There must be another way
Ann Marie Rogers took Swindon Primary Care Trust to the Appeal Court to force the PCT to pay for Herceptin that had been prescribed for her. Last week, three judges found in her favour but it was a messy way for natural justice to prevail. Swindon PCT’s policy of only
funding such treatment in “exceptional circumstances” was
its downfall because it was unable to define what it meant by exceptional
circumstances and its decision was deemed illegal. Other PCTs, faced
with women in similar circumstances to Ann Marie Rogers, have funded
Herceptin without hesitation.
However, Swindon PCT should not be solely blamed for the mess. Government
policies covering the prescribing of medicines have so many holes in
them that patients are often denied treatment because of the area in
which they live.
Primary care organisations across Britain must fund drugs and treatment
that have been accepted by the National Institute for Health and Clinical
Excellence or the Scottish Medicines Consortium. PCOs find that task
hard when there are competing clinical priorities that have all been
sanctioned.
The trouble for women who desire to have Herceptin is that it is not
licensed for
early-stage breast cancer and it is still under scrutiny by NICE. In
theory, therefore, Swindon PCT might have been entitled to deny treatment
with Herceptin to certain women — it just seemed to have used irrational
arguments.
The judgment does not mean every person wishing to be prescribed an unlicensed
medicine would automatically have a course of treatment funded. They,
too, might have to go to court to prove their case. What a waste of time
and resources! If the Government really wishes to make it possible for
patients to have access to expensive and unlicensed medicines irrespective
of where they live, it needs to create a central funding system.
Prescribers who believe there is a good clinical case for a patient to
be given a course of treatment — either unlicensed or before NICE
or the SMC have made their pronouncements — could apply direct
to the central fund. A small team of experts could then assess the individual’s
clinical needs and fund the treatment if they share the prescriber’s
view. This process would mean that all patients seeking an innovative
treatment would be treated equally and, arguably, much more fairly than
at present and without having to go anywhere near a court.
The benefits to patients, to prescribers, to PCOs and, almost as important
in these circumstances, to politicians, are clear.
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