Tuesday, January 30, 2007

Death and taxes: the NHS has become the battleground for survival

Alice Mahon (former MP) today became the latest in a growing line of people threatening to take legal action against the NHS. Calderdale Primary Care Trust (PCT) have refused to prescribe her a series of injections of a new treatment to prevent her going blind costing several thousand pounds because it has not yet been approved for use by NICE. When Ann Marie Rogers went to court in order to try and obtain cancer drug Herceptin on the NHS she was originally refused, but won her case on appeal. NICE then ordered Herceptin to be made available across the country.

Individuals can’t be blamed for trying every available avenue open to them to secure treatment for a disease that could severely affect quality of life or cause their deaths. However, one person’s successful battle for treatment means another’s cut in funding, extended waiting list and death. In November doctors in Norwich estimated that funding Herceptin for 75 people would mean around 200 people not receiving chemotherapy. There must be hundreds of other examples across the country where one person has managed to work the system to their advantage leaving other services on which people depend without the resources they need to function to save more lives. We may not literally fight each other in the UK for our survival anymore, but the natural instinct for self preservation above all others is still alive and well.

We are all fighting for scarce resources and NICE and NHS trust managers are caught in the middle holding the purse strings having to make incredibly difficult decisions about the most effective use of funds and, to put it bluntly, who should live and who should die. It seems ludicrous that a court of appeal judge is able to make a decision about a drug’s or treatment’s availability without ever having a chance of appreciating the complexity of choices NICE and NHS managers have to make and without having to deal with the subsequent implications for funding of other treatments. If we want the fairest outcome for all people, not just those able to take their claim to court the decision must be left in the hands of the medical experts and trust managers. They won’t always make the ‘right’ decision because managing funding is not an exact science and you can’t always anticipate the consequences of funding a particular treatment, but at least the decision will be made taking into account all the factors. We need a transparent system, with a means of appeal within the NHS so that patients can understand the decisions made, but judges need to recognise that they cannot rule on something so far reaching.

In the meantime as a country it is time to start deciding what our priorities are – do we want to invest in quality of life or length of life? Is dying with dignity more important than curing all diseases? In a consumer society this is a tough conversation to have because we are used to the idea that we can have everything if only we can discover it and pay for it. We hide from our collective mortality, even when dealing with our frail ill health. But however much money gets taken from our payment packets and ploughed into the NHS we will all still get ill and die. The NHS proves once and for all that however hard you try you cannot avoid death or taxes.

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