Cancer – the state we are in
The Government has just announced yet another plan to improve cancer care under the NHS.
The report accepts the view that cancer sufferers do not survive as long in the UK as in most of the rest of the developed world, despite a tripling of resources since the last plan was launched in 2000.
This time, there will be no extra money. Instead, the Government is expecting local trusts to improve efficiency and to invest more resources in screening and prevention. It also notes that there is as much as a fourfold difference between the highest and lowest trusts in terms of their spending on cancer services.
This is all rather gloomy news, but perhaps the picture is not as bad as it seems. We were represented recently at a private conference where a leading cancer specialist stated that the oft-quoted statistics that put the UK at the bottom of the pile are misleading. Britain is unique, it seems, in having the means to track survival rates for everyone who has cancer, irrespective of the treatment they receive or where they receive it. Other countries tend to calculate survival rates from the performance statistics of the leading cancer treatment centres. The implication is that people whose cancer is diagnosed too late for effective treatment and who are cared for outside the specialist centres, could be excluded from the figures.
We should also remember that comparisons, valid or not, can disguise the fact that things are still getting better. There is general agreement that a new breed of cancer drugs will drastically improve survival rates. The problem is that they are hugely more expensive than previous drugs – upwards of £20,000 for a year’s course; and as soon as a new one becomes available everyone who might benefit wants it immediately, even though it may be too early to be certain of its effectiveness. It is this that accounts for national variations in spending, as some trusts will jump in quite quickly while others will wait for NICE, the Government’s ‘watchdog’ on new medical developments, to make a report.
In all the circumstances, it is not surprising that anyone with medical insurance will expect the private sector to make up for the perceived deficiencies of the NHS. Often the differences between private and public treatment for cancer are perception as much as reality, but it is true that as far as the new drugs are concerned, private insurers are more likely to pay whether or not the drug has been assessed by NICE.
This is not to say that all medical insurers are the same. Some will pay for virtually unlimited supplies of drugs, others will limit benefit to a single course. In the wider area of cancer care, some will continue paying even after active treatment has ceased, while others will stop benefit on the expectation that terminal care can be provided at minimal cost in the home or in a hospice.
The overall message to the corporate customer is to think hard about what you want. Employers may well decide that such a sensitive area of employee benefit must be fully funded whatever the cost, but they need to realise that this cost will be considerable and is growing all the time. One leading insurer has estimated that the cost of the new drugs alone will add 2% to medical inflation. Any employer not prepared to take on this cost has options, but they need to be considered carefully.
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