Take one NHS with a finite budget, running up an extensive deficit. Balance this against medicine development costs of more than £1 billion per treatment and what do you get?
High priced new medicines that often exceed what the NHS can afford and which are repeatedly restricted or rejected for England by the National Institute for Health and Care Excellence.
New cancer treatments bypassed this deadlock because of a government policy response that funded them at any cost, giving patients access to treatments either rejected or not yet appraised by NICE. But now this open access policy, known as the Cancer Drugs Fund, which has certainly served men in England with prostate cancer pretty well, is about to be transformed into a 'managed pot'. It's to rejoin the system whose repeated cancer drug or therapy 'rejections' it was set up to get round; now it will be transformed into a fund that gives patients access to new treatments that NICE consider cost-effective, but where the clinical benefit isn't certain and needs further evaluation.
Sounds good? On the surface, there is lots of shiny potential for a step change in the way NICE appraises cancer treatments. Faster appraisals and a new middle ground of 'conditional approval' between the usual 'yes' or 'no' are exciting developments - but are these enough to redress the appraisal process sticking-points that made the CDF necessary in the first place?
Delve deeper and this promised land of NICE reform appears to be little more than another financial standoff between the NHS and the pharmaceutical industry, where access to the CDF is predicated on Big Pharma significantly dropping its price to get its fingers on an increasingly-constrained NHS budget. Behind all lies the threat that any failure to comply will see manufacturers' new treatments rejected by a bargain-hungry NHS.
We have come full circle. What's not clear is who within this standoff will blink first. What is clear is that patients are caught in the middle and will very likely lose out. And their loss should not be dismissed lightly, as it will all too often be a matter of life or death, with many not having the time to wait for the NHS and manufacturers to resolve their financial tug of war.
What's needed by men with prostate cancer - and other patients come to that - is a more robust solution that can incentivise these commercial manufacturers to make their treatments affordable to the NHS, while balancing the books with the wider NHS cost savings their treatments can make possible. And we need reform proposals that are less about restricting the pharmaceutical profits possible in a climate of finite health resources and more about what patients need and deserve.
Today sees the end of the consultation on the proposals for CDF reform that have inspired this blog. Let's hope that what's written here and in Prostate Cancer UK's consultation response - alongside the similar input from our sector - inspire NHS England and NICE to make sure we don't return to the limited access to new cancer treatments that made the CDF so painfully necessary in the first place.