Professor Karol Sikora has thrown a starving cat into the pigeon loft of irrational debate on the NHS. Feathers are flying.
Professor Sikora, a noted cancer specialist, has advocated ‘rationing’ as a cure for the NHS’s financial ills. He quite reasonably states that the NHS “simply can’t do everything for everybody”. So far, so good.
Not that rationing doesn’t already take place within the NHS; just in dark corners, on a local level, where hopefully the recipients don’t make too much of a noise in their local newspaper. It is as well to bring the issue into the daylight.
However, and it is a mountain of an ‘however’ as far as I am concerned, Sikora believes age has to be a factor when allocating drugs within limited budgets – he is suggesting that ‘expensive cancer drugs to be rationed for the frail elderly in favour of being given to younger patients’.
Let’s kick into the long grass first the canard that ‘the elderly have paid into the NHS all their lives and to deprive them of health care just when they need it most’ is morally wrong. Not all the elderly have so paid. Some were work shy dole bludgers all their lives; some only arrived here the week before last courtesy of their relationship with another British citizen, so whilst it is romantic to hold fast to the vision of war veterans ‘who gave their all for this country’ – it is not necessarily, nor automatically, true.
The real problem is how do you define ‘elderly’. Past retirement age? Many are still working. Beyond ‘economic usefulness’ to the country? Maybe not in paid employment, but looking after grand children to allow someone else to work though? Perhaps working on a PhD to distill 40 years of experience into a form that can be accessed by others?
An arbitrary age barrier simply won’t work – how do you quantify the value to society between a 66 year old retired cabinet maker who is teaching under-privileged children his craft at a local youth group and a 35 year old drug addict?
“My view is that age should be taken into account when comparing the potential benefits of expensive treatments,” he said. “As technology improves, we simply can’t do everything for everybody.”
That statement will be music to the ears of NICE (the National Institute for Health and Care Excellence) which is currently cogitating on the thorny issue of whether to take age into account when deciding whether a drug is prescribed on the NHS. NICE is approaching the issue with a strictly utilitarian agenda:
Nice is proposing that, for the first time, “wider societal impact” is considered when deciding whether a drug is approved. This would take account, for example, of the impact on society of a patient being able to work or look after children. Age, it says, is inevitably part of that.
‘Beyond economic repair’ seems to be a term fated to move from the motor car industry to the NHS – so where does that leave those who have never been of economic use to society? No job, no children, no prospects – no cancer cure?
Last month Nice turned down a breast cancer drug, trastuzumab emtansine (brand name Kadcyla), costing £90,000 a patient on the grounds that it was not effective enough to justify the cost. It is estimated potentially to extend a patient’s life by six months.
Sikora argued it may be justified for the NHS to fund this drug in young women. Why? An extra six months is not going to put a dent in the national debt, whatever rate you pay tax at – nor is it going to make a material difference to child care. Orphaned at 7 years and six months, or on your eighth birthday? Harsh but true.
I would argue that the NHS should ration – but in line with the French system, which seems eminently fair. The French draw a firm line between life threatening illnesses, and life enhancing treatment.
If you are suffering from a life threatening illness, then no matter what your age or status in life – everything is free. Everything. Prescriptions, transport to and from your various treatments. Even the famed ‘cure’ – a stay in one of the many spas, designed to put you back on your feet after debilitating treatment. The only thing you pay for is your food whilst in hospital, a particular bête noire for moi, who was at various times either forbidden to eat it, unable to eat it, or wouldn’t have dreamt of eating it – but I can understand the principle – why should you eat for free simply because you are in hospital – pensioners don’t, in the UK the state pension is raided after ‘x’ number of days!)
‘Life enhancing treatment’ is different, and the state only pays for around 60% of that. The rest you either fund yourself or hold an insurance policy which pays for the excess should you ever need it. That covers things like breast surgery, IVF treatment, getting your ears pinned back, and tattoo removal – or even having a baby, or root canal treatment, (assuming there is a difference between those last two).
That seems a fairer rationale for rationing than an arbitrary age. Given that the NHS has to curtail costs at some point – where would you draw the line? Did you realise that NICE was proposing to draw it under“wider societal impact”?
A qualitative evaluation of your worth to society decided by faceless bureaucrats? Votes Labour? Hmmmn.