Friday, March 13, 2009

Shropshire man falls foul of the Nationality Lottery

A Shropshire man has fallen foul of the nationality lottery after Telford & Wrekin NHS Trust refused to treat him with Lucentis to try and save his sight.

Allan Farley has punctate inner choroidopathy and two consultants have told him that Lucentis will help to save the sight in his right eye. He is already blind in his left.

But the NHS Trust, acting on guidelines issued by the increasingly inaccurately named National Institute for Clinical Excellence (NICE), have refused to fund a course of Lucentis. Honestly, someone really should complain to Trading Standards - they are neither "national" nor "nice".

Two years worth of Lucentis will cost about £18k, pocket money compared to the cost of paying benefits and providing services to a blind man and his family for the next 50 or 60 years. If you'll excuse the pun, the decision is more than a little short sighted.

Mr Farley says he's being refused Lucentis because of the cost. Yes, it's an expensive drug and the NHS Trust probably doesn't have £18k stuffed down the back of the Chief Exec's sofa to pay for it but finding the money for the drug is a secondary issue and the NHS Trust does have the money if it wants to spend it.

The real reason why Mr Farley is being refused Lucentis is because he lives in England. If he lived in Scotland he would have been treated by now and the sight of his left eye might have been saved. The Scottish Medical Consortium - the equivalent body to NICE north of the border - allows Lucentis to be provided on the NHS in Scotland, along with a host of other drugs such as cancer and alzheimers treatments that are unavailable to English people.

1 comment:

Unknown said...

I think you've got the wrong end of the stick here. Guidance IS available from the National Institute for Health and Clinical Excellence (NICE) for the use of Lucentis for Wet Age-Related Macular Degeneration. However, this is not the condition that Mr Farley (his symptoms are similar, but it is not the same illness). His condition is very rare so there is no clear evidence that any treatment works - you can only really use "case evidence" (effectively, anecdotal evidence based on whether the treatment has worked on another patient). Becuase the treatment has proved successful for Wet AMD does not mean it will be successful for PIC.

Also, it is not the NHS Trust that has refused to pay for his treatment but his local Primary Care Trust. Primary Care Trusts are the bodies responsible for deciding which NHS services and teatments to purchase on behalf of the communities they serve. They need to balance up all the different issues before deciding whether to make a treatment available - including whether there is sufficient evidence to suggest that a treatment will be successful. Every decision has both a "cost" (i.e. how much will this treatment cost to the taxpayer) but also an "opportunity cost" (i.e. if we pay for this treatment then what treatments will we not be able to provide, since we only receive a finite amount of taxpayers money ... they can't spend willy-nilly else taxes would have to go up even further) ... and all of this needs to be weighed up against whether there is any evidence that this will benefit the person concerned.

So, this is not an issue about which of the UK home nations Mr Farley lives in at all.