Treatment approval or not

[ Home ] [ Up ] [ The Campaign ] [ Petitions ] [ Events index ] [ Health Policy ] [ Democracy ] [ The NHS ] [ Talks Letters & Articles ] [ Contacts and Further Reading ]
 

• An elderly woman who moved house to be near her daughter may lose her expensive NHS drugs for Alzheimer's disease because of the reluctance of her new consultant to prescribe them and the health authority to pay for them. Guardian Tuesday May 29, 2001 [Northampton]
• Payment by results test for MS drugs James Meikle, health correspondent Guardian Unlimited Thursday November 1, 2001
• Watchdog increases NHS drug bill by £200m David Walker Guardian Society Thursday November 8, 2001
• David Wheable tells how his dying wife was denied the latest 'wonder' drug.  Guardian Thursday March 21, 2002 [Cheshire]
• The NHS's cost watchdog is in trouble over limiting some treatments. But some argue it should be much tougher in its health management.  David Walker Wednesday October 16, 2002 The Guardian
• Doctors could prevent more than 9,000 deaths a year from heart disease if four basic drugs were prescribed for every patient needing them, according to new government findings. The power of the 'magic four' - cholesterol-busting statins, ACE inhibitors which lower blood pressure, beta blockers and the humble aspirin - dwarfs even that of the national crusade to cut down smoking. Gaby Hinsliff, chief political correspondent Sunday March 21, 2004 The Observer
• Cancer charities have today repeated their call for more money to meet new national guidelines for the care of patients dying from the disease. Their plea followed the publication of guidance by the National Institute for Clinical Excellence (Nice) on improving supportive and palliative care for adults with cancer. Debbie Andalo and agencies Wednesday March 24, 2004
• The National Institute for Clinical Excellence (Nice) is five years old. But while it is now well established in the NHS, it emerged this week that Nice is struggling to fulfil one of its key aims: to end the "postcode lottery" in access to drugs and services. This is not through want of trying. Nice has powered through more than 200 clinical cost-effectiveness studies, handing down binding, and sometimes controversial, guidance on which drugs and treatments the NHS should and should not provide. Patrick Butler Wednesday May 19, 2004 The Guardian
• Women with osteoporosis could be denied treatment with a new drug because of rationing based on age, according to campaigners. Draft guidance issued by the National Institute for Clinical Excellence (Nice) says it would not be cost-effective to allow women under 65 to get the drug Forsteo on the NHS. David Batty and agencies Monday May 24, 2004
• The NHS faces a £50 million increase in its drugs bill next year to pay for a new generation of anti-cancer drugs that will allow millions more people to survive with the disease for many years. A special Observer investigation reveals that by 2010 there will be thousands more drug compounds to treat cancer, dramatically improving patients' survival rates. The drugs, many of them engineered to hit specific genetic abnormalities in tumours, will boost the armoury of treatments available for tackling the 260,000 new cancer cases diagnosed every year in the UK. Jo Revill, health editor Sunday November 28, 2004 The Observer
• Don't ration drugs. Cancer treatment is for everybody. Leader Sunday November 28, 2004 The Observer
• Breast cancer drug dilemma. Treatment brings new hope - and a huge bill. Sarah Boseley, health editor Wednesday December 8, 2004 The Guardian
• A man who had to pay £8,000 for surgery to rid him of prostate cancer is demanding a refund and apology from his health trust, saying he was the victim of a "postcode lottery". Bob Norburn, 56, an engineer from Westhoughton, near Bolton, was diagnosed with terminal prostate cancer, but the NHS refused to pay for cryotherapy - a procedure offered at Sunderland hospital specifically for this illness. Though not approved by the National Institute of Clinical Excellence (Nice), the treatment has a 98% success rate. He opted to pay privately. The operation was a success and, two months on, he has been given the all-clear. Helen Carter Saturday December 11, 2004 The Guardian
• GPs are under increasing pressure to consider costs before sending patients on to see a specialist. But are we paying a price with our health? By Clare Longrigg. Tuesday December 21, 2004 The Guardian
• Doctors were told yesterday to restrict the use of the NHS's frontline painkiller for very sick patients in an attempt to eke out supplies. The Department of Health said stocks of diamorphine, a drug routinely used for cancer, heart and terminally-ill patients could hit critically-low levels within weeks. James Meikle, health correspondent Friday December 24, 2004 The Guardian
• Women are being denied the contraception of their choice because of NHS rationing, family planning experts warn today. Almost a third of primary care trusts are now restricting access to so-called long-term methods such as the contraceptive implant - inserted under the skin to deliver a controlled dose of hormones - or the Mirena coil, an intra-uterine devise which also slowly releases hormones into the womb. And GPs are even struggling to get hold of sufficient supplies of free condoms, despite the crusade to reduce unwanted pregnancies, according to Dr Alison Bigrigg, president of the Faculty of Family Planning and Reproductive Health Care. Gaby Hinsliff, political editor Sunday March 6, 2005 The Observer
• Hundreds of patients with severe rheumatoid arthritis are being denied treatment that could ease their pain and suffering, doctors said today. Nearly a third (31%) of specialist doctors said they were unable to provide anti-tumour necrosis factor alpha treatment (anti-TFNa) to all eligible patients, with more than half citing cost as the reason. This is despite the NHS treatment watchdog, the National Institute for Clinical Excellence, issuing guidance three years ago that anti-TNFa drugs should be provided to rheumatoid arthritis sufferers across England and Wales. Monday June 6, 2005
• Bowel cancer patients are celebrating Christmas today in protest at being denied access to new drug treatments, which mean they may not survive to see the festive season. The charity Beating Bowel Cancer said it is staging Christmas five months early for the 7,084 patients who may not live until the end of the year. Monday July 25, 2005
• Rationing of cancer drugs by the NHS will provoke fresh controversy this week with a revelation that a treatment which could help thousands of patients will not be available across the country for at least two years. Jo Revill, health editor Sunday August 14, 2005 The Observer
• End the cancer drugs lottery now. NHS rationing must be scrutinised. Leader Sunday August 14, 2005 The Observer
• Every UK Bupa hospital uses Herceptin. Funding is the only reason why it is not available in NHS hospitals. The DoH should admit as much. Extract from Letters to the Editor Sunday August 21, 2005 The Observer 
• Patients in England still face a postcode lottery on drugs and treatment guidance, five years after a system designed to end such patchy provision was introduced. James Meikle, health correspondent Thursday September 8, 2005 The Guardian
• A nurse with breast cancer is taking legal action to force the NHS to prescribe her a powerful, life-saving drug which could significantly increase her life expectancy. Barbara Clark, who has an 11-year-old son also with a terminal illness, could be dead within months unless she gets the drug Herceptin. So far her primary care trust has refused her the treatment, but Clark, 49, will take her fight to the High Court if they do not change the decision within a fortnight. Anushka Asthana, Martyn Halle and Jemma Gander Sunday September 18, 2005 The Observer [Somerset
• A nurse with breast cancer is taking legal action against her health authority to force it to give her a drug to fight the disease, it emerged yesterday. Barbara Clark, 49, of Bridgwater, Somerset, is trying to use the Human Rights Act, which enshrines a right to life, to compel Somerset Coast Primary Care Trust to give her the drug, Herceptin. Though available privately, the drug is only licensed to be used on NHS patients with advanced cancer. Ms Clark is in remission after undergoing chemotherapy. Steven Morris Tuesday September 20, 2005 The Guardian
• A leading cancer charity today launches a "dossier of delay", claiming that patients are dying unnecessarily because 23 new drugs have not yet been given approval for use in the NHS by the under-funded National Institute for Clinical Excellence (Nice). Cancer Bacup is leading the charge, but other patient groups are close behind in the growing criticism of the sluggishness of the drug approval process. Nice, whose task is to assess new drugs on suitability and cost effectiveness grounds for use in the NHS, has admitted that it has had to close down one of its three appraisal committees because its government funding was cut by £3.5 m. Sarah Boseley, health editor Tuesday September 20, 2005 The Guardian
