91% of applications approved
More than 2,500 cancer patients have been treated with drugs not routinely funded on the NHS thanks to the Cancer Drugs Fund, which is approving 91% of applications, according to the first progress report on the scheme.
The Rarer Cancers Foundation's (RCF) survey of strategic health authorities (SHAs) - the NHS bodies administering the fund - found that 2,506 patients had requests for funding approved between October 2010 and March 2011. During this period, 187 patients were denied funding, despite the fact that the fund as a whole was £22.5m in credit.
The survey identified significant variation in the operation of the fund, something anticipated by commentators when the Government announced plans to launch it. It found that SHAs in the south of England approved a lower proportion of applications than elsewhere in the country. For example, NHS South Central approved around 75% of applications, while NHS North East approved every application it received.
The application and spending rate among SHAs also varies. For example, NHS South Central received two and a half times as many applications per person as neighbouring NHS South West which used less than one quarter of its allocated funds, compared to NHS Yorkshire and Humber which went slightly over budget.
One SHA - NHS North West - is continuing to operate a blacklist of drugs which will only be funded in exceptional circumstances, despite the fact that the Cancer Drugs Fund was intended to put such decisions in the hands of doctors, rather than managers. The RCF is calling for such lists to be abolished.
The fund is currently covering 34 treatments, which otherwise would not have been routinely available on the NHS because they have not been approved by the National Institute for Health and Clinical Excellence (NICE). Patients with bowel, kidney and blood cancers have been amongst the most significant beneficiaries while the five most commonly requested drugs through the fund were Avastin (bevacizumab), Erbitux (cetuximab), Afinitor (everolimus), Tyverb (lapatinib) and MabThera (rituximab).
The report also highlights concerns about the funding of cancer drugs by primary care trusts (PCTs). In most cases, patients seeking access to cancer drugs not routinely funded must first go to their PCT with an exceptional funding request. The RCF's survey (to which 93 out of 151 PCTs responded) found that some are still taking more than four weeks to make decisions about exceptional funding, which may mean that it is then too late for the patients to benefit from the Cancer Drugs Fund. Between April 2007 and December 2010, the 93 PCTs received 4,717 applications of which 59% were approved.
The report also looked at the extent to which patients are "topping up" their NHS care with privately-purchased drugs, something which used to mean they lost their right to NHS care but which is now permitted, provided that the care is delivered separately. The RCF found that less than one quarter of NHS trusts reported patients topping up with no trust earning more than £250,000 as a result.
"The proportion of private income attributed to cancer is significantly lower than the proportion of NHS programme expenditure attributed to the condition, suggesting that cancer constitutes a disproportionately small part of private healthcare delivered by NHS providers," reads the report.