This paper examines the law relating to healthcare resource allocation in England. The National Health Service (NHS) Act 1977 does not impose an absolute duty to provide specified healthcare services. The courts will only interfere with a resource allocation decision made by an NHS body if that decision is frankly irrational (or where the decision infringes the principle of proportionality when a right under the European Convention on Human Rights (ECHR) is engaged). Such irrationality is very difficult to establish. The ECHR has made no significant contribution to domestic English law in the arena of healthcare provision.
All patients in England suffering from a disease which causes blindness are to get access to a sight-saving drug. Lucentis treats age-related macular degeneration, the leading cause of sight loss in the country.
NICE has introduced new criteria for appraising end of life treatments. James Raftery looks at how they might affect availability by applying them to previously refused drugs
Comprehensive guidance for doctors on care at the end of life, including difficult decisions on when to provide, withhold, or withdraw life prolonging treatment, will go out for consultation from the UK’s General Medical Council in March. The draft guidance was approved by the council at its February meeting, subject to minor amendments. The consultation will be launched in the week beginning 23 March and will end in July. The new advice takes account of the Mental Capacity Act 2005; government strategies on end of life care in England and Scotland; GMC guidance in 2007 on consent; recent research; and a Court of Appeal judgment on a legal challenge to the GMC’s 2002 guidance Withholding and Withdrawing Life-Prolonging Treatments (Burke).
Aims: This Handbook represents initial good practice guidance and resources to help PCTs to review current decision-making processes about the funding of medicines with co-operation from Provider Trusts and other stakeholders. Intended audience: Healthcare professionals. Publication history information: Published February 2009. Access: Available to the general public.
A trainee teacher with primary refractory Hodgkin’s lymphoma has launched a High Court action against her primary care trust, NHS Surrey, which has refused to pay for her treatment with an unlicensed drug. Philippa Bigham, aged 28, from Frimley, Surrey, has been given a prognosis of two years’ survival without a bone marrow transplantation. But her medical team at the Royal Free Hospital in London want her to have treatment with radiolabelled basiliximab, a monoclonal antibody conjugated with radioactive iodine and also known as CHT-25, before she has the transplantation. The primary care trust has refused to pay for the drug, which costs £3000 ({euro}3500; $4900) for a course of treatment. Basiliximab is licensed in the United Kingdom for use in renal transplant rejection but the radiolabelled version is not yet licensed.
A LESBIAN couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals. The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians. The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility. From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.
The government says it will ban all private transplants of organs from dead donors in the UK. The move comes after media reports of overseas patients paying to get onto the waiting list for organs donated by British people. An independent report said organs were scarce and no one should be able to pay for transplants, to ensure NHS patients did not miss out. Surgeons said it should reassure people organs went to those in most need.
More than 80% of NHS primary care trusts in England fail to offer the recommended three free cycles of IVF to infertile couples, an MP has claimed. The Department of Health says 30% of PCTs provide three cycles of the fertilisation treatment. But Tory MP Grant Shapps, who has contacted every PCT, says these figures are out of date. A "postcode lottery" operates, with rules on age, relationships and other children varying widely, he insists. In some cases women who would be deemed too old for treatment by one PCT would be seen as too young by another.
The government has announced a ban on patients paying for private transplant surgery using organs donated within the NHS. Ministers have accepted the recommendations of an independent report commissioned by the government after concerns that foreign patients were bypassing lengthy NHS waiting lists by paying up to £75 000 ({euro}90 000; $130 000) for a transplantation. Earlier this year it was revealed that the livers of 50 British NHS donors were transplanted into foreign patients over a two year period, with the bulk of the operations taking place in London at King’s College Hospital and the Royal Free Hospital.
A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute of Clinical Excellence (Nice) provisionally ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body's Scottish equivalent has recommended patients in Scotland be treated with the drug.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
The medicines watchdog, NICE, is to lose its power to turn down new medicines for use on the NHS. It will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends, the Department of Health has confirmed. Instead, groups of GPs will decide whether a drug should be funded or not. Ministers hope to make new drugs affordable to the NHS by negotiating with pharmaceutical companies on price. The plans, called value-based pricing, are set to come into effect in 2014. They are subject to consultation.
All new IVF treatment will stop in Surrey as the NHS tackles a deficit this year of £125m. The board of NHS Surrey met in Cobham on Friday to look at how to tackle "serious financial challenges". A spokesman said current courses of IVF would continue and women nearing 40 would still be considered, with IVF policy to be reviewed next November. NHS Surrey is also no longer funding some treatments including acupuncture and some cosmetic procedures. Treatments which would no longer be funded included male baldness, facial blushing, tattoo removal and spinal epidural injections for chronic back pain.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.