Leading article: Our health service can no longer dodge reform

The spiralling cost of drugs presents an unavoidable challenge

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It is the sort of warning liable to give health ministers sleepless nights. Professor Karol Sikora, the director of a private provider of cancer services, has warned that the National Health Service's bill for cancer drugs could rise to as much as £50bn, swallowing up half of the entire present health budget. The consequences would indeed, as Professor Sikora argues, push the NHS towards "meltdown".

Nor does such a scenario sound particularly far-fetched. The national drugs bill is certainly rising rapidly as new products are brought to the market by pharmaceutical companies. NHS spending on prescription drugs in England has more than doubled in a decade to £8.2bn a year.

The problem is that our collective willingness to pay for healthcare through our taxes is at its limits. At the moment it is the National Institute for Clinical Excellence (Nice), charged with approving new drugs for use on the NHS, which is caught in the middle of these two opposing forces.

Nice's decision last month to reject the NHS's use of four expensive kidney cancer drugs on the grounds that they are not "cost effective" unleashed a storm of anger from patients and consultants. Nice was labelled inhumane for denying patients access to these drugs which have been shown to extend the lives of cancer sufferers by up to six months.

To address this highly emotive criticism, it is imperative that we take a step back and acknowledge some basic realities about our healthcare system. The NHS does not have limitless financial resources. And these resources need to be rationed for the sake of fairness. One might reasonably argue that Nice's cost-effectiveness limits for new drugs ought to be revised. But the bottom line is that if Nice did not exist, it would have to be invented. To argue that the NHS should approve any new drug that has a proven beneficial effect on health, regardless of cost, is irresponsible.

That said, the status quo is plainly unstable. At the moment those patients who pay for expensive drugs privately are denied any supplementary NHS treatment, forcing them to pay yet more from their own pockets. To exclude such patients from NHS treatment seems wantonly cruel. But the unpalatable fact is that to allow them full access to NHS care would be effectively to allow the well-off to "top up" their care, while the poor would be forced to get what they are given. Such a scenario would strain the very concept of an income tax-funded national health service, free at the point of use.

We are in uncharted territory here. The Government's head of cancer services, Mike Richards, is conducting a review of top up payments, due to report next month. But Professor Sikora believes that the only practical way forward is a wholesale restructuring of the NHS and the development of new ways to fund the health service. When one considers the demographic pressures of an ageing society, the rapid advances in medical technology and the increasing price of drugs, it is hard to resist the logic of this argument. With many of the expensive new drugs already available in European health systems, the pressure for reform of the NHS will only grow.

There are several questions that we, as a society, need to answer: what do we want our health service to look like, how do we want to pay for it and what precisely do we want it to do? The urgency of these questions is growing. It is the responsibility of all serious politicians to help develop an answer.

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