Who decides?

Tweet When I hear a politician talking about ‘post code lotteries’, I hear the voice of a centralist demanding uniformity and consistency driven from the centre.  It's something from which all four parties in the Assembly suffer on a regular basis, but latest up last week was the leader of the Tories in the Assembly, demanding a ring-fenced cancer drugs fund, like they have in England, so that cancer patients can get access to the drugs they need.

His timing was unfortunate, to say the least, coming as it did just a day or two before it was announced that the said English fund will no longer be funding certain drugs because they’re too expensive.  But then, expecting ‘Dave’ to tell RT what he was going to do would be wholly unrealistic. Even RT himself would never expect that.

The idea of a ring-fenced fund to pay for certain drugs for certain illnesses is superficially attractive, particularly for the patients involved.  The fund in England has undoubtedly made some drugs available to people who would not otherwise have had them; and I can well understand why that would make this a popular initiative.  And it’s that popularity, of course, which drives the Tories in Wales to keep demanding that Wales follows suit - they think that there are votes in it.

But is it the right way to run a health service?  Effectively, it is a case of the politicians telling the doctors that they can’t have enough money to treat everyone, whatever their illness, in the way that the doctors would like.  Instead, the politicians will set the priorities for them, and ring fence a sum of money for certain drugs for use only in the case of certain illnesses, regardless of whether the medical professionals consider that to be the best use of funds to achieve the best outcomes for the largest number of people. 

Driven, as it is, by electoral considerations, I’m far from convinced that this is the best way of making clinical decisions.  And, as they’ve discovered in England, it gives the drugs companies no incentive to reduce the cost of the drugs.

Responding to wholly understandable public demands that the latest drugs should be available by creating a ring-fenced fund is no way to address the overall problem of lack of resources in the health service.  Attending to the high profile diverts attention from, but does not resolve, the decisions which doctors face daily about how best to use the resources they do have to benefit the greatest number.  And, ultimately, that’s my real objection to the idea of a ring-fenced fund – it’s not tackling the real problem.