Leading article: Life and death cannot be decided by a means test

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The Independent Online

Unfortunately, most of what led up to the panel hearing encapsulated what is wrong with NHS prescribing practice. Herceptin is expensive and it is licensed in this country only for treating advanced breast cancer. It has not yet been approved for use on women in the early stages of the disease, even though tests have shown that it can reduce the recurrence of cancer if it is prescribed earlier. Mrs Clark's cancer was not judged to be terminal, therefore she did not qualify.

If Herceptin were available only as a drug of last resort for those whose cancer is far advanced, the refusal Mrs Clark received when she initially asked to be prescribed Herceptin on the NHS might have been more acceptable. But this is not so. The private health insurer, BUPA, agreed earlier this year that private patients could receive it at an earlier stage. Mrs Clark argued that a life-saving drug should not be available only to those who can pay for it. She is right: it is unacceptable that life or death should be decided by means. This is what socialised medicine is all about.

With Herceptin, however, the discrepancy is not only between private and NHS patients. In some parts of the country, notably in Scotland, but in some health authorities in England as well, Herceptin is prescribed on the NHS. In other words, there is a postcode lottery, as there is in many other aspects of NHS provision. If Mrs Clark had lived elsewhere, she might not have had to choose between a private prescription for Herceptin and remaining in her home.

Mrs Clark, to her credit, refused to take no for an answer and prepared to fight through the courts. In the event, this proved unnecessary. Her appeal was upheld and her local health authority has now agreed that it is in her best interests for her to receive Herceptin immediately on the NHS. The wording of the ruling made clear, however, that it was Mrs Clark's "personal exceptional circumstances" that qualified her to receive the drug. Among these is the fact that she has an 11-year-old foster son with an incurable lung disease.

The inference is that this ruling should not be regarded as a precedent. Mrs Clark has made her case, but others will have to launch their own appeals, one by one. This is patently as unsatisfactory as it is that NHS prescribing should be so dependent on where someone lives. A National Health Service should be precisely that: a national service.

True, progress is being made. The National Institute for Health and Clinical Excellence was set up to decide which drugs and treatments should be funded by the NHS, and it has started to iron out inconsistencies. But its wheels turn all too slowly, not only where caution is fully justified - where safety and efficacy are still at issue - but in approving the funding of drugs for illnesses such as cancer where time is of the essence. Scotland has a fast-track procedure for giving interim approval; Nice recently requested authority to introduce a similar system in England. Ministers should give it their blessing without delay.