to think 90000 is a small price to pay to increase people with cancer lifes

[suziepra]

I can't believe the NHS know a drug is effective but refuse to pay it! I don't care how much it costs, print the money and let people live for as long as possible!

Self-inflicted is a pretty broad church - driving too fast, horse-riding, not trying to conceive til 39, skiing, eating too many saturated fats, not taking the recommended amount of exercise, travelling abroad and catching malaria, not practising safe sex and catching VD....

You'd need some sort of NHS judiciary to sort it out.

My fairy - so what? Having seen the parlours state of NHS cancer treatment in some places, anyone that seriously thinks IVF deserves more funding needs to learn how to think.

I never said I think it deserves more funding.

When I posted I didn't realise it was related to a particular story in the media - the most 'sexy' disease of all - breast cancer.

What about all the other cancers - hundreds - that all have different drugs, combinations of drugs that offer 2 weeks - 6 months survival advantage? It's important at this stage to realise we are talking about palliative treatment and not curative treatment. I have never witnessed a situation in my 20 years in Oncology of a 'cure' being identified and not used. It seems that every day a new 'recipe' arrives that 'may' offer a survival advantage for palliative care patients.

I have poured hundreds and hundreds of thousands of pounds (probably millions) worth of drugs into my palliative patients, the majority of which has made little difference. For some people the drugs will not work for, some they speed up the death with side effects, some will have a longer life but it will have no quality of life and others will get quality and longer length,but hardly any. Occasionally someone will get a long remission that is most unexpected. Most people don't realise how few - a handful a year will see real benefit?

Maybe it is worth it? Do we as a society think that giving a few people a couple of months longer with their families and paying millions for the privilege is worth it? I see patients and their families after, sometimes years after - some feel it was worth it, many definitely do not.

I don't know what the answer is? I do think it's funny though those people who think we should charge people with 'self-inflicted illnesses' like smoking and alcoholics and the obese. You do know there is a causal link between these things and cancer?

The sad woman crying because the NHS won't fund her breast cancer treatment may drink alcohol (causal link), smoke (causal link), be obese (causal link) she may even have dared not to exercise regularly (causal link). In fact when you think about she caused it really, eh?

The people sitting at the 'top' making decisions are 'normal' people who have experiences of cancer and other diseases except they have to make the figures add up. Their kids want to go the Disneyworld but they can only afford a caravan in Skegness. They want to pay for all these treatments but THERE IS NO MONEY.

I broadly agree with FunLovinBunster.

I don't agree with charging people for beds in hospital, but I think it would be fair to charge for food, IVF treatment, GP appointments, children's prescriptions and treating sports injuries. I also think we should be paying a standard charge for giving birth on the NHS.

People choose to have children and take part in activities where they run a risk of injury, no one chooses to have cancer.

Cancer affects so many of us, if drugs are available to treat it, they should be provided on the NHS.

My mom wouldn't have taken this drug. An extra 6 months in pain is not worth it even when she had a 15 year old son who just found out her cancer was terminal. As a family we would have loved to have an extra 6 months with her but that's selfish. Why prolong the pain? At the end of the day you don't know what you'd do unless you're in that position.

There should be focus and money for the cure and impr

oving the quality of life.

I was diagnosed with an aggressive type of cancer in both breasts when DD was 8 weeks old. She turns one this month, and while I currently have no breasts, no hair and a not great 5 year prognosis, I'm still here.
Would I pay 90000 for another 6 months with my DCs? Yes I would. The drug won't benefit me anyway so it's a moot point. You have to draw the line somewhere I suppose.

1. Charge all in patients for bed and food. All ops, therapies, drugs free of charge. Would have added effect that food and cleanliness might improve too.

So, if you have a pensioner who cant even afford to heat their own home and ends up sick and needing hospital treatment, theyve to be turned away because they cant afford the linen

2. Charge for GP appointments. But abolish prescription charge. Would have added effect of ensuring people who really need an appointment get one. There are a lot of "do not attends" and people who don't need a doctor but are just going for a chat...