• Being diagnosed with breast cancer is distressing enough for women without being led to believe that treatments are being denied to them by NHS bureaucracy. ('Dying nurse sues NHS for denying her cancer drug', News, last week). The EMEA (the European body which evaluates many new drugs) has yet to assess whether Herceptin is a safe treatment for women with early breast cancer. Until they do this, it can't be licensed for general use in the UK. The EMEA can only start work when a manufacturer applies for a licence, or asks for a licence on an existing drug to be extended. And licencing is important: drugs have to be shown to work and to be safe before they are made available for widespread use. Nice develops guidance for the NHS on significant new drugs once they have been licenced, to help ensure equal access for patients. We have already recommended the use of Herceptin for advanced breast cancer (which it has a licence for), and we will issue guidance on its use in early breast cancer as close to the drug being licenced for this condition in the UK as possible. Andrew Dillon Chief executive, National Institute for Health and Clinical Excellence, London WC1. Letter Sunday September 25, 2005 The Observer [Somerset
• A 49-year-old nurse with an aggressive breast cancer has won her battle to obtain NHS treatment with Herceptin, an expensive new drug which can prevent the life-threatening disease returning. Barbara Clark's victory sets a precedent for potentially 10,000 women in Britain - a quarter of all those diagnosed with breast cancer each year. Campaigners were jubilant yesterday, but the decision will alarm those who hold the NHS purse strings. They are likely to receive demands from other women for treatment that costs around £20,000 a patient a year. Sarah Boseley, health editor Tuesday October 4, 2005 The Guardian [Somerset]
• Speeding up approvals. Drug rationing. Leader Wednesday October 5, 2005 The Guardian
• The new and expensive breast cancer drug Herceptin will be made available on the NHS to any woman who can benefit from it, the health secretary announced yesterday. The announcement by Patricia Hewitt follows the victory of Barbara Clark, the 49-year-old nurse who persuaded her local health authority to pay for her to have the £20,000-a-year drug and threatened to go to the European court of human rights if they did not. Sarah Boseley, health editor Thursday October 6, 2005 The Guardian
• Live or die? Your postcode decides. Dr Simon Atkins on the prescription lottery. Thursday October 6, 2005 The Guardian
• In the cancer lottery, I'm one of the lucky ones. Dina Rabinovitch Friday October 7, 2005 The Guardian
• The UK is lagging behind most of Europe in its access to cancer drugs, alongside the Czech Republic, Hungary, Norway and Poland, according to a report by Swedish economists published yesterday.  Sarah Boseley, health editor Friday October 7, 2005 The Guardian
• Cancer charities last night stepped up pressure on the NHS to widen access to a promising new class of breast cancer drug as evidence was published suggesting the new treatments outclassed tamoxifen, the long established gold standard drug for women with early stage disease. Pooled results from three European trials of anastrozole, one of the new drugs, suggested that postmenopausal women who switched from tamoxifen two years into treatment after surgery were more likely to be alive two and a half years later. James Meikle, health correspondent Saturday December 10, 2005 The Guardian
• The decision by some NHS trusts to deny hip and knee replacement surgery to obese patients has been criticised by doctors. Last month it emerged that obese people would not be entitled to such surgery on the NHS in East Suffolk. The ruling came as part of a series of measures to be taken by the three primary care trusts in the area in an attempt to save money locally for the NHS. It is believed that the risks of operating on obese patients are higher and the treatment may be less effective, with replacement joints wearing out sooner. But Nicholas Finer, a consultant in obesity medicine at Addenbrooke's Hospital in Cambridge, challenged claims that surgery could be withheld on the grounds of increased risks for obese people, saying no evidence supports withholding joint replacement from obese people. Friday December 16, 2005 6:58 AM
• A high court judge yesterday ordered NHS managers to pay for a woman with breast cancer to have the unlicensed drug Herceptin until her legal challenge to require the health service to fund her treatment could be heard. Ann Marie Rogers, 53, has borrowed £5,000 to start treatment privately, but cannot afford a year's course of the intravenous drug, which is being administered every three weeks. She is seeking to force Swindon primary care trust in Wiltshire to pay for Herceptin, which trials have suggested halves the chances of the aggressive HER-2 form of cancer returning after a year. James Meikle, Health correspondent Thursday December 22, 2005 The Guardian
• An NHS trust is scrapping the routine procedure that cured Tony Blair of a heart murmur, because of its financial deficit and the need to hit the government's six-month waiting-list targets. The move by Oxford Radcliffe trust will leave hundreds of patients with a debilitating condition that reduces their quality of life. Cardiac catheter ablation, a procedure performed in day surgery which is more than 90% successful in curing an irregular heartbeat, will now only be available to a minority of high risk cases. Around 50 patients in Oxfordshire and Buckinghamshire who had been referred to the heart unit at the John Radcliffe hospital in Oxford have been taken off the waiting list and told they cannot now have the operation on the NHS. The numbers will build up over the next year. Sarah Boseley, health editor Monday January 2, 2006 The Guardian
• Patricia Hewitt, the health secretary, yesterday denied the government was responsible for a decision to withdraw a routine treatment from NHS patients which cured Tony Blair's irregular heartbeat in 2004. But her assurances were challenged by cardiologists, who insisted that a pricing bungle by the Department of Health was to blame and that hundreds of patients would suffer as a result. The Guardian disclosed yesterday that Oxford Radcliffe NHS trust has removed about 50 patients with the same condition as the prime minister from its waiting list, in an attempt to balance the books. It will no longer perform cardiac catheter ablations - day surgery to restore the normal rhythms of the heart - unless the patient's condition is a lot more serious than his. John Carvel, social affairs editor Tuesday January 3, 2006 The Guardian
• Hospital trust attacked for taking heart patients off list. Commenting on Oxford Radcliffe NHS Trust's decision to de-list cardiac catheter ablation, the government's national director for heart disease Dr Roger Boyle said that getting the value of the national tariff for the procedure right first time was a "tall order" and the Department of Health was "working to get it right", but it "is no excuse for taking people off waiting lists, however bad the financial problem in the locality." Local Lib Dem MP Evan Harris said the hospital had spent £100,000 treating patients with the condition in the private sector at £7,500 a time: "The NHS won't pay the Radcliffe more than £2,000 per case but it can pay whatever it likes to the private sector. It is just one way that the private sector makes a mint out of stupid NHS targets." Summary by Keep our NHS Public of Financial Times 3 January 2005
• Fertility treatment denied to thousands of couples. A small survey of PCTs has found that 80% have stricter criteria for offering IVF treatment than those recommended by NICE. 60% say it will take at least three years to hit the government target of offering three free cycles to all infertile couples. Summary by Keep our NHS Public of  Independent 16 January 2006
• Threat to bowel cancer screening. A £37m initiative for a national screening programme to help to prevent up to 5,000 deaths a year from bowel cancer is in doubt because of the financial crisis gripping the NHS. Ministers are refusing to give an assurance that the programme will go ahead in April as planned. Summary by Keep our NHS Public of  Sunday Telegraph 22 January 2006
• Alzheimer sufferers win £60m drug fight · Family protests force policy U-turn · Acute dementia patients left out. Jo Revill and Yvonne Roberts Sunday January 22, 2006 The Observer
• U-turn lets Alzheimer's drugs be used by NHS. Campaign leads to rethink on three treatments but dissatisfied patients' groups say fight goes on. Sarah Boseley, health editor Monday January 23, 2006 The Guardian
• Drugs lottery with a devastating cost. Letters Tuesday January 31, 2006 The Guardian
