Dr Richard Greville says medicines are key to tackling illnesses, but face a tough challenge in the current political climate.
Healthcare systems across the developed world are facing a double whammy – rising demand for services alongside increased financial constraints. In Wales, addressing these issues within the current public spending environment is a tough challenge that can only be met by everyone involved in the nation’s health working together. This is why initiatives like the IWA’s “Let’s Talk Cancer”project, which brings people together to support innovation in the delivery of healthcare, are so important.
How society places a value on medicines has never been easy, and at times it has proven highly controversial. In an era of devolved healthcare, differences in policy across the UK can give rise to stark choices for individual patients and clinicians. Each time we hear of or read about a patient travelling over the border to receive a treatment they can’t access at home, it throws a spotlight on the issue of how different systems evaluate medicines, and how patients ultimately want the best care they can find.
Medicines, more so than any other intervention, have been assessed for their value and effectiveness for over 15 years. What makes that possible is the extraordinary, extensive research base in which innovative pharmaceutical companies, our members, invest. However, bringing medicines to life remains a risky, costly business. Without any guarantee of success, it costs £1.2billion per medicine, on average, to undertake the required research and development.
In a survey being launched this autumn and sponsored by the ABPI Cymru Wales Oncology Therapy Group, a sample of Welsh oncologists and haematologists overwhelmingly reported less and inconsistent access to new treatments within Wales.
These views support the work of a senior British oncologist, Professor Mike Richards, who in 2010 looked at international variation in the use of medicines. The Richards report compared the level of uptake for best-practice medicines in the UK and thirteen other countries. He found that the UK finished in the bottom four in the case of seven out of sixteen medicine groups – including for cancer medicines launched in the last five and ten years.
Professor Richards’ research was updated earlier this year by the Office of Health Economics, who expanded it to show results at a devolved nations’ level. Wales was shown to be using just above average amounts of the very newest, under 5-year old, cancer medicines (105%). However, for older treatments (launched over 10 years ago) the use was 70% of the average and, most worryingly, the data showed that for those treatments launched between 6 and 10 years ago, usage was at only 21% of the average.
This low usage is particularly disappointing when the pricing of medicines is taken into account. The Pharmaceutical Price Regulation Scheme (PPRS) is a voluntary agreement between the UK government (on behalf of all the nations of the UK) and the pharmaceutical industry, designed to control how much the NHS spends on branded medicines. This gives companies greater predictability in the UK – recognising the high cost of researching and developing innovative new drugs – while at the same time setting a limit on how much is spent on branded medicines in order to give stability for the NHS and the taxpayer. If the branded medicines bill in the UK exceeds the agreed level – i.e. if the pharmaceutical industry sells more than was agreed – then industry pays back the difference with limited exceptions, to the Department of Health.
What all this means in cash terms is that for this financial year (2015-16) the Department of Health has forecast that industry will make payments of up to £1 billion and this is expected to reach £4billion over the length of the current scheme.
At a devolved level, this equates to some £200 million coming into the Welsh Government’s budget.
The key priorities of everyone involved in healthcare must be focused on patients and delivering improved outcomes; working in partnership and improving patient access to the treatments that profoundly change their lives for the better. Medicines can play a vital role in the health of our nation, transforming the lives of people suffering from life-threatening illnesses and long-term conditions. In cancer alone, new therapies have contributed to a 20% fall in deaths since the 1990s, with two out of three people diagnosed with cancer now surviving at least five years.
There is a long way to go and there needs to be a commitment to collaboration with all those involved in the health system in Wales. Through initiatives, such as ‘Let’s talk cancer’, there is the opportunity to ensure that everyone, no matter what the disease or where they live, has the right access to the right medicine at the right time.
The most significant point Richard makes is in the following statement:
“The key priorities of everyone involved in healthcare must be focused on patients and delivering improved outcomes; working in partnership and improving patient access to the treatments that profoundly change their lives for the better”
No one can argue with this and it’s something that the Welsh patients deserve and should have but then the murky politics come into the play.
The Welsh Government has been depriving essential public services of adequate funding for years now to fund Social Engineering and ‘bilingual nation’ Welsh Language Industry costing billions to the point where there is not enough money left in the finite public finances pot to provide adequate care for Welsh patients.
