All sides have shown a willingness to move but there is an element of pre-election tidying in all of this. It is a step forward but there is a long way to go before a sustainable solution to access to cancer drugs is found

This has been a week of cancer announcements.

From improvements in survival rates to partnerships with charities, funding for radiotherapy or changes to car parking guidance, the Department of Health has hardly stopped talking about the condition the public still say they want to prioritise the most.

The latest such announcement is more money for the cancer drugs fund, together with a new process for assessing the effectiveness of drugs and getting better value from manufacturers.

Tidy up

There is an element to pre-election tidying in all this. Ministers are clearly worried about cancer waiting time targets, which have been breached in recent months and show signs of heading further south this winter.

Unlike the 18 weeks target, you can’t spot purchase your way out of a cancer waiting times crisis. The private sector simply doesn’t have the capacity or expertise.

‘Ministers are seeking to shore up aspects of cancer services they believe should be political positives for the election run-up’

Instead, ministers are seeking to shore up other aspects of cancer services that they believe should be political positives for them in the run-up to next May.

They are helped in this by the attitude of NHS England chief executive Simon Stevens. As one of the architects of the original NHS cancer plan, he gets the political significance of cancer in a way that perhaps his predecessors did not.

He is also keen for the NHS to think in terms of programmes of care or medical conditions if you strip away the jargon. After a period where everything had to be applicable to all people, talking and thinking about particular illnesses appears to be back in fashion at NHS England.

More than a quick fix

Nowhere is the shoring up more apparent than with the cancer drugs fund.

Anyone who has watched Prime Minister’s Questions will know that this is the Conservatives’ flagship health policy and a major attack point against Labour.

‘The shoring up is apparent with the cancer drugs fund’

The changes are designed to neutralise attacks on the policy as a broken instrument, amidst reports of significant overspending and controversies about the price of new cancer drugs and National Institute for Health and Care Excellence’s decisions on them.

However, the announcement of more money appears to signal more than just a short term fix.

I will make my usual declaration of interest. Over the years I have advised a range of organisations on issues relating to access to different cancer treatments, including campaigning charities, manufacturers and the DH and NHS.

Pragmatic fix

As I wrote for HSJ last year, the cancer drugs fund was a pragmatic fix to a particular problem.

However, pragmatism can easily become dogmatism if changes in circumstance are not reacted to and addressed.

‘Pragmatism can easily become dogmatism if changes are not reacted to and addressed’

The fund has already evolved significantly. From the initial (unworkable) policy announcement during the 2010 election – an announcement which originated from the Conservative Party alone - although the problem it sought to solve was being highlighted by a range of organisations at that time, a regional process owned by clinicians was established.

Over time greater consistency in these regional processes was introduced, ultimately leading to the creation of a single national list, ending accusations of postcode lotteries - those considering moving the commission of chemotherapy back to clinical commissioning groups may wish to take note.

The time has now come to evolve the policy again.

Cogs of the same wheel

Having spoken to all sides of the debate in recent months, it is clear that all agree the current system is not functioning correctly.

A standoff has emerged between industry, NICE, NHS England and charities. All sides accuse each other of intransigence, and all sides might have a point.

This standoff cannot be allowed to damage patients. A high quality health service must enable patients to receive the treatments their doctors wish to prescribe, but it must do so in a way that is affordable and sustainable.

Importantly, there now appears to be a recognition that dealing with the fund, NICE and drugs pricing all in isolation makes no sense. They are three cogs in the same wheel. What happens in one will inevitably affect the others, and we therefore need to consider them together.

This week’s announcement stops short of doing this, but it does open the door.

‘The success of the fund boost will depend on clinical opinion and patient experience’

A significant uplift in money will be coupled with a new process for assessing drugs. Treatments will come off the fund as well as going on to it.

We are promised that this process will be based on clinical opinion, with the experiences of patients at the heart of it. The success of this announcement will depend on it.

Importantly, NICE has been brought back onto the pitch.

NHS England is to work with NICE, charities, researchers and industry to consider a new process for commissioning cancer drugs.

NICE has indicated that it is willing to delay appraisals until a drug’s performance in NHS practice can be evaluated. This delay could work alongside an evaluation by a commissioning scheme, presumably separate from the approach with the similar name already in place at NHS England.

A step forward

For reform to work in the long term, the overlap between the fund and NICE will have to be removed, but the two instruments will need to work together in a more consistent way.

Ideally, the fund should be used to fill the gaps in evidence required to obtain a positive NICE recommendation.

NICE will do its work later but at a time when the evidence will be greater and global drug prices will have been set.

‘All sides have indicated a willingness to move. Now they must back up words with action’

For such an arrangement to work manufacturers must be willing to do deals with NHS England and there must be a consequence for failing to secure a recommendation from NICE.

The institute will also need to show much greater flexibility in its cancer threshold and be willing to consider evidence of effectiveness which are currently dismissed.

There is a long way to go before a sustainable solution to access to cancer drugs is found, but this week is a step forward.

All sides have indicated a willingness to move. They must now back up words with action. It is in the interests of patients, doctors and the NHS to do so.

Mike Birtwistle is a founding partner of Incisive Health

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