• A nurse with breast cancer yesterday won the first round in her battle to persuade her primary care trust, Bristol North, to fund her treatment with the cancer-fighting drug herceptin. A high court judge, Mr Justice Silber, ordered the trust to pay for the treatment pending the outcome of Elisabeth Cooke's challenge to the trust's refusal to provide the drug free of charge. Clare Dyer Thursday February 2, 2006 The Guardian
• Most doctors want a public debate about the acceptability of refusing treatment to people who smoke or drink too much, according to a poll today in BMA News. The doctors were asked if they agreed with a cost-cutting decision by Suffolk East primary care trust to withhold joint surgery from the clinically obese. Four in 10 doctors thought the trust was right, and the same proportion wanted the policy to be widened to exclude smokers and excessive drinkers from certain clinical procedures. Although half the doctors took the opposite view, 96% said it was time for an open debate on rationing. John Carvel Friday February 3, 2006 The Guardian
• A breast cancer sufferer begins a High Court fight to force the NHS to allow her the life-saving treatment it refused on grounds of cost. Mark Townsend and Jo Revill Sunday February 5, 2006 The Observer [Swindon]
• A woman who today began a landmark legal battle to get the breast cancer drug Herceptin on the NHS said a decision to deny her the medication amounted to "a death sentence". Ann Marie Rogers is challenging Swindon primary care trust (PCT) in the first court case against a decision not to provide the drug, which is said to halve the chances of the aggressive Her2 form of breast cancer recurring. Today, Ian Wise, appearing for Ms Rogers, asked a judge to declare "arbitrary and unlawful" the PCT's policy of only providing Herceptin in "exceptional cases". Monday February 6, 2006
• Q&A: Herceptin. As a test case over the rights of a patient to receive Herceptin gets under way, David Batty looks at the breast cancer drug and its administration.  Monday February 6, 2006
• Lung cancer patients are not getting the care they deserve because the illness has the stigma of being seen as a "smokers' disease", campaigners said today. Cancer charities said more than 38,000 people died from lung cancer each year in the UK - more than from leukaemia, breast and prostate cancer put together. Despite this, lung cancer received only 4% of the national cancer research budget. Tuesday February 7, 2006
• A woman with an aggressive form of breast cancer who has been denied funds for the drug Herceptin has said she feels she has been handed a "death sentence" by her local NHS trust. Ann Marie Rogers, 54, is fighting a landmark high court battle to force health service managers to pay for her treatment. She has been refused the drug, which is said to halve the chances of the aggressive Her2 form of breast cancer returning, by Swindon primary care trust (PCT) in Wiltshire. Sam Jones Tuesday February 7, 2006 The Guardian
• NHS chiefs' fears on patient safety. A poll of 169 NHS chief executives by the NHS Confederation has shown that three-quarters fear that patient safety is in danger of being undermined due to politicians and patients sidelining the regulatory process for new drugs like Herceptin. 91 of those polled said less vocal patients will lose out from the pressure to prescribe unlicensed products.  Summary by Keep our NHS Public of Financial Times 15 February 2006
• Woman loses Herceptin court bid. Breast cancer patient Ann Marie Rogers has lost her legal challenge to be allowed the drug Herceptin on the NHS. The high court ruling supported Swindon PCT's position that they were acting in line with official advice, despite Patricia Hewitt saying that it would be wrong to deny the drug on grounds of cost.  Summary by Keep our NHS Public of BBC Online 15 February 2006
• Cancer patient loses legal battle for Herceptin. · Judge turns down plea for early-stage treatment · Ruling enforces postcode lottery, says lawyer. Clare Dyer, legal editor Thursday February 16, 2006 The Guardian
• Ambulance crews in drug row. Heart attack patients across Birmingham and the Black Country are not given the blood clotting Thrombolytic drug en route to hospitals because local PCT's say they are unable to fund it. Neighbours in Staffordshire and Shropshire are given the £350 shot which can prove the difference between life and death. The West Midlands ambulance service runs in both regions but is forced to treat patients from the two areas differently. Summary by Keep our NHS Public of Birmingham Mail 16 February 2006
• The manufacturer of the breast cancer drug Herceptin has applied for a licence to allow it to be used in treating the early stages of the disease, it emerged today. If the application, by Roche Pharmaceuticals, is successful, it could mean the drug - used to treat the aggressive Her-2 form of breast cancer - is fast-tracked for use in early stage breast cancer across the NHS. The move came after a patient with early stage breast cancer lost a landmark legal bid for the NHS to provide her with Herceptin, which research suggests halves the risk of the Her-2 form of the disease. Friday February 17, 2006
• Q&A: Herceptin. Following the case of the patient who took her bid to be treated with Herceptina to the high court, David Batty looks at the breast cancer drug and its administration. Friday February 17, 2006
• Postcode lottery of NHS. Claire Rayner, agony aunt and president of the Patients' Association, said: "I don't think we've got a 'national' health service any more. What we have got is a loose network of individual trusts and licensing areas with great holes in it through which individual patients can fall. All I want to see is the NHS the 'national' health service we were promised, that treats patients as individuals and consultants as well-trained, knowledgeable people who know what's best for an individual. And if those consultants say this patient needs these drugs, the NHS should provide it."  Summary by Keep our NHS Public of Daily Mirror 17 February 2006
• Breast cancer patients hoping to benefit from Herceptin, the drug that many perceive as their best hope of conquering the disease, will have to wait until August before the NHS decides whether it gives value-for-money treatment for women with early stage disease. James Meikle Saturday February 18, 2006 The Guardian
• The second woman to take her fight for the breast cancer drug Herceptin to the high court has been told she must wait for the outcome of Ann Marie Rogers' appeal at the end of the month. Solicitors for Elisabeth Cooke, 59, a mother of two from Bristol, said that much was resting on the appeal. Both women want access to Herceptin for early stage breast cancer. At the moment it is only licensed for advanced disease. Sarah Boseley Tuesday March 7, 2006 The Guardian
• Breast cancer victims who would currently be refused the 'miracle' drug Herceptin by the NHS have been treated by their private medical insurers instead. Bupa says that since last year it has provided Herceptin to about 100 women who have been diagnosed in the early stages of the deadly HER-2 positive form of breast cancer, while Standard Life has paid for the drug in 30 early stage cases. Norwich Union has also provided funding for Herceptin in early stage cases since June last year. Herceptin recently hit the headlines as two women with early stage breast cancer went to the High Court in a bid to get treatment with the drug through their health trusts. A year-long course of Herceptin costs more than £20,000, and some cash-strapped trusts have refused the drug in early stage cases, even though Health Secretary Patricia Hewitt has ordered them to provide it if doctors think it will help. Sunday March 12, 2006 The Observer
• The world's largest medical experiment will be launched this week in the Cheshire town of Altrincham, when hundreds of volunteers will give blood and DNA to the controversial new genetic database, Biobank.  Robin McKie, science editor Sunday March 12, 2006 The Observer [Potentially this will identify which treatments will work for which patients]
• A controversial drug for Alzheimer's can reverse some of the mental deterioration experienced by people who are in the advanced stages of the disease, according to a study published today. Relatives and many doctors have campaigned for the drug, Aricept, to be made available to people with Alzheimer's - not least because there is no other treatment for the disease, which erodes the memory. The National Institute of [Health and] Clinical Excellence, which assesses the cost-effectiveness of drugs, recommended that Aricept be made available only to patients who have moderate dementia. Sarah Boseley Thursday March 23, 2006 The Guardian
• The selling of a wonder drug. Four years ago, almost no one had heard of it. Today, Herceptin is a household name and women with early-stage breast cancer are going to court for the right to get it. Yet the drug is not actually licensed for use in early-stage cancer - and the clinical tests, while promising, don't yet prove it will ever save lives. How did Herceptin become a cause célèbre? Sarah Boseley investigates. Wednesday March 29, 2006 The Guardian .  Roche, the manufacturer, is promoting patient groups etc.
