The budget for the Cancer Drugs Fund will rise £280m in 2014-15, and an estimated £340m from April 2015, but 25 treatments have been removed, plus the rest of today’s news and comment

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5.50pm The NHS has overtaken immigration as the main concern for voters, according to the latest ComRes poll for ITV News.

About 50 per cent of those polled said the health service was among their top three concerns – an 11 per cent rise since last month.

A significant majority (71 per cent) said significant organisational reform was needed for the health service.

Three quarters said they thought patients demanded more from the NHS now compared to 20 years ago.

5.46pm Commenting on the changes to the cancer drugs fund, Mark Flannagan, chief executive of the charity Beating Bowel Cancer, said: “This is bad news for bowel cancer patients.

“It’s likely that 65 per cent of patients with advanced bowel cancer face the probability of an earlier death by being refused innovative treatments that were available before,” he claimed.

“These changes are a backward step in treatment for advanced bowel cancer. Doctors will be forced to tell their patients there are treatments that can prolong their lives but they will no longer be available.  

“Since 2010 the Cancer Drugs Fund has allowed more bowel cancer patients to survive longer and have a better quality of life. For many patients with advanced bowel cancer, survival rates have increased from 8 months to 30 months. 

“The process by which these decisions have been made has fundamentally failed patients. We are extremely concerned that these decisions have been made without sufficient consideration being given to the views of charities and patients in terms of what it really means to have these treatments and the confidence of doctors to prescribe them.   

“We all agree we need to see a longer term sustainable solution that ensures future patients get clinically effective cancer treatments that their doctors want to prescribe to their patients. 

“But until then, we urge NHS England not to give up on bowel cancer patients and to consider the severe consequences of its decision today to remove treatments that give hope to thousands of bowel cancer patients.”

“As a charity we were consulted on the proposed changes to how decisions will be made.  In our response we made it very clear that the experience of patients who have received these treatments through the CDF should be taken into account to ensure the outcomes in terms of extra life are considered.  

“We also asked for consideration of the level of clinical confidence in a particular drug and that they should recognise the cumulative benefit that different treatments can deliver. Although the benefit of one treatment may only be modest, the effect of several treatments used one after the other may be substantial.”

5.12pm NHS England has unveiled a list of the most expensive drugs to be cut from the Cancer Drugs Fund alongside measures it believes will save £80m to reinvest in treatments. 

A list of 25 ‘indications’, or clinical uses, of drugs have been struck off the list out of a cohort of 84 that had previously been available to patients.

The full list of indications can be found here.

The remaining 59 clinical uses will be rolled over into the fund next year.

The fund is to grow to an estimated £340m from April 2015, a £60m boost from its allocation in this financial year, according to a review into the fund published today.

The national agency hope to make £80m in savings through a series of cost cutting measures, such as negotiated price reductions and more effective treatments.

The removal of the 25 treatment uses has created what the body described as ‘headroom’ for four new treatments.

These include Panitumumab, a treatment for bowel cancer, Ibrutinib, a treatment for mantle cell lymphoma, a type of non-Hodgkin lymphoma, and Ibrutinib for use in chronic lymphocytic leukaemia.

In laying out the changes, NHS England pointed out that any patient currently receiving a drug treatment through the fund would continue to receive that treatment, even if the drug is no longer in the fund.

The body has said that without the action it has taken, the fund is projected to have grown to approximately £420m next year.

It added that this would have meant offsetting the growth in the fund with cuts in other aspects of cancer treatment, such as radiotherapy, cancer diagnoses, cancer surgery and other key services.

About 55,000 patients have benefited from the approximately £750m paid out through the fund since it was introduced by the coalition government in 2010.

The controversial fund was launched by the conservative government in 2010 to pay for cancer drugs that have not yet been approved by the National Institute of Clinical Excellence and are not yet available on the NHS. It is due to run until March 2016.

Critics of the fund argue that it reduces the incentives for drug manufacturers to cut prices.

Peter Clark, chair of the cancer drugs fund, said: “We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound.