Sometimes the people "going for a chat" could be there due to mh problems/depression...how would your life be if the only person you could chat to was your GP? This could be the only opportunity they get to be diagnosed with mh/depression.

Charging for GP appointments is a really bad idea. It will result in people avoiding visiting their GP so conditions (e.g. cancer) are not caught early enough to treat effectively and will ultimately cost a lot more, both in terms of money and human suffering.

Care and treatment should be funded on the basis of need and on evidence-based outcomes, not on who 'deserves' it - that is a horrible slippery slope with all sorts of unintended consequences.

At the moment, NICE puts a financial value on each additional 'quality-adjusted life year' that any given treatment can be expected to provide. The current threshold is £20-30,000 per QALY. It's not pleasant to have to think about the value of human life in financial terms like this but I can't think of a system that would be more fair.

I'm just glad it's not my job to have to make those decisions.

weebarra

Charging for GP appointments is often suggested by those I suspect with no health problems. I have an inherited chronic illness that requires many GP appointments. The reality is 30 years ago most of them would have been hospital appointments. But many health conditions that were once managed through outpatients, are now managed by GPs. It would cost me a fortune, even if the charge for each appointment was relatively small.

Also charging for food in hospitals. If you are poor, you probably spend very little on your food, far less than any hospital is going to charge you. Some patients may elect not to have the hospital food and instead eat sandwiches and the like, which may simply prolong their stay in hospital.

And many people do not get paid by work off sick. When I was in hospital, financially it was a major struggle. I wouldn't have paid for food, and I was not on benefits. I would have simply kept sandwich making stuff in my bedside cabinet.

Slight tangent but feel compelled to post about the suggestion to charge for elective surgery.

Which elective surgery would that be? Elective open heart surgery, elective hip replacement, elective mastectomy? Elective simply means planned (as opposed to emergency, unplanned surgery). The term elective has absolutely no bearing on the reasons for the surgery.

The reality is that difficult decisions are made about funding treatment everyday and the answers are not simple, as nice as it would be to think they are.

Charging for GP appointments is a phenomenally bad idea unless it's backed up with an expensive and wide ranging screening check across all age groups in order to pick up the early symptoms of cancer and other more serious illnesses. It's definitely not a way of saving money.

And at the rate I'm going through appointments at the moment to sort 1 problem I don't fancy the idea of potentially running out of money before it gets treated. Having grown up in an area with no NHS and paid GP appointments, that's a real fear.

banning ALL elective surgery ...so it's only ever emergency surgery - with all the negative outcomes etc that follows ??? what an odd suggestion

I agree with posters who have talked about a good death - life ends - it does, for all of us. Sometimes it ends horribly early and that's tragic but money would be better spent helping people have good deaths

it's horrible and I am glad I don't have to make those choices - but £90k for something that has a 1/4 failure rate is not viable

My father's brother died of cancer needing a drug that the NHS deemed too expensive. His family paid for it privately for as long as they could and his standard of life was very good. It is a large sum of money and the drug companies charging it should be ashamed of themselves.

I don't think anyone can judge whether it is a waste of money unless they personally have been in that position. I know for a fact that my uncle's family would have paid any amount to have him for another 6 months or longer. Of course he would still be dead now in all likelihood but these are human lives we are talking about and I believe that the money should be found from somewhere. I don't know enough of the NHS financial situation to comment on what could or should be cut back.

Also many people in hospital already have increased costs. Parking or bus fare costs for their partner to visit them. Paying to be able to watch TV. Paying increased childcare costs because you are in hospital so can't look after children.

There is lots of research to show the financial strain put on many people who have long hospital stays or a series of hospital stays. Charging them money for food, will simply cause a lot more financial strain on very ill people and their families. Because if you are in hospital for more than a few days, these days that usually means you are either very frail with no one to help you at home, or you are very ill.