• Pros and cons of Herceptin. Letters Monday April 3, 2006 The Guardian
• IVF: how a generation of women is being denied the chance to give birth. Thousands of desperate couples are being denied the chance to have children because ministers are failing to enforce their pledge to give infertile women free IVF treatment on the NHS. Guidelines from the National Institute for Clinical Excellence state that all women between the ages of 23 and 39 who have experienced infertility problems should have up to three cycles of free IVF on the NHS. Yet a survey by Nice has found that only 40% of England's 400 primary care trusts have confirmed they offer free IVF treatment. Summary by Keep our NHS Public of  Independent 9 April 2006
• Breast cancer patients living in Wales are getting the so-called "wonder drug" Herceptin free at a hospital but women living in England have to pay, it emerged yesterday. The "postcode lottery" surrounding the potentially life-saving drug means that women in Wales do not have to pay for the treatment at the Royal Shrewsbury hospital because Herceptin provision is funded by their health board. But women in the early stages of breast cancer who live in England must raise the £30,000 a year cost themselves, because their primary care trust will not foot the bill. The disparity - which illustrates the differences in priorities between different PCTs - was exposed yesterday by Owen Paterson, the North Shropshire Tory MP. Since February, all Welsh local health boards have agreed to pay for the drug for women living in Wales who need it, even if they are treated in England. Sarah Hall, health correspondent Monday April 10, 2006 The Guardian
• Breast cancer patient Ann Marie Rogers won her legal battle for NHS treatment with the drug Herceptin in the court of appeal yesterday, but primary care trusts will still be free to ration it for other women.  Clare Dyer and Sarah Hall Thursday April 13, 2006 The Guardian [Swindon]
• Meddling judges make it worse. Leader Thursday April 13, 2006 The Guardian
• Q&A: Herceptin. Following the case of the patient who took her bid to be treated with Herceptin to the high court, David Batty looks at the breast cancer drug and its administration. Wednesday April 12, 2006
• Huge referral cuts could be enforced. London's transitional leadership is drawing up proposals that could require primary care and acute trusts to make dramatic cuts to their referral rates to meet 'best practice' requirements. Draft proposals are understood to suggest that cutting referral rates to those of the lowest 10% nationally would save £25m across London, and to recommend that PCTs which cannot achieve this set up 'review panels' of GPs and other clinicians by specialty. The guidance from the team running the London cluster, headed by John Bacon, stressed: "PCTs will expect trusts' co-operation in these circumstances. In particular, trusts should not assume 'referral' as 'authorisation to treat'." Summary by Keep our NHS Public of  Health Service Journal 13 April 2006
• Demand management plan is 'frightening'. Primary care leaders have described proposals that could see GP referrals unfunded if they are not authorised by primary care trusts as 'absolutely frightening'. National Association of Primary Care chair Dr James Kingsland said the concept of demand management centres ran counter to the aims of practice-based commissioning. Summary by Keep our NHS Public of  Health Service Journal 13 April 2006
• Rationing the health service. In a letter to the Times, Chairman of the BMA James Johnson writes: "referral management centres are completely at variance with the Government's patient choice policy (letters, April 11 and 12). These initiatives erect a barrier between the doctor who has seen the patient, usually the GP, and the consultant best placed to look after the patient's needs." Summary by Keep our NHS Public of  Times 13 April 2006
• Women are unfairly denied Herceptin by the NHS. Letters Friday April 14, 2006 The Guardian [Includes letters about drug companies disease-mongering]
• Health watchdog refuses to approve insulin inhaler.  Costs outweigh benefit for 'needle-phobes', says Nice.  Diabetes campaigners call for decision to be reversed. Sarah Hall, health correspondent Wednesday April 19, 2006 The Guardian
• I'm not 'emotional' - I really do need Herceptin. The breast cancer drug receives national funding in France and Italy. Why not here? asks Kasia Boddy. For the second time this year, the Guardian leader column has attacked the "interference" of judges and government ministers in the provision of drugs that have not yet been approved by the National Institute for Clinical Excellence (Matters of Nice judgment, January 26; Meddling judges make it worse, April 13). The Herceptin story has become one of "emotional" patients versus hard-pressed managers. But patients such as Ann Marie Rogers and myself have not demanded the drug because we're the gullible pawns of drugs companies and charities. We want it because our oncologists have told us that we need it - they don't think Herceptin is "hype-over-hope". Wednesday April 19, 2006 The Guardian
• Hospitals may have to close to pay for new drugs, says Hewitt. Patricia Hewitt has told her cabinet colleagues that hospitals will have to close if Britain is to afford expensive new drugs, which she referred to as "hundreds of new Herceptins in the pipeline". Hewitt insisted that the reforms - including hospital closures - are needed if Britain is to afford expensive new drugs about to come on to the market. Summary by Keep our NHS Public of Independent 23 April 2006
• A government advisory body is expected to reject two new breast cancer drugs for use in the NHS, even though they have been approved for use in Scotland. The decision, in draft guidance from the National Institute for Clinical Excellence published today, is likely to anger patient groups that have been campaigning for access to every new drug that appears to show an improvement over older, cheaper medicines in clinical trials. The two drugs, docetaxel and paclitaxel, are licensed for use in combination with other standard drugs in women who have a first breast cancer which has spread to the lymph nodes. Sarah Boseley, health editor Friday April 28, 2006 The Guardian
• Obese patients to be refused hip operations. Overweight people are to be made the latest victims of a cash crisis gripping healthcare in North Staffordshire. People classified as clinically obese will be denied hip and knee replacement operations, to help the area tackle its £30 million of NHS debt, which is already forcing the loss of 1,000 hospital jobs. The cut-off point will be a Body Mass Index (BMI) measurement of 30. The clampdown, which is still awaiting final approval, could rule out treatment for a quarter of the 700 patients having joint replacement surgery at the University Hospital of Staffordshire every year. The initiative is among a string of economies revealed by North and South Stoke-on-Trent PCTs, which are £9 million in the red, and need to cut annual spending by £18.5 million a year to balance coming budgets. Summary by Keep our NHS Public of  Stoke Sentinel 2 May 2006
• Obese patients should not be denied hip ops. The NHS should not deny obese patients hip replacement surgery simply on the basis of weight. A study led by Professor Cyrus Cooper, professor of rheumatology at the University of Southampton, found obesity did not affect a patient's long-term outcomes after surgery, with the severity of disease a much more important factor. The findings cast serious doubt on the policies of some PCTs, which have sought to bar obese patients from surgery. Summary by Keep our NHS Public of  Pulse 5 May 2006
• Treatment limits to cut NHS costs. Smokers and overweight people in Lincolnshire will be given lower priority for some treatments as part of measures to cut costs. Officials have said many treatments for non-life threatening conditions are not as effective on smokers or the obese. Plans include closing sexual health clinics for a year and changing the threshold for IVF fertility treatment so it will only be available to women under 35. Other treatments highlighted were breast reduction, hip replacements and hysterectomies. The move does not constitute a ban on these procedures, but each case will be dealt with individually. Summary by Keep our NHS Public of  BBC Online 11 May 2006
• Cuts may mean some operations rationed. North Yorkshire primary care trusts are considering rationing certain surgical procedures to help balance the books by the end of the financial year. Operations to carry out varicose vein removal, vasectomies, and hip replacements may be curtailed for all but exceptional cases. Summary by Keep our NHS Public of  Yorkshire Post 22 May 2006
• A new class of breast cancer drugs is to receive preliminary approval for use in the NHS today, raising the prospect of improved quality of life for some women, but at a substantially increased cost. The drugs, known as the aromatase inhibitors, will be approved for use alongside tamoxifen, for decades the "gold standard" treatment for post-menopausal women who have undergone surgery for a first breast cancer. Although doctors will have the option to prescribe either the new drugs or tamoxifen, most experts believe the aromatase inhibitors will gradually replace the standard drug. Sarah Boseley, health editor Tuesday May 23, 2006 The Guardian