Professor Clark, who is also a practising oncologist, said: “There were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those.

“There were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments.

“These are difficult decisions, but if we don’t prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline.”

4.09pm NHS Clinical Commissioners, the body representing clinical commissioning groups, has issued a warning to the Department of Health and NHS England about plans to transfer the responsibility for two specialised services – renal dialysis and morbid obesity services – to CCGs by April.

A statement published this afternoon reads: “Responding to the DH consultation, we have been clear that any transfer of services must be done so with the sole purpose of improving pathways of care for patients.

“However our members tell us that the current timeline for the transfer poses risks to patients as CCGs will not have the time and readiness to plan the services that patients need.

“We also see the current proposal as a piecemeal approach to the transfer.

“Transferring these two specialised services to CCGs in less than three months will put the commissioning system under some significant pressure.

“Many CCGs will be taking on more responsibilities for primary care commissioning and delivering against their local better care fund plan which are key priorities for the NHS.

“This comes at a time when CCG running costs are being reduced which make the need to prioritise even more critical.!

Steve Kell, co-chair of NHS Clinical Commissioners said: “We must build commissioning capacity not reduce or undermine it.

“Robust commissioning of specialised services are essential for patients but we feel that any current issues can, and should, be addressed without shifting commissioning responsibilities this year.”

“There are a number of areas of concern in trying to move services over this year, key is patient safety but we also need to make sure that this transfer is not simply moving financial risk from one part of the commissioning system to another.”

“Joining up commissioning pathways for specialist services to ensure patients get the best possible care, seamlessly, is important and CCGs are ideally placed to support the integration of services and improvements in pathways but it must be done in a safe, planned and managed way.

“We will be working with NHS England and DH to ensure our members are involved in all stages of the planning, preparation and delivery of specialised services”

NHS Clinical Commissioners’ full response can be read here.

3.46pm The BBC’s James Gallagher examines how payments should be paid for expensive drugs. It comes as a number of treatments are expected to be dropped from the cancer drugs fund.

He writes that while there “inevitably be outrage” at any decisions made, “here is a much more fundamental conundrum that needs addressing”.

“The Cancer Drugs Fund is a sticking plaster - it exists because the old system no longer works,” he adds.

“So how does the industry make a profit (out of drugs that are often taken for just a few months) while the NHS gets a price it can afford?”

3.10pm Cardiology services are set to be merged across Northamptonshire’s two major acute hospital trusts, commissioners have said.

Corby Clinical Commissioning Group has set out its intention to commission a single cardiology service across Northampton General Hospital Trust and Kettering General Hospital Foundation Trust.

The major reconfiguration plan comes after an internal review was carried out examining cardiology services across both hospital trusts.

2.48pm Concerns have been raised about ongoing uncertainty over arrangements for emergency dermatology patients at a major teaching hospital, just a month before the service is set to be axed.

The future for trainee dermatology doctors at Nottingham University Hospitals Trust is also hanging in the balance as it emerged the hospital was in talks with trusts in Derby and Leicester to take on teaching.

2.22pm EXCLUSIVE: The chief executive of Healthwatch England emailed the Care Quality Commission during a live tender, enquiring whether the regulator’s procurement process could be flexed to help local Healthwatch bidders, HSJ has learned.

The emails, obtained by HSJ under the Freedom of Information Act, raise the question of whether Healthwatch England attempted to use its position as a statutory committee of the CQC to influence its decision making.

1.50pm EXCLUSIVE: National public health officials are investigating concerns about a ‘sustained’ fall in the life expectancy of older people in some areas, after a local authority raised an alert.

Public Health England confirmed to HSJ it was examining recently released data in response to the concern, but said the figures had “fluctuated” in the past.

An email seen by HSJ, which was sent by Blackburn with Darwen Council’s public health director to others in the region and to PHE, was described as an “alert” and calls for a national review to examine “the causes and developing local/national recovery plans”.

It suggests the fall in life expectancy at 85 could be due to “central government driven reductions in adult social care budgets [which] have reduced or stopped early/preventive interventions for older people”.

