Drugs funding in the NHS

5 November 2014

Article written by Philippa Watkins, National Assembly for Wales Research Service

During the recent intense political and media debate over the performance of the Welsh and English NHS, the Welsh Government has strongly defended its record on access to cancer treatments.

Image from Wikimedia Commons. Licensed under Creative Commons.

Image from Wikimedia Commons. Licensed under Creative Commons.

The Cancer Drugs Fund in England, established in 2010, routinely funds a number of cancer medicines not otherwise available on the NHS. Additionally, the Fund receives requests for medicines to treat individuals with rarer types of cancer. The Fund will run until the end of March 2016.

Early in 2013, the Scottish Government launched a £21 million fund to cover the cost of medicines, not available for routine prescription, for individual patients with rare conditions. In October 2013, Scotland announced an extension of its Rare Conditions Drugs Fund until 2016.

The Welsh Government has continued to resist calls for a similar fund in Wales, arguing that spend per head on cancer in Wales is greater than that in England, and that the Cancer Drugs Fund in England has not expedited access to new, cost-effective cancer medicines when compared to Wales. The Health Minister highlighted that Wales was the first country in the UK to make the multiple sclerosis drug Sativex available for use on the NHS, and that Wales is the only part of the UK where the new pancreatic cancer drug Abraxane is routinely funded by the NHS. The First Minister has stated:

… we know now that the cancer drugs fund is nothing more than a confidence trick. I will explain why I say that. Of those who apply for funding to the cancer drugs fund, more than 70% are refused. For the equivalent in Wales, the individual patient funding requests, which are open to people with all conditions, not just those with cancer, more than half of the applications are accepted.

Review of the individual patient funding request process

If a particular medicine has not been recommended by NICE or the All Wales Medicines Strategy Group (AWMSG) for general use within the NHS in Wales, a clinician can make an individual patient funding request (IPFR) to a Health Board. These requests are considered on the basis of ‘exceptionality’. An all Wales IPFR policy was published in 2011, and was intended to support a consistent approach to decision-making.

There has however been continued criticism of the IPFR process. The Assembly Health and Social Care Committee’s recent inquiry into implementation of the Welsh Government’s Cancer Delivery Plan heard that there is variation in the interpretation of ‘exceptionality‘, a lack of flexibility to respond to cohorts of patients seeking access to new treatments, inconsistent willingness among clinicians to engage with the process and inconsistency in the decisions made by local IPFR panels.

In October 2013, the Health Minister announced a review of the Individual Patient Funding Request (IPFR) process. The review concluded that the IPFR process does support rational, evidence-based decision making for medicine and non-medicine technologies which are not routinely available in Wales. It made a number of recommendations to strengthen the process, but did not propose moving to a single, all Wales IPFR panel. The Minister has indicated that an announcement on the outcome of the IPFR review will be made shortly.

The Health and Social Care Committee’s cancer delivery plan report (October 2014) did recommend that a national IPFR panel should be established, to ensure consistency and equity across Wales. The Welsh Government’s response to the Committee’s report is expected in due course.

Review of orphan and ultra-orphan medicines

In May 2013, the Health Minister commissioned a review of the appraisal of orphan and ultra-orphan medicines in Wales. These are medicines indicated in the treatment of rare and extremely rare conditions.

The review recommended that there should not be a separate orphan/ultra-orphan medicines fund in Wales, and that the appraisal of these medicines should remain within the framework of AWMSG.

The review highlighted that access routes for orphan and ultra-orphan medicines need to be simplified and streamlined, and made a number of recommendations in relation to the appraisal process, assessment criteria used and ensuring equity of access. It stated:

There cannot be a guarantee that all medicines approved for use in England will be approved for use in Wales. Different methods across UK may result in difference in recommendations. Of greater importance is that there is fairness and equity across Wales.