• Health trust withdraws cancer drug from patient. A woman has been refused a cancer drug by her local NHS trust despite being previously allowed to have the treatment. Guildford and Waverley Primary Care Trust is facing a £20.9m deficit and is working with the independent financial consultant PriceWaterhouseCoopers to develop a "turnaround plan". Summary by Keep our NHS Public of  Telegraph 23 May 2006
• Smokers who need heart bypasses and alcoholics who need liver transplants should not get them free on the NHS, according to four out of 10 hospital doctors. A quarter of those questioned in a survey also believe obese patients should not be given free anti-obesity drugs or receive free orthopaedic treatments.  Sarah Hall, health correspondent Thursday June 29, 2006 The Guardian [Unequal treatment positively correlated with poverty]
• Cancer patients and women about to give birth who have been denied asylum in the UK are being refused care by NHS hospitals unless they can pay thousands of pounds for their treatment, it is revealed today. Asylum seekers are vulnerable and usually destitute, says a report from the Refugee Council, which says the failure to treat people who are at risk of dying is a breach of the human rights enshrined in the NHS core principles.  Sarah Boseley, health editor Thursday June 29, 2006 The Guardian
• Both have cancer. But why can't one get the best care? Observer sports writer Bill Elliott was diagnosed with prostate cancer in April. Within an hour, his wife Val was told she had breast cancer. Now they have had to come to terms with the stark fact that her treatment has 10 times as much funding as his. Health Editor Jo Revill examines the human cost of NHS inequalities. Sunday July 9, 2006 The Observer [Surrey]
• Thousands of NHS patients are failing to receive appropriate care due to waste, inefficiency and postcode prescribing, the chief medical officer for England said today. Professor Sir Liam Donaldson blamed variations in care across the country on doctors and NHS managers who put their own preferences for certain treatments before the needs of patients. Both the over-use of some treatments and the under-use of others were wasting millions of pounds, he warned in his annual report on the state of public health. David Batty and agencies Friday July 21, 2006 Guardian Unlimited
• Billions of pounds could be saved if NHS doctors stopped providing outdated treatments and medicines that no longer offer the best patient care, the government's chief medical officer for England said yesterday. Sir Liam Donaldson warned in his annual report of "widespread over-use of treatments of little therapeutic value". John Carvel, social affairs editor Saturday July 22, 2006 The Guardian
• The row over the rationing of prostate-cancer therapy deepened this weekend, as the government's former chief economic adviser on the NHS revealed that he had received the treatment only after threatening to publicise the fact that its use was being restricted. Two weeks ago, The Observer revealed how a Surrey couple, Bill and Val Elliott, were both diagnosed on the same day with cancer, but while Val is receiving treatment and expensive drugs for her breast cancer, Bill is having to fight for his care. Bill Elliott's local health body, the Guildford and Waverley Primary Care Trust (PCT), told him last month it would not pay for the relatively new form of treatment his consultant had recommended, known as brachytherapy, which carries fewer side effects than a surgical operation and is less invasive than the alternative, a radical prostatectomy. He is now appealing against the decision. The trust has refused the treatment to 11 out of the 12 men who have asked for it since April 2005, though the local hospital treats around 100 men a year from other parts of England. But the 12th man from Guildford, who did win the right to treatment, is Professor Clive Smee, the former chief economic advisor to the Department of Health. After reading about Bill Elliott's case, he came forward to reveal that he had to fight for brachytherapy himself. Smee, 64, who is making a good recovery from his prostate cancer, was diagnosed in June 2005. His consultant at the Royal Surrey Hospital in Guildford, Stephen Langley, recommended him for brachytherapy. 'I was left in limbo for two months while the PCT considered whether they would fund it,' said Smee. 'I had to write first to the trust's director of public health, and then I had to threaten to write to my local newspaper.' Smee also set out an economic evaluation of the treatment to explain why they should fund it. It was Smee who chaired one of the committees which led to the setting up of the National Institute of Health and Clinical Excellence (Nice), the body which considers the cost and clinical effectiveness of therapies. Last year, Nice decided that brachytherapy was an intervention which worked, and had a place in the NHS. 'As someone who spent 20 years working for the NHS, I find it perturbing that the service would be making decisions about withholding treatment on such an unaccountable basis,' he said. 'Because I was articulate and well-informed and also, I suspect, because I had connections with the Department of Health, I got the right to my treatment. 'I did inquire about what would happen to the six other men who at that stage were waiting for brachytherapy. I was told that they would all have to make their own case. But all of the men, including myself, were considered by the consultant to be eligible for treatment, so how could a PCT have extra knowledge which would help them decide?' Jo Revill, health editor Sunday July 23, 2006 Observer
• Up to 10,000 breast cancer patients are to be given free access to a drug that could save as many as 600 lives a year. Taxotere, a chemotherapy drug already given to women with late-stage breast cancer, will be given to certain women in the early stages of the disease, under draft guidance to be issued today by the government's drugs watchdog, the National Institute for Health and Clinical Excellence. The guidance comes nine months after the Scottish equivalent of Nice, the Scottish Medicines Consortium, approved the use of Taxotere for Scottish women in the early stages of the disease. The guidance is still open to consultation, but the final version is not expected to be changed when it is published next month. Sarah Hall, health correspondent Monday July 24, 2006 The Guardian
• There can't be many health issues more emotive than the treatment of cancer. So it's not surprising that an interim decision not to provide the drug Velacade to people with the rare bone marrow cancer myeloma has been reported as "a death sentence" in today's Telegraph newspaper. Preliminary guidance published today by the National Institute for Health and Clinical Excellence (Nice) - the agency that decides which treatments are provided on the NHS - cites a lack of evidence on the clinical and cost effectiveness of the drug compared to other treatments. The drug, which costs up to £18,000 for every patient, is said to extend life expectancy by 18 to 24 months, according to the manufacturers. It is recommended for use in the rest of the UK and in many other countries worldwide. The doubts raised about the drug's cost effectiveness have, perhaps inevitably, raised hackles. Eric Low, head of the International Myeloma Foundation, claims that myeloma sufferers have lost out because of the recent preliminary approval of Herceptin as an early stage breast cancer treatment. By David Batty / UK news 05:33pm
• Prostate cancer sufferer Bill Elliott has finally won his battle to receive the treatment he needs, after his local primary care trust approved the funding. Elliott, who was diagnosed with prostate cancer on the same day that his wife, Val, found out she had breast cancer, has spent two months battling with the Guildford and Waverley PCT which initially said it would not pay for a course of brachytherapy. The treatment, which involves planting tiny radioactive seeds into the prostate gland to kill the cancer, is £1,500 more expensive than the surgical alternative, which costs £3,500. But Elliott still doesn't know what will happen to four other men in the area who have appealed for the therapy. Jo Revill Sunday July 30, 2006 The Observer
• Scots get anti-blindness drug as those south of the border lose out. An effective treatment for the commonest cause of blindness, age related macular degeneration (AMD) has been approved for use in Scotland, but awaits the National Institute for Clinical Excellence's approval for use in the UK. Between now and NICE's timetable for completion of its appraisal of the drug, Mucagen, twenty thousand people in England and Wales could go blind. NICE said that, as they had only been instructed to look at both Mucagen and another similar treatment called Lucentis together, they would have to wait until Lucentis received a licence before producing their appraisal. Summary by Keep our NHS Public of Independent 8 August 2006