1.10pm The Daily Mail reports that patient groups have criticised decision to place Hinchingbrooke Health Care Trust into special measures.

The paper also claims that at least one of the 35 inspectors of the trust is a member of campaign group Keep Our NHS Public.

1.00pm A Daily Mail leader column, highly critical of the Labour leader, argues that “the confused state of Ed Miliband’s memory is really becoming a state of concern”.

It continues: “It’s depressingly clear that Mr Miliband is prepared to exploit the suffering of sick for party political gain, even though Labour sowed the seeds of the NHS crisis with its open-door migration policy and deeply floored reforms to GP contracts.”

12.49pm Back to today’s papers, The Daily Mail reports that Ed Miliband refused seven times to deny that to he wanted to “weaponise” the NHS in a television interview.

Speaking on the Andrew Marr Show yesterday, he said: “What I’ve said is I want to fight for the NHS. I don’t recall exactly what I said.

“But we are in a fight for the National Health Service, and I make absolutely no apologies for the fact that I’m really concerned about what’s happening to our National Health Service in this country.

“I don’t recall exactly what I said, but what I’m clear about is we are in a fight for the NHS and I think that’s really important. The Prime Minister went into the last general election and he said he could be trusted with the National Health Service.”

12.31pm Shadow health secretary Andy Burnham has tweeted:

The Conservative Party has stated its six themes for the upcoming general election are the deficit, jobs, taxes, home ownership, education and retirement.

12.06pm AstraZeneca today announced that it has withdrawn its application for Lynparza (olaparib) from the current round of evaluations for reimbursement by the Cancer Drugs Fund (CDF.

The drugs firms cited concerns that the newly-approved medicine was “caught up in the review process primarily designed for medicines already on the CDF list rather than for new applications,” in a statement released today.

“Withdrawing olaparib from the current round of assessment will allow AstraZeneca to update its application and work with the Panel to ensure that a reimbursement decision can be made at the earliest opportunity,” the statement reads.

Olaparib, a treatment for ovarian cancer for patients who have already undergone chemotherapy, is currently awaiting review by the National Institute of Clinical Excellence.

Lisa Anson, president of AstraZeneca UK and Ireland, said: “AstraZeneca is disappointed that Lynparza was caught up in the CDF re-review process and that patients in England will not have immediate access to it while we await review by NICE.

“We have been concerned by a number of limitations within the recent re-review process, which has been geared more towards the assessment of those medicines previously on the CDF list than newly-approved medicines like Lynparza. In particular, we feel it is important that emerging evidence should be taken into account in assessing Lynparza’s clinical value.

“For this reason we have made the decision to withdraw our application from the current round of CDF evaluations, and focus on providingfurther information that will allow for a rapid reassessment. We firmly believe in the value Lynparza can offer to patients with BRCA-mutated ovarian cancer and we remain focused on ensuring that this targeted therapy is made available through NHS England as soon as possible, to women who currently have very limited treatment options.

“AstraZeneca will continue to work with the Government, NHS and NICE to implement a sustainable funding model to ensure patient access to the oncology and specialist care medicines of the future, one that achieves early access for patients, cost-effective reimbursement through regular NHS channels and provides clarity of process to industry.”

Jonathan Ledermann, professor of medical oncology at the University College London Cancer Institute and Primary Investigator of the pivotal olaparib clinical trial, said: “Most women will respond to the first round of chemotherapy but subsequent relapses are highly likely and many of these women will have a genetic BRCA mutation.

“Before the approval of Lynparza, there was no specific treatment for this group of women, so this is an important, much needed treatment option. While I am saddened that patients in England will not be able to access Lynparza straight away, I support AstraZeneca’s decision to withdraw from the current CDF process so that they can share additional information with the Panel.”

11.57am ln The Daily Telegraph, Ed Miliband is under pressure to admit that he plotted to “weaponise” the NHS as an election issue after it emerged he secretly briefed up to 15 executives at the BBC over his plans.

The Labour leader used the phrase at a meeting with some of the BBC’s most senior figures and said he intended to make the NHS the centrepiece of his campaign.

