence of a ‘postcode lottery’ operating within the UK National Health Service. For example (p. 26), the Mid-Essex PCT has granted 96% of requests to its ‘exceptional cases panel’, while neighbouring South-West Essex PCT has granted none.

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Cold and Calculating NICE

Yesterday’s Daily Mail online contains an opinion piece bemoaning the decision by NICE – the UK body responsible for rationing healthcare resources – to decline funding for four new treatments for Kidney Cancer. The Mail complains:

…what does NICE offer by way of explanation? A cold, calculating statement that, while the drugs work for many of those with advanced kidney cancer, they are not ‘cost-effective’.

What a clinical way to assess whether a person should be afforded precious extra months and years of life, or consigned to a ‘death sentence’.

I don’t want to defend NICE’s decision in this particular case, but the Mail’s attack on NICE’s "clinical" decision-making process is clearly unjustified.

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The point of death

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off.  The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead." 

This is a familiar way of describing such happenings, even among clinical professionals.   Brain death is pronounced, so the life support machine is switched off, and the patient dies.   The clear implication is that brain death is not death.  The machine is still keeping the patient alive, and it is switching off the machine that causes real death. 

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Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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