• A new class of breast cancer drugs yesterday won final draft approval for use in the NHS alongside the "gold standard" Tamoxifen, which many expect them quickly to replace. The National Institute for Clinical Excellence said the aromatase inhibitors, such as anastrozole, should be available despite their increased cost over Tamoxifen because they have fewer side-effects and studies have shown they reduce cases of breast cancer that recur. The drugs inhibit production of oestrogen. The government has said doctors must be free to use the drugs as they see fit. Sarah Boseley Friday August 11, 2006 The Guardian
• Revealed: trusts block GPs' choice over BP drugs. GPs are being barred a choice of first-line treatments for hypertension by cash-strapped primary care organisations in a direct challenge to new NICE guidelines. A Pulse investigation has revealed 55% of PCOs aim to restrict GPs to use of diuretics as main first-line drugs - even though NICE gives calcium channel blockers equal billing. A third of these have released local guidance giving the impression of being in line with NICE while omitting calcium channel blockers as a first-line option. Summary by Keep our NHS Public of Pulse 11 August 2006.
• Cancer charities reacted angrily last night to news that the NHS is to deny bowel cancer patients two drugs that promise to prolong life for up to five months. Nice, the government watchdog that assesses the clinical and cost effectiveness of treatment, will announce today that it is ruling out the use of bevacizumab (brand name Avastin) and cetuximab (Erbitux) for advanced bowel cancer on the grounds they are not cost effective. The guidance will say there is some evidence Avastin prolongs life, but that "neither drug represents a good use of scarce NHS resources". It will say there is insufficient evidence to judge whether the NHS could justify spending money on Erbitux rather than existing treatment.Sarah Hall, health correspondent Monday August 21, 2006 The Guardian
• The drug does work.  But has the outcry over Herceptin distorted its importance and undermined the process by which NHS medicines are approved, asks David Batty. Wednesday August 23, 2006 Guardian Unlimited
• Q&A: Herceptin. David Batty Wednesday August 23, 2006 Guardian Unlimited
• The King's Fund, the health thinktank, has warned the government to overhaul the NHS cancer plan. It believes that the current strategy would not be adequate to deal with a rise in cancer cases, rapidly ageing population and prescribing expensive treatments, such as Herceptin. It predicted more battles over disparities in the provision of such drugs, and urged the government to open a public debate about spending priorities.  Tania Branigan, political correspondent Friday August 25, 2006 The Guardian
• Couples desperate to have a baby still face a postcode lottery to obtain infertility treatment on the NHS, with help for all in some areas but for only a few in others, experts say today. The British Fertility Society, which represents professionals working in assisted conception, says little has changed in spite of guidance published two years ago by the National Institute for Clinical Excellence (Nice), the organisation set up to establish a level playing field in healthcare. Nice recommended couples should be given a minimum of three attempts at IVF (in vitro fertilisation) on the NHS. The then health secretary, John Reid, said that all clinics should immediately offer at least one, with the intention of expanding provision in time. "Our immediate priority must be to ensure a national level of IVF is available wherever people live ... In the longer term, I would expect the NHS to make progress towards full implementation of the guidance," he said. But the BFS says that there is still a "wide disparity of access" to fertility treatment, poor planning to meet the government target, and no clear criteria as to which couples should be allowed to have IVF and which should not. Its survey of clinics in England, which will be published in the journal Human Fertility next month, found that the number of cycles, or attempts at fertilisation, had increased, but that there were still "black holes". Primary care trusts are responsible for funding treatment, but some are more willing to find the money than others. Since 2004, 16% of clinics report a decrease in funding for NHS treatment, not an increase. In the vast majority of cases, only one cycle of treatment is permitted. Only 9% of the clinics said they had funding to offer two cycles. The BFS is pessimistic about the future. "There is little indication of PCTs making any long-term plans to implement the Nice guidance, and no reassurance that the full guidance will be implemented (in contrast to Scotland)," it says. Some people find they are refused treatment that they would have been given if they had lived elsewhere. "There is a wide disparity on the social criteria used for acceptance on to an NHS-funded programme," said the BFS. Half of clinics would not accept somebody for treatment who had previously had a child. Other clinics turn people down because they are overweight or because they smoke, says the BFS, complaining of uncertainty and inconsistency. The BFS has written to every PCT in England asking them to meet the government's fertility targets. "Anybody who works in the field will tell you things haven't changed as much as they should have done," said Allan Pacey, secretary of the society. As a taxpayer, he said he could understand the argument that PCTs had high priorities, such as cancer care, for their budgets. "But the government has set out its stall," he said. "Inequity is something PCTs have been told to address." The society has made 11 recommendations on the reform of social criteria used by clinics to decide who to treat. They include that no woman should be treated on the NHS over the age of 40, that single women and same-sex couples should be treated the same way as heterosexual couples, that previous children should not exclude couples from treatment, and that those who are severely overweight - which reduces the chances of success - should go on a weight reduction programme before they get treatment.  Sarah Boseley, health editor Wednesday August 30, 2006 The Guardian.  [We are opposed to all social criteria for treatment]
• Most people believe that money should be no object when drugs and treatments are given to NHS patients, according to an opinion poll. Forty per cent of those surveyed felt that money should be no object if the drugs or treatments on offer were proven to work, while 31% said they believed that all drugs and treatments should be available regardless of cost or effectiveness. Hélène Mulholland and agencies Friday September 1, 2006 Guardian Unlimited
• Millions of pounds could be saved from the NHS budget if doctors used the most appropriate drugs and treatments and stopped some out-of-date procedures, the government said yesterday. Out - in most cases - should go the removal of tonsils and the insertion of grommets in children with glue ear, said the government's expert advisory group, the National Institute for Clinical Excellence (Nice), which is charged with ascertaining what drugs and treatments are cost-effective. Other areas where doctors will be advised to modernise are in the over-use of hysterectomies and antibiotics. Sarah Boseley, health editor Thursday September 7, 2006 The Guardian
• Ageism 'endemic' in NHS. NHS underfunding has caused "endemic" ageism, a medic has warned. Professor John Young claims elderly patients are denied treatments for life-threatening illnesses, such as cancer and heart disease, that are readily offered to young people. Prof Young, of St Luke's Hospital, Bradford, said: "Whenever a clinical stone is turned over, ageism is revealed." He said early progress has been made in England through the National Service Framework for Older People since 2001. Summary by Keep our NHS Public of Mirror 8 September 2006
• Natural births at risk from NHS cuts. Dozens of midwife-run birthing centres could close because of NHS cuts according to the National Childbirth Trust. The organisation says that five out of 100 of the "home style" units have been shut temporarily and another 19 could be scrapped altogether. Critics have said the centres provide an "easy target" for cuts. However, recently the National Institute for Clinical Excellence raised safety concerns by reporting that babies born in the centres were twice as likely to die as in birth at a hospital due to the proximity of emergency services. Earlier this month, David Nicholson angered supporters of maternity centres by saying that women were best served by maternity units in hospitals staffed by consultants, attracting concerns from the Royal College of Midwifery. Any closures would undermine the government agenda of 'choice' and the Department of Health said that "By 2009 we expect women to have a choice about where they give birth…Decisions on reconfigurations are a local matter and will not be taken centrally." News comes as Stroud Maternity Unit received a reprieve from closure after a campaign by midwives and local residents. Summary by Keep our NHS Public of Telegraph 24 September 2006
