For example, in a few months a new drug for multiple sclerosis, beta interferon, will get its licence. It will cost about £7,000 a year to delay the progress of the disease for two or three years in some cases, but it is not a cure. Those who manage the budgets she sets have no choice but to set priorities, though the Government denies the need for a full and honest public debate about it. All the GP does is to foot the bill, while the patient is treated by the consultant as a hospital outpatient.Child T’s GP protests that he won’t be used as a rubber stamp and that with his signature comes legal liability.In Child T’s case, the growth hormone is not technically licensed for this condition, so there is added risk. Clinically and ethically, the consultant should put his name on the prescription The hospital says it is a grey area still to be negotiated. But money and clinical judgements are interwoven in an almost seamless web.The language of rationing is everywhere now in the NHS – except on the lips of Virginia Bottomley, or any other politician in any party.
“They say if we, as a national specialist centre, prescribed growth hormone for all our cases from all over the country, then it would take up 25 per cent of the hospital’s drug budget, so we expect the patient’s GP to do it,” he says. Bromley Health’s chief executive, Claire Perry, replies tartly that prescribing such drugs falls within the terms of her contract with the hospital. Not fair, replies the hospital, it was never spelt out in the contract and Bromley is changing the terms and conditions. Impasse.Bromley’s red list of banned drugs comes dressed up in some very respectable clothes.
The consultant, however, says he is under an edict from his managers not to prescribe this drug. It has drawn up a “red list” of 23 very expensive drugs, which GPs are told they must not prescribe. The list includes the latest drugs for cystic fibrosis, multiple sclerosis, HIV/Aids and many other conditions. Bromley’s unilateral action, until now unpublicised, is unprecedented.Bromley Health says it is not intended to deny these drugs to patients, but to make hospitals pay instead of GPs. Its contract with Great Ormond Street covers treatment for stunted growth. Child T’s GP refused, and the family feels it has been caught in the crossfire over who should pay.
They live in Bromley, where the health authority has just taken a drastic step.
The National Heritage Memorial Fund similarly replied with a leaflet explaining the first steps in the application process. The Sports Council sent nothing, but when telephoned again apologised for having run out of material. The fourth, the National Lottery Charities Board, has said that it is still “in a consultation exercise with the voluntary sector” but hopes to be ready to invite applications in May (1995 presumably) and begin making grants in the autumn.As it is these last two agencies whose grants will have the most potential to satisfy the ordinary punter that the proceeds are being well spent, it is sad that they couldn’t get their act together faster.Yours truly,PHILIP JACKSONPyworthy, Devon28 April. Child T is tiny, far too small.