11.43am In other pharma news, The Times reports that deals in the drug industry soared in value to more than £200bn last year.

The total size of mergers and acquisitions in pharmaceuticals jumped by 155 per cent, increasing from $88bn in 2013 to $223bn in 2014.

11.29am The Times also reports that pharmaceutical firm Shire has pledged itself to an independent future by striking a $5.2bn deal to buy NPS Pharmaceuticals, a specialist developer of medicines for rare diseases.

The purchase is the FTSE 100 company’s biggest acquisition and according to The Times marks an attempt to “bounce back” from the collapse of an agreed $32bn takeover by AbbVie, an American rival, in October.

10.56am The Times reports that Lord Darzi, the former health minister, has claimed the NHS should stop needlessly treating dying patients to help finance the rising cost of new cancer drugs.

Lord Darzi, professor of surgery at Imperial College London warned that “cancer treatment is becoming unaffordable” because the cost of new drugs is rising four times father than inflation.

“There is evidence of doctors ordering unnecessary tests, over treatment and needless use of expensive technology,” he writes in The Times today.

“Aggressive treatment near the end of life is still common despite being of questionable value. Many patients treated in hospital could be looked after at home – where most would prefer to be.”

10.50am The Daily Telegraph reports that thousands of patients with cancer will be plunged into “great anxiety” because of cuts to drug treatments announced today, according to Lord Saatchi.

The Conservative peer said he has been “immersed” in cancer recently, with loved ones suffering from the same disease that took his wife. He criticised the reduction of NHS funding for it.

Charities and industry experts warned that NHS England’s expected decision to stop funding a series of cancer drugs would endanger lives.

10.40am Flicking through today’s papers, The Financial Times reports that drug companies are calling for an overhaul of way in which medicines are evaluated for NHS usage.

It comes as the government is expected to announce the removal of some treatments from the Cancer Drugs Fund today.

10.27am In a comment piece for The Financial Times over the weekend, the paper’s former public policy editor Nick Timmons argues in favour of a single, ring-fenced health and social care budget.

He writes: “In the end what may be required is a sweeping reform — one that brings health and social care spending together in a single, ringfenced, budget, as the King’s Fund’s Barker Commission [for which he was a commissioner] argued last summer.

“That is such a major change to NHS and local government responsibilities that it cannot remotely be introduced overnight.

“But the divide between health and social care is becoming ever more problematic for growing numbers of elderly patients and is one of the key causes of the A&E problems today. The time to pull it down is nigh.”

10.08am In the first of a series of blogs for the Challenge Top-Down Change campaign, Helen Bevan outlines why she supports NHS change from the bottom up.

10.00am Catch up one of our leading stories from last week, thatHinchingbrooke Health Care Trust has been placed in special measures after the Care Quality Commission rated it ‘inadequate’. The news comes just hours after Circle Partnership announced plans to pull out of its 10 year contract to run Hinchingbrooke, the UK’s only privately managed NHS trust.

Circle’s announcement was made in statement on Friday morning. The CQC published its inspection report into Hinchingbrooke later that afternoon. It rated on the questions of whether it is caring, safe and well led. It is the first time the regulator has rated a NHS provider inadequate on how caring it is.

7.00am Good morning and welcome to HSJ Live.

HSJ, in association with NHS Improving Quality, has launched a campaign to help the NHS achieve transformational change.

Challenge-Top Down Change aims to identify a series of ideas and solutions to help NHS organisations drive real and sustainable change.

Working with our sister title Nursing Times and our partner organisation NHS Improving Quality, we are inviting the NHS – its workforce and leaders, as well as patients and other interested parties – to share their ideas and thoughts about:

  • what aspects of the health service could work better; and
  • how we can encourage change processes that include staff at all levels in NHS organisations.

Our conversation begins today via a crowdsourcing platform delivered by our partner Clever Together and will run over the next 10 weeks. All ideas will be shared anonymously and refined by participants.

Find out more about the campaign and how you can get involved here.