• Hospitals are being overwhelmed by large numbers of obese people asking for radical surgery to reduce their appetites, with doctors turning away patients because the queues are so long. Jo Revill, health editor Sunday September 10, 2006 The Observer
• It's time to take the politics out of cancer. The killer disease is on the march. In this controversial polemic, a leading specialist argues that fierce lobbying for just a handful of cancers means that sufferers of other forms are denied possible life-saving treatment. Karol Sikora Sunday October 1, 2006 The Observer
• Doctors are expected to ration this year's flu jabs for the next two months because of a delay in supplying vaccine after a glitch at laboratories earlier in the year. High-risk groups including the elderly and those with respiratory conditions will be prioritised more rigorously than usual until medical suppliers catch up with the government's order for 15.2m doses, probably in late December. Martin Wainwright Monday October 2, 2006 The Guardian
• Alzheimer's campaigners have lost their long and hard-fought battle to obtain new drugs on the NHS to treat people in the early stages of the disease, it was announced today. The Alzheimer's Society, which is fronting the campaign, reacted with fury to a statement by the independent National Institute for Clinical Excellence (Nice) that it was rejecting its appeal and would recommend the drugs be used only in moderate disease, and not in the early stages. It called for the Department of Health to reverse the decision. Three drugs, donepezil (better known by its trade name Aricept), galantamine and rivastigmine, do not work well enough in people with mild Alzheimer's to justify prescription on the NHS, Nice said. A fourth drug, memantine, should only be used within clinical trials. Patients already on the drugs, which have been in NHS use since they were approved by Nice in 2001 (Nice reversed its decision last year), should continue to get them.  Sarah Boseley, health editor Wednesday October 11, 2006 The Guardian
• Nice is cutting its costs at the expense of the weakest. Dr Wilkinson, consultant in old age psychiatry at Moorgreen Hospital, Southampton, writes: "The decision by Nice to withhold Alzheimer's drugs to sufferers in the early stages of the disease is atrocious and an utter betrayal of patients and their families. It amounts to a disgraceful, retrograde step that has set back the treatment of dementia by 20 years. I am appalled, but not altogether surprised, that the appeal to make the drugs available to patients in all stages has failed. After all, Nice can't be seen to agree to every new drug that comes on the market, so it has decided to make a wholly unintelligent, and downright immoral stand, to withhold drugs from elderly people. There's no question that these drugs are effective and NICE acknowledges this. So the message it is sending out is "what's the point of improving the lives of people with dementia for a few years when they're only going to die anyway ?" Summary by Keep our NHS Public of Telegraph 12 October 2006
• 'Fat' patients offered private deal after NHS rejects them. Patients denied operations on the NHS are being offered private treatment from the same hospital that rejected them. Debt-plagued University Hospital of North Staffordshire is hoping to generate as least £1m a year from fee-paying patients. Those offered private operations will include those denied NHS care because they are obese. GPs have been told not to refer patients for hip-replacement surgery if they are clinically obese and have also been asked to clamp down on a range of other procedures. Ian Syme, leader of health pressure group Healthwatch, said the move would "without doubt create a two-tier system in the local NHS." Summary by Keep our NHS Public of Stoke Sentinel 16 October 2006
• The prospect of progressively losing one's faculties might seem as grim as any imaginable. Yet for patients diagnosed with Alzheimer's, the recent decision by the National Institute for Health and Clinical Excellence (Nice) to block NHS use of certain drugs that may help them will add to the agony. The exception for advanced cases hardly helps, amounting to an offer of remedial action that can be cashed in only after half the mind is lost. On Friday, Nice was back under fire after it was learned it would also reject a bone-cancer treatment, Velcade. In the Alzheimer's case, the £2.50-a-day costs were relatively modest, and the dispute centred on how much benefit the drugs offered. Doctors are split on the evidence, with Nice being downbeat about the effect, but support charities offering a more optimistic interpretation that sufferers will understandably be drawn to. Government talk of patient power may leave some hoping that it would be for them to decide which assessment to believe, but choice will prove a cruel illusion for those without the funds to buy the drug themselves. Decisions on new cancer drugs can be even harder, transparently turning on whether high costs - £18,000 per cycle in the case of Velcade - are justifiable, leaving Nice putting a price on life. Denying life-prolonging treatment on cost grounds will always feel wrong, and there are doubts about whether Nice adequately factors in the broad social costs of withholding medicines, many of which accrue outside the NHS. Yet rationing is not new in the NHS, it has always occurred, although it used to be done opaquely, through ad hoc rules that hospitals would employ, for example, to rule out some treatments to people above a certain age. A world where patients were unaware of what they could not have was perhaps kinder, but with medical information so readily available, there is no prospect of going back. Nice may make misjudgements - any system would - but the transparent and expert deliberation it embodies is the least bad way of tackling an impossible job. Even if there is no better system, the denial of life-saving treatments that logically flow from it should never be tamely accepted. There is a moral onus on ministers to bear down on the number of such cases by continually pushing the boundaries of what can be provided. That means continuing to increase NHS spending, pushing for efficiencies elsewhere in the service to free resources for drugs, and then driving the toughest feasible bargains with the drugs companies to ensure that the budget stretches to its limit. Leader Monday October 23, 2006 The Guardian
• This sinister assault reeks of political opportunism. Attacks on the decisions over the value of drugs are being used as a battering ram to break support for the NHS. Polly Toynbee Tuesday October 24, 2006 The Guardian
• Cancer patients who cannot get the modern drugs they need on the NHS are ordering them directly from international 'internet pharmacies', often without their doctors' knowledge. Patients are beginning to self-prescribe cancer treatments by ordering them online, after learning about the newer therapies, such as Avastin for bowel cancer and Tarceva for lung cancer. Many treatments have not yet been licensed by the government's watchdog, the National Institute for Health and Clinical Excellence (NICE), but are widely promoted on the internet. One of Britain's leading cancer specialists, Karol Sikora, told a meeting of politicians and doctors last week that he had a number of private patients who had begun to order drugs from one of the largest internet pharmacies in Canada, CanadaDrugs.com. 'These patients are well informed, and they shop around for the cheapest prices,' he said. 'I had one patient, a very well educated young woman who wanted Tarceva for lung cancer. She couldn't get the drug on the NHS. The price from a Harley Street clinic worked out at around £75 a tablet - but ordering from Canada would bring it down to £35 a tablet.'  He told the conference that a younger generation of patients would demand the best treatments, even if the NHS decided they were not affordable. 'We're in a world where an easyJet flight can be booked within minutes. The idea that you can't get a cancer drug that will extend your life because a government body has decreed you can't have it just won't work.'  In the past, the worries have been about patients ordering so-called 'lifestyle' drugs online to reduce weight, cope with depression or boost sex life. Viagra or Cialis for impotence, Prozac for depression and Reductil for weight loss have been widely ordered online over the past five years. But there are concerns over safety when consumers move into ordering more mainstream medicines. Jo Revill, health editor Sunday November 5, 2006 The Observer [It may not be possible to stop this, but it is a dangerous development.  Drugs that have been reviewed by NICE and rejected should typically cost more than £30,000 for one year of healthy life expectancy.  Anyone on a modest income incurring that sort of cost risks impoverishing relatives for minimal benefit.  There is also the danger of this practice becoming acceptable and as a consequence of NICE's threshold  being reduced to £10,000 or even £5,000 for a year's healthy life.  This could open up a class divide and lead to people refused NHS treatment without good reason buying their way out of trouble, if they can afford to do so, rather than campaigning for fairer treatment for all.]
