If you live in the UK, your life is worth £30,000 a year.
That’s not the tariff of some Celtic protection racket. Nor is it the heating bill you pay to stop your blood freezing (that’s much more). £30,000 is the maximum amount the NHS will pay for a treatment that will give you a year’s good health. That’s their limit and that’s how much they value your life.
Strict enforcement of the £30,000 limit has meant that if a ‘promising’ new drug costs too much, the NHS will not pay for you to have it – even if it is safe, effective and in use in other countries.
In 2013, a new breast cancer drug called Afinitor was released with much fanfare by its developers. Clinical trials showed that while Afinitor wasn’t a cure, it did help to keep the disease under control for several months – long enough to see a grandchild born perhaps, or to have a last summer holiday.
However, after expert consultation and debate Afinitor was not deemed cost-effective enough for the NHS to provide it. For some breast cancer patients, this was devastating news. Having paid tax all their lives, they were denied a drug that they knew could help them and died quicker as a result.
Drugs have been denied to people on the NHS because of high cost many times before and it will happen again. Every time this happens, the media leap on the issue, lambasting bureaucrats for condemning the sick to death by spreadsheet.
These reports almost always carry emotive quotes from those directly affected (“It’s hard to know there’s something out there that could help but they’re saying you can’t have it because of cost”) followed by a call for legislative reform.
I should say that I am exceptionally fortunate. No one close to me has died, or is dying from a terminal condition that requires expensive treatment. I am aware of my naivety to the frustrating impotence and anguish that must come when faced with the problems above – and am glad of it.
However, while I acknowledge that, of course, this is emotionally difficult territory, I believe that these limits are actually essential.
Our government has a certain amount of money, which it gets from taxes and trade agreements. This money has to be spread across all functions of state, with a fraction set aside for healthcare.
That amount of money (nearly £109bn this year) has to provide birth to death care for everyone in the UK. All your immunisations as a child, all your appointments for snivels, all the plaster for all the bones you’ve broken.
If £109bn sounds a lot, it isn’t. All those bills and pills add up, leaving a highly delicate economic ecosystem with little wiggle room. If one area of healthcare is given a bigger slice of the pie, then it has to be taken from another department’s plate.
When patient groups successfully lobbied for the expensive breast cancer drug Herceptin to be covered on the NHS in 2002, one trust had to close down a diabetes clinic to pay for it. There was simply no excess money in the system, so it had to come from somewhere else. Agreeing to provide Afinitor on the NHS would have led to similar decisions being made.
Would people campaign so vociferously for an extremely expensive drug that delivered marginal health benefits if they knew it meant fewer social workers to protect vulnerable children? Or fewer palliative care nurses to give comfort to those at the end of their lives? Or fewer home visits to patients with dementia? These may seem callous questions, but limits are essential to make sure that the greatest good is done for the greatest number of people.
Of course, it is one thing to agree that there should be a limit to what we spend to extend lives, it is quite another to agree where the limit should be set. The answer requires us to consider the question, ‘What is life worth?’
A dramatic (and perhaps religious) response would be that life is infinitely valuable and that matters of life and death should be above financial considerations. But as we have seen, that would be an impractical and irresponsible approach. We should therefore add a caveat to our golden question, ‘What is life worth…and is that practical in the context of a healthcare system?’
If I knew the answer, I would not be sat in my pyjamas rambling on a blog about it, so delegation is needed. These are clearly vital and complex questions that need expert consideration and specific responses. One rather feels that this is the sort of question that Russell Brand might struggle with were he the Prime Minister.