Putting Patients First Doesn't Mean The NHS Has To Sign A Blank Cheque: In Search Of The Win-Win

30/09/2016 12:28

After the gloomy news over recent weeks about the state of the NHS finances - and with the questions on Brexit implications vastly outnumbering the answers - the mood was somewhat sombre at the start of a recent Westminster Health Forum event to discuss the future of drugs pricing and access.

At the forum - a platform to discuss future challenges and identify opportunities - it was clear that both commissioners and pharmaceutical companies are well aware that price negotiations aren't going to be easy. With so many competing pressures, the potential for lengthy delays and failed decisions which leave patients high and dry remains huge.

A major concern is that future negotiations between pharmaceutical companies and the rationing bodies, such as NICE, lead to a stalemate scenario and the number of new treatments approved dramatically reduces, allowing NHS standard practice to fall behind other countries. If we allow financial pressures to stifle innovation in this way, it could mean that the NHS may no longer be able to maintain its status as a world-leading base for clinical research, because new treatments can no longer be trialled against the best comparators. You don't need to be an expert to see that these kinds of scenarios would be a disaster for patients, for sustainability of the NHS, for the businesses involved and with a knock on impact to the economy as a whole. Not the best prescription for relieving the financial pressures which have led us to where we are now.

As the UK's leading men's health charity, it's up to us to make sure that the voice of the man living with prostate cancer is not lost in the midst of everything. At the forum, I had the opportunity to present Prostate Cancer UK's vision of a future in which prostate cancer is tamed and fewer men have to go through the advanced stage of the disease, which is when the most expensive drugs are needed. As I outlined ideas around how we might go about achieving this collectively, I wondered if anyone could see the vision through all the gloom and daunting challenges. Could they see that, if we focus energy now on improving outcomes in all areas of the prostate cancer journey, then, in time, better cancer outcomes won't have to mean more and more expensive drugs, and that there could eventually be a win-win?

There are a number of innovations coming through which provide some chinks of light in the gloom. Only a couple of weeks ago the ProtecT trial research findings offered the first hard evidence to support active surveillance as a valid treatment option for men with low grade localised prostate cancer, meaning men who chose this option can often delay, or even avoid completely, the more radical treatments, as well as the implications of side effects.

Research into precision medicine is also offering the prospect of matching drugs to specific types of prostate tumours, with the resulting improved effectiveness giving men more precious time with their families as well as avoiding using up the NHS' precious cash on drugs which aren't effective for a particular tumour.

Further research by Prostate Cancer UK, with funding from the Movember Foundation, is looking into a supported self management model for prostate cancer patients post treatment which includes a remote monitoring platform, enabling them to draw down on NHS services when they need them rather than being required to report to hospital for follow up appointments on a rigid schedule. It is expected that, as well as improving outcomes for men, there will be a reduced need for hospital visits, freeing up secondary care resources.

And of course the big prize of early diagnosis would make prostate and other cancers much more tameable, catching them before they develop to a stage where they need chemotherapy and other expensive drugs for advanced disease.

These longer term and system wide benefits need to be front and centre to drive the innovation and transformation needed to bring about better outcomes for men with prostate cancer in the future, at the same time as balancing the books.

Back in the room at the Westminster Health Forum, the will to make the transformation happen was evident. The language was collaborative and constructive rather than dogmatic and combative. The stakes are high and all the parties want to reach agreement.

The stated intentions behind the Cancer Drugs Fund reforms and the much anticipated Accelerated Access Review are absolutely the right ones to try to improve the process of appraisal for new treatments in the short term. They talk to flexibility and patient focus which is music to our ears. What is less clear is the ability to implement these in practice in a cash strapped NHS where resource for driving through changes is stretched.

Like so many others, I have lost close family members to cancer too young. Nothing can bring them back, but focussing on the right things now can make sure the next generation don't need to live in dread of a diagnosis. If energy and resource is invested in the transformation needed, cancers like prostate cancer can become manageable "tamed" diseases which are less of a drain on the NHS. And more importantly we can stop wasting tens of thousands of lives in the UK every year. There really is a win-win for cancer but it's going to take a lot of energy and focus to create the conditions where it can be achieved.