The cancer drugs fund was met with scepticism – but it is working, says Mike Birtwistle
The cancer drugs fund is a curious thing. Its architect, Andrew Lansley, is hardly known for his political pragmatism or his populism. Yet this is the ultimate policy, designed to be good on the doorstep and fix a particular problem.
At a time when the National Institute for Health and Care Excellence’s responsibilities appear to be ever-expanding, the fund has shifted some responsibility – or at least impact – away from it. While austerity has bitten hard in some areas of the NHS, the policy has expanded the chemotherapy bill by about one fifth.
‘Cancer drugs are a litmus test and the policy has proved to be an affordable way of healing what had become a running sore for the NHS’
When the fund was first announced on the eve of the 2010 election, it may have proved popular with newspapers but it led to howls of outrage from NHS quarters. Charges of skewed priorities, unaffordability, letting drugs companies off the hook and undermining NICE abounded.
I should declare an interest. Over the years I have advised a range of public, voluntary and private sector clients with an interest in ensuring cancer patients get access to the best form of treatment, be it surgery, radiotherapy or drugs. I have seen the frustrations caused by variations in access or availability, as well as the damage to perceptions of the NHS that these cause. I also see the suspicion with which cancer advocates are sometimes viewed in the NHS.
The cancer drugs fund – or its equivalent, smaller, radiotherapy fund – was not the answer the cancer community was seeking.
Efforts were focused on changing the NICE process, not working around it. The policy, when it was announced, was woefully short on detail. For example, it spoke of delivering funding through the tariff, despite high-cost cancer drugs being excluded from the tariff. It wasn’t just those outside the cancer community who were sceptical.
Yet, the prime minister’s conference announcement that the fund is to be extended has not met with the same level of scepticism. What has happened?
Most importantly, the need has not gone away. NICE has continued to reject new cancer drugs – and in increasing numbers. You can argue about the rights and wrongs of this, and plenty do, but without the cancer drugs fund, the impact would be indisputable.
Clinical practice in the UK would have diverged from that of other countries, meaning patients would be unable to access drugs that could have extended and improved their lives. The clinical demand was clearly there: more than 30,000 patients have had treatment provided through the fund. In case there is any doubt, the situations in Scotland and Wales prove the need the cancer drugs fund has helped meet.
The policy has also proved to be affordable. Cancer doctors have shown that – given the freedom and responsibility to prescribe these drugs – they won’t blow the budget. Whether £200m proves to be sufficient in future years remains to be seen (which other areas of health experience zero inflation over successive years?) but the question of affordability has been answered. These drugs might have a high unit cost but the overall budget impact is modest.
Finally, the fund has changed the nature of the debate on access to drugs. Before 2010, NICE rejecting a cancer drug was almost a guaranteed front page story. Now, it is relegated to the news in brief section. NICE, charities, drug companies and journalists know that there is an alternative.
‘Clinicians can and should be empowered with budgets. They make more informed and defensible decisions’
Why does this matter? Well, it matters to thousands of cancer patients and their families, who now know that their doctors are free to do everything they can to help them.
It should also matter to NHS commissioners. An important part of commissioning is to develop policies that attract the confidence of the communities the NHS is there to serve. Rightly or wrongly, cancer drugs are a litmus test and the policy has proved to be an affordable way of healing what had become a running sore for the NHS.
Odd policy fit
The fund may be an oddity, an idea that runs against the broader direction of policy, but it has proved to be a highly successful one. Although it remains an exception, there are lessons that can be learned. First, clinicians can and should be empowered with budgets. They make more informed and defensible decisions than other processes ever could and they are instinctively cautious in how they spend resources.
Second, faster processes are often better than more robust ones. Former NICE chair Sir Mike Rawlins has acknowledged that some of the drugs most commonly used through the fund have been those stuck in the NICE process. Clinical panels have been able to make decisions much more rapidly and perhaps this approach could be usefully applied to other areas of care, as indeed NHS England’s specialist commissioning programme is doing.
Third, policy-making can be overcomplicated. Sometimes intellectual purity and consistency is less important than fixing the problem in front of you. The cancer drugs fund is a compassionate response to a real issue. We could all learn from it.
Mike Birtwistle is a health policy consultant