Tory Cancer Drug Fund is fatally flawed

The Conservative party’s approach to cancer is misleading and has four major flaws. Their Cancer Drug Fund is uncosted, inequitable, inefficient, and encourages top-down political interference.

The Conservative party’s manifesto presents a misleading picture (page 44) of cancer death rates in the United Kingdom, showing Britain suffering more deaths per 100,000 people (178) than a biased selection of other European nations, including Germany (162), Spain (157) and Finland (158) – yet it fails to mention the European average, nor Britain’s cancer death rate relative to that average, and fails to mention long term trends.

As the graphs below show, taken from the Health Profile of England 2009 (pages 67-68), Britain’s England’s premature mortality from cancer is well below the EU average for men and has decreased steadily since 1997.

The policy also faces major flaws:

1. The policy is unfunded: The manifesto pledges to “create a Cancer Drug Fund to enable patients to access the cancer drugs their doctors think will help them”, paid for by “using money saved by the NHS through our pledge to stop Labour’s jobs tax” (ie. the rise in national insurance to pay down the deficit).

This funding arrangement was discredited last week by the chief economist of the King’s Fund, John Appleby, who pointed out that the cut in the proposed NI rise next year would not release any new money that was not being spent this year. He said:

“The £200m they say will be needed to fund extra cancer drugs essentially has to come out of the current budget. That means stopping something else for other people.

“It’s a sleight of hand in the sense that the money is not there to be saved.”

2. The policy is inequitable: The NHS is based on principles of equity, which means equal treatment for all depending on need (and capacity to benefit). This is the basis for NICE assessments which evaluate treatments to help doctors and commissioners allocate resources fairly. The high profile drug campaigns, sometimes funded by the pharma companies, have focused on cancer.

But taking money out of the wider NHS pot and ringfencing it for cancer treatments effectively discriminates against people with heart disease, dementia, stroke, mental illness, injury or diabetes, whose treatment is also rationed but who won’t have a special pot of politically driven deficit spending allocated to their disease.

3. The policy would increase inefficiency: The NHS will have a massive challenge to meet rising need, expectations, quality improvement and costs with flat real-terms funding over the next period. The Tories and their cheerleaders have made massive commitments about increasing productivity – the healthcare bang for the buck. How would this be achieved?

The real money, and potential savings, are in clinical practice: front line services that could be better organised to prevent hospitalisation, streamline pathways, cut down errors and follow most cost-effective practice. Public health doctors and health economists know that one way of cutting waste is to improve priority setting, for example providing fewer ineffective treatments and more cost effective ones (for example, substituting more expensive branded drugs for equivalent cheaper generic ones).

However, lowering the bar for purchasing cancer drugs will – whether popular or not – reduce productivity as money is moved from more cost effective treatments to less cost effective ones. How can a Conservative health service square the circle of cutting more waste yet also committing to vote-catching initiatives that will actually reduce productivity?

4. Top down political interference: This leads us to the third inconsistency. The Tory mantra on health is to devolve decision making, creating an independent NHS board and GP budget holding. Yet, whereas at present clinically-chaired committees make decisions on high cost drugs on the basis of guidance from an independent authority, here we have a would-be prime minister making a central decision on how local budgets should be allocated for a particular medical condition.

The Cancer Drug Fund repeats the same mistake as the moratorium on hospital reconfiguration. While talking the rhetoric of efficiency, clinical autonomy, devolution and political distance, when it comes to really tough choices the Conservative policy is to intervene to win cheap votes. But the media fails to call them on their lack of credibility.

UPDATE 18.37:

An earlier version of this story suggested that the graph’s were of Britain’s premature cancer rates. They are actually of England’s. But p.60 of the report shows that the United Kingdom and England’s results are broadly similar. For men, they are well below the EU average. For women, they are just above.