Thousands of cancer sufferers are being denied life-saving drugs because of delays and bureaucracy in making them available on the NHS.
The hold-ups are a matter of life and death for desperate people who have been diagnosed with cancer of the breast, colon or lung, or with a brain tumour.
Last week, a patient who was refused the drug Herceptin for her breast cancer launched a High Court challenge to the decision. But The Independent on Sunday has established that an "exciting" new range of drugs which work in a similar way is also being denied to patients.
Doctors are furious that drugs such as Avastin, which is used to treat colon cancer, and Cetuximab, a treatment for head and neck cancers, are being blocked by the National Institute for Clinical Excellence (Nice), a government-appointed quango set up to decide which drugs should be routinely prescribed on the NHS.
But backlogs mean that Nice is taking up to two years to make its decisions. That means drugs such as Avastin, which have been officially licensed and approved for use, are currently denied to NHS patients although well-off people can obtain them privately. In some cases, patients are being told they face a three-year wait if they want to obtain these life-saving treatments free.
Cancer charities, MPs and leading specialists are warning that this is creating a two-tier system where only those with money, and the well-informed, can afford the drugs, which cost many thousands of pounds.
They also condemn the postcode lottery over prescribing of cancer drugs, which means that some people are turned down for treatment but others are successful in proving that their case is "exceptional", depending on what part of the country they live in.
Senior Labour and Liberal Democrat MPs last night called jointly for a radical overhaul of how trusts provide treatment, with the public having a say in the decision on how cash is to be allocated.
A prominent committee of MPs is also demanding that the Government ring-fence money for cancer treatment and that specialist networks, not NHS trusts, should be set up to decide where the cash is spent.
The All Party Group on Cancer, which last week published a damning report revealing the huge inequalities in provision of cancer drugs, wants decisions to be fast-tracked by Nice.
"It's now becoming a case of life or death for cancer patients," said Ian Gibson, the group's chair. "People are not getting the drugs they need and it's not acceptable to have one region where people survive and others who do not."
Nice acknowledged there was a backlog but said there was no reason for trusts to withhold treatment using drugs that had not yet been approved. A spokes-woman also said that Nice had speeded up the system so that cancer drugs would by approved by the panel "within weeks" of being licensed.
"It's not acceptable for trusts to use Nice as an excuse not to prescribe," she added. "It's true that there is a backlog, but we believe our process is thorough. Our new process will ensure that newly licensed drugs are approved within a matter of weeks."
Professor Steve Webb, the Liberal Democrat spokesman on health, said that the prescribing lottery was "unacceptable" and called for patients to be consulted over how NHS trusts spend their surplus cash. "These arbitrary variations based on postcodes are unacceptable," said the MP for Northavon.
"Each year the PCTs (Primary Care Trusts) should consult the public about how they want the money to be used. Local people should have more say."
Leading cancer specialists also point out that Britain is lagging behind much of Europe in the availability of the newest generations of cancer drugs. They are calling for the gap between the licensing of drugs and Nice approval to be closed as a matter of urgency.
One of Britain's leading oncologists, Professor Jonathan Waxman of Hammersmith Hospital in London, said that trusts were also guilty of "outrageous arrogance" in how they decided who received life-saving treatment and who was turned down, especially as they are dealing with people for whom even a day's delay is a blow to their chances of survival.
"Why should cancer in Tottenham be different from cancer in Totnes? There should be a fair, central process," said Professor Waxman, who has written to Patricia Hewitt, the Secretary of State for Health, outlining his concerns over how NHS trusts operate.
"It's outrageous arrogance that trusts say it's not appropriate to provide drugs to certain people."
The charity Cancerbacup, which provides advice for patients, backed demands for specialist cancer networks to replace the current system where hundreds of funders try to manage small pots of money.
"Access to new cancer treatments depends on where you live or failing that how much money you have," said Joanne Rule, the charity's chief executive.
"Consultants tell us that they are treating their private patients with drugs they can't use in the NHS. The process for making new treatments available on the NHS needs to be speeded up."
Effective treatment for colon cancer that can shrink tumours by 40 per cent. Yet to be approved for general NHS use. Cost for 24 treatments: £20,000
Breast cancer drug that uses natural immune system to kill cancer cells. Costs £20,000 a year. Currently denied by NHS to women in early stages.
Stops cancer cells growing and increases effectiveness of chemotherapy. Available on NHS only in exceptional circumstances. Twelve doses: £7,000Reuse content