I don't believe general cosmetic surgery should be available on the NHS. But banning all cosmetic surgery/treatment would mean babies born with prominent facial birth marks would get no treatment, those with very bad scarring on their face from burns, would get no cosmetic treatment, etc. I don't think you understand from this suggestion who would not receive any treatment.

I believe that the money should be found from somewhere.

Any suggestions as to where?

I have stage 4 breast cancer. I am absolutely fine at the moment not all sick and bald although I have been and will be again. I would happily pay £90k for a chance at six more months with my kids no matter how poorly I feel thank you very much.

My bil was run over yesterday at a dangerous crossing (he is OK luckily - he just bounced off the bonnet). The driver didn't see the red light, it apparently happens a lot because the crossing is badly designed. So I can see that spending the money on things like that might give you more bang for your buck.

Unfortunately we just cannot fund everything. There isn't enough money. It's a sad sad state of affairs but it's the truth. I wouldn't like to have to make these decisions, and it's not done whilst they're rubbing their hands with glee I'm sure.

"the drug companies charging it should be ashamed of themselves"

Erm, no they shouldn't! The drug wouldn't even exist if it wasn't for these companies spending billions on development over the years - and there are plenty of drugs that never make it to the market and are dropped after millions of pounds worth of investment. They need to make the money back somewhere - if they didn't, they wouldn't exist, and then there'd be no new drugs at all.

Stop blaming where blame is not due.

And OP, YABU - as others have pointed out, there isn't an unlimited amount of money available, and as harsh as it sounds you have to do a cost-benefit analysis based on all stakeholders (i.e. taxpayers as well as those immediately involved).

It is very sad, though.

I have had breast cancer and have several friends/acquaintances who are now Stage4. If I were in the situation where £90000 would cure me or give me a few years with a good quality of life I would sell the house to fund it. 6 months? Maybe not...although dh says he would want to. I feel there ought to be a scale of need for these drugs. A young mum should be given them by NHS but an old woman (like me at 70) maybe not. I can honestly say that if I could choose between me and a young woman I would give her the chance. However, unless it was my dd, I wouldn't sell my home to fund a stranger's treatment so not so altruistic.
Money is finite. When the NHS was started treatments were simpler and cheaper so state funding was viable for all. This is no longer the case unless money is taken from another pot. Fewer schools maybe, roads left unrepaired, police forces reduced perhaps or a little from each. What is 6 months of life worth? To the patient it is worth everything but there are many patients with many illnesses. What is the solution?

By the way Flange I have never smoked, was not obese and doubt if I drink more than 4 glasses of wine a month, if that. I used to walk and swim. I resent your suggestion that I 'caused' my breast cancer.

I think Flange was trying to point out to the people who said "charge people for self inflicted conditions" that unfortunately medical conditions don't fall into nice, well delineated categories of "self inflicted" and "non self inflicted".

There are several lifestyle factors that are causally linked to breast cancer - eg smoking, obesity. But there are lots of people who don't have any of these risk factors who still sadly develop breast cancer anyway. But there are lots of people who develop liver disease without drinking to excess or lung disease without smoking too, so these can't really be classed as "self inflicted".

This drug is effective for 1 in 5 and can extend life by 6 months. Costs £90,000 per patient.

Please correct me if I'm wrong then but doesn't this actually mean that you need to spend £450,000 to prolong one person's life (not save).

£450,000 that could be spent on research to investigate which could identify which out of the 5 patients would benefit from the drugs and which 4 would be given false hope and potentially have to endure side effects with no benefit at all.

This drug may well be worthwhile in the future, but as it stands I don't think its ready to be rolled out universally. It might sound harsh, but I think its better to fully develop a product first before putting it out there. This research is being done thankfully.

I dislike the emotional blackmail that ends up being used by various groups (from the manufacturer to cancer support charities) to try and force the NHS to endorse these drugs, as it isn't necessarily in the best interests of even the sickest patients.