Written Statement - Cancer Drugs Fund

This Written Statement clarifies the Welsh Government’s position regarding a Cancer Drugs Fund for Wales.  We reject the notion of a Cancer Drugs Fund in Wales as such a fund would not improve the health and well-being of cancer patients in Wales and would create unacceptable inequities in our health service.

Any money put into such a fund must be taken away from the treatment of other serious and potentially life threatening conditions, as is the case in England.  We, collectively, have a duty of care to all citizens in Wales and this unfairness conflicts with our core values.  

There is no evidence a Cancer Drugs Fund improves the quality of life or survival rates of patients. The available evidence shows survival is closely linked to early diagnosis and also to timely and high quality surgery and radiotherapy.  Countries with high levels of access to cancer drugs do not always demonstrate high survival rates.

We already spend £4.50 more per head of population than England on cancer treatment.

Our Programme for Government commits to better health for everyone and reduced health inequalities.  The key actions to support this are to prevent poor health, to improve health outcomes by ensuring the quality and safety of services is enhanced, and to improve appropriate access and patient experience.  The NHS in Wales has shown a clear commitment to the Welsh Government’s agenda. We know more people are being treated and treated faster than ever before.

However, there are significant challenges.  Demand is increasing as our society ages, patients rightly have high expectations of the NHS and there is continuous improvement in the treatments available.  The challenge is to meet these expectations when there is less money available.  We must ensure we are using our precious resources effectively by delivering high value care at all times.  An evidence based approach to determine what treatments should be routinely available in the NHS system is crucial.  It provides everyone with the assurance money is being spent to bring about clear health, social and economic benefits, regardless of whatever disease they or their loved ones have the misfortune to suffer.

We have a particularly strong arrangement in place for medicines.  The All Wales Medicines Strategy Group (AWMSG) and the National Institute for Health and Clinical Excellence (NICE) provide the NHS with authoritative and expert advice on the management of medicines.  Their work is highly respected for its rigour and consistency between specialities across England and Wales.  There is already a sympathetic approach to cancer patients through the application of ‘end of life’ criteria for cancer drugs.

The Welsh Government believes, as do the majority of senior clinicians, that a Cancer Drugs Fund would undermine the world renowned work of NICE and AWMSG and create unacceptable inequities in our health system.  

So far, AWMSG has issued guidance on nearly 130 medicines and over three quarters have been approved for use in NHS Wales.  These medicines were appraised in advance of NICE guidance and clearly demonstrate we have an effective process to make new medicines routinely available when the evidence makes this appropriate.   For example, the prostate cancer medicine, abiraterone, was routinely available in Wales from February 2012 following appraisal by AWMSG.  The publication of NICE guidance on its use in England is not expected until June 2012.

Patients may also apply for a new medicine that has not been appraised or approved for use on the NHS, if they and their doctor feel they will benefit because of some exceptional circumstances. In Wales, we have developed a standardised policy used by all Health Boards to process these as Individual Patient Funding Requests (IPFRs).  This process has recently been reviewed to ensure decision-making is consistent in all parts of Wales and is understandable, open and transparent.  To support the IPFR process even further, AWMSG will be producing more fast track evidence based reviews on new medicines that have not yet been appraised.  IPFR panels have access to the same evidence base on which to reach their decisions. All of this will mean geographical variation is minimised in Wales.

In April 2012, the Welsh Government introduced the Wales Patient Scheme for Access to Medicines, following a successful pilot. This scheme will help ensure that cost discounts on new medicines can be considered by AWMSG during their appraisal and further opens up the opportunity for more new medicines to be available routinely in Wales, again where this is appropriate.

Any life threatening or life limiting disease is an emotive issue and cancer is no different in that respect.  It is difficult and challenging to have to say ‘no’.  As previously stated, we already spend more per head of population than England on cancer treatment, but we have to put the money where it will secure the most benefit. That means a focus on early diagnosis and early treatment such as surgery and medicines that have been recommended for use following a rigorous appraisal.  When the end of life is near, there is evidence early referral to high quality palliative care services can improve both quality of life and survival, and we have invested significantly in this area.

We will shortly be publishing Together Against Cancer - a delivery plan for the NHS and its partners.  This plan makes clear the Welsh Government's expectations of the NHS in delivering fast and effective treatment for cancer, where there is clear evidence it is clinically and cost effective.  I would wish to reassure everyone of our strong commitment to excellent, high quality care for cancer patients in Wales.

For all of these reasons it would be irresponsible for the Welsh Government to introduce a Cancer Drugs Fund when everything is telling us the responsible way forward is the evidence based approach we are already taking.    

I am confident in Wales we are taking a reasoned approach to this most complex and emotive of issues, and one which seeks to use limited NHS resources in the best way possible, based on benefits to all patients.  Vitally, this approach includes medicines and treatments for everyone, not just those relating to cancer.