Take a close look at the standing orders and practices within the Welsh Health Boards when it comes to expenditure on medication – Pressure put on GP’s to use ‘Generics and More Generics’ that most often do not provide the desired outcome given in Richard’s article!
II know I should not give your anti-Welsh language rants the oxygen you so desperately crave to fuel your ego but the money spent on the Welsh language is peanuts compared to the money spent on the NHS. The English moan about immigrants to England not integrating but in Wales it seem the Welsh should adapt to accommodate white flight English immigrants. Some how pot and kettle doesn’t sum it up
Philip from Monmouthshire – I think that most of the Englis speaking people in Wales are actually Welsh.
Yes Phillip from Monmouthshire, the Welsh language isn’t the only NHS problem but it has been mentioned by the medical profession as a barrier to recruitment. There is no evidence that incomers from England are “White flight” escapees as far as I know and you have to remember that 8% of people born elsewhere do speak Welsh.
Of those people born in Wales, only 23% say that they speak Welsh to some degree….that figure fell by 1% between the 2001 and 2011 census’.
Carol yes, most of us are Welsh, but Welsh people are not telling fellow Welsh people not to speak their own language. Also it’s a bit rich we are getting a white flight from England, who are the ones who moan about people coming to England and not integrating into English society yet are desperate to stamp out the Welsh language and everything Welsh. In Wales English immigrants make up over 25% of the population. Let’s put that in proportion, for England that would mean over 15 million immigrants, that would mean minding your own business and having an immigrant come up to you and scream at you for speaking English in England. Somehow I don’t think that English would let that happen.
First you have to look at where this author comes from, and what they do, and who they really represent:
http://www.abpi.org.uk/contact/Pages/ABPI-Wales-Cymru.aspx
“ABPI Cymru Wales is committed to working with our partners to support a common understanding and a shared value for new and innovative medicines.”
Fine words but the National Audit Office paints a very different picture when it comes to the Cancer Fund. Maybe ‘new, innovative, and expensive medicines’ might be more accurate? The reports are here:
http://www.nao.org.uk/report/investigation-into-the-cancer-drugs-fund/
The NAO finds a significant overspend and precious little evaluation of real efficacy following the use of a series of very expensive drugs which purport to extend the lives of cancer patients. So we don’t really know whether the patients are really getting much in the way of life improvement or extension and we don’t have much idea whether these expensive new drugs represent value for money compared with existing therapies or with doing nothing.
Speaking of doing nothing, most degenerative and similar diseases go through periods of natural remission, they don’t progress in a linear fashion, so it is very difficult to tell if a drug is actually working or whether the patient is in remission. Many trials are too subjective and they rely on responses from patients and/or carers who WANT to see an improvement.
Add to that a tendency for the number crunchers to design clinical trials where ‘success’ is measured not by any measurable improvement but by assigning success to the status quo – or lack of further deterioration. So if, say, 25% of patients in the trial don’t get any worse then the drug will be described as being potentially of use in up to 25% of patients. But those 25% may simply have been in remission! This is a statistical con trick, to put it bluntly, because there is little/no robust evidence in many cases that it is the drug which has maintained the status quo rather than a period of natural remission. The anti-cholinesterase drugs being used to treat Alzheimer’s fit into that category.
We should all know that adverse reactions are under-reported at the best of times. And we should all know that assessing adverse reactions in patients already taking multiple drugs is difficult at best. There’s no point in shrinking a tumour if the side-effects are going to kill you another way!
There is a lot of evidence that pharma is getting away with far too much and it is pretty clear that some branches of the NHS are becoming ‘industries’ where the outcomes seem to favour pharma and the medical professionals rather better than the patients and their carers….
I’m not sure what you are trying to tell us in this article. You tell us that there is a higher uptake than average (105%) of the more modern cancer medicines in Wales. As a layman surely that seems a good thing ?
Philip – could i ask about the 25% English immigrants? Does this include people born in England – perhaps because their parents were in the forces or working there – who have spent most opf their lives in Wales, perhaps have Welsh parents and who consider themselves Welsh?
The other question I have is where does the data come from about English people’s hostility to the Welsh language? How many reported incidents of Welsh speakers being “screamed at” in the street for speaking Welsh?
Finally, if you think that there is no hostility towards the Welsh language from Welsh people then you must move in very different circles to me!