• Open up NHS to our drug firms, White House demands. The White House is lobbying British ministers to allow the world's main drug companies unrestricted access to the NHS as part of a package of free market reforms for the service. The US government is positioning itself behind the giant pharmaceutical firms, predominantly based in America, which have been piling pressure on the body that approves drugs for use in hospitals and for prescription by GPs. The drug companies claim that they are being held back by the National Institute for Clinical Excellence and have separately lobbied for it to be reformed. In a surprising intervention, the US deputy health secretary, Alex Azar, forced the issue in London yesterday, ahead of talks with officials following a trip to the US last week by the health secretary, Patricia Hewitt. He said attempts to use rationing mechanisms such as Nice to cut soaring drugs bills would stifle innovation - an argument that is constantly made by the pharmaceutical industry. Sarah Boseley, health editor Tuesday November 14, 2006 Guardian
  • Keep the market out of the NHS.  Letters Wednesday November 15, 2006 The Guardian
  • NICE approach to drug evaluation.  Letters Friday November 17, 2006 The Guardian
• Watchdog rules against new treatment for lung cancer. Thousands of lung cancer sufferers are set to be denied the potentially life-extending drug Tarceva, under draft guidance from the government's health watchdog. Tarceva, which costs £6,796 for the average 125-day course of treatment, is considered one of the few significant advances against non-small cell lung cancer to have occurred for a decade, and is designed for patients who have failed at one chemotherapy regime. The drug is seen as particularly crucial because it could be effective for 80% of lung cancer sufferers, accounting for 30,000 new cases a year. While it does not offer a cure, it increases the chances of being alive after a year by 42%, according to the drug manufacturers Roche. Sarah Hall, health correspondent Tuesday November 14, 2006 The Guardian
• Third drug firm joins lawsuit against Nice. A third company yesterday announced it would join a legal challenge to the ruling by the National Institute for Clinical Excellence to restrict the use of Alzheimer's drugs in the NHS, as protesters took to the streets around the UK. Shire, one of Britain's leading drugmakers, said it would back Pfizer, the American pharmaceutical group, and Eisai, a Japanese biotech company, in seeking a judicial review of the process Nice followed in making its decision. Nice has ruled that people with mild and severe Alzheimer's disease should not get Pfizer and Eisai's Aricept on the NHS, nor rival treatments including Novartis's Exelon and Shire's Reminyl.  Marianne Barriaux and Sarah Boseley Saturday November 18, 2006 The Guardian
• The government's health watchdog is set to recommend that severely overweight children at risk of developing life-threatening diseases should be offered radical weight-loss surgery. The National Institute for Health and Clinical Excellence (Nice), which is currently under fire for rationing Alzheimer's drugs, will shortly publish its long-awaited plans for the treatment of obesity in adults and children. The institute will recommend that severely overweight teenagers for whom other treatments have failed should be offered surgery, including 'stomach stapling', as a last resort to prevent them from developing diabetes, cancer and serious heart conditions. But the decision to give the go-ahead to the £8,000 procedures will be greeted with dismay by NHS officials and hospital bosses, as the health service, which is cutting jobs and restricting access to clinics, struggles to contain its £800m deficit. Jo Revill, health editor Sunday November 19, 2006 The Observer
• Channel 4 to launch NHS postcode lottery website. Channel 4's current affairs documentary strand, Dispatches, is backing up its film, Britain's Healthcare Lottery, with a dedicated website offering a searchable database of the treatments available in different postcodes. Jon Snow leads the investigation into the geographical differences in treatment and drug rationing. The website will be launched when the programme is aired on Monday 27 November at 8pm, linked from the Channel 4 Dispatches homepage. Jemima Kiss Thursday November 23, 2006 MediaGuardian.co.uk
• Herceptin costs 'would put thousands of other patients at risk' . Thousands of patients could be denied life-saving medicines if hospitals are to pay for the few to be given the breast cancer drug Herceptin, doctors warn today. The real cost of Herceptin, which has been approved for use on the NHS after a high-profile campaign by cancer sufferers, will be borne by other patients whose treatment has to be dropped to balance the books, say cancer experts at the Norfolk and Norwich University Hospital NHS trust and East Anglia University. It will cost the trust £1.9m each year to pay for Herceptin for the 75 patients with the type of breast cancer for which it is recommended, say the doctors in this week's British Medical Journal. That is four times the cost of the drugs used to treat a range of other cancers, including lung, colon and post-menopausal breast cancer. The authors calculate they could pay for Herceptin if they did not give treatment to 355 patients with the other cancers, 16 of whom would be cured. Ann Barrett, lead clinician for oncology, and her colleagues said: "We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the 'treatment of the moment'."  The National Institute for Clinical Excellence (Nice) which approved the drug neither provided extra funds for Herceptin nor suggestions as to what should be cut to fund it. "In the case of Herceptin, high profile patients, media bias, industry support and political gaming put considerable pressure on the NHS to offer this drug in early stage breast cancer," say the authors. Under this sort of pressure, Nice has adopted a "rubber-stamping" role, they argue, adding that "in priority setting Nice's bark is much worse than its bite". Sarah Boseley, health editor Friday November 24, 2006 Guardian
• Operations cancelled as NHS runs out of money. Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year. NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A& E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended. In one example of the cash-saving strategies a PCT in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under 8 weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff. The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24m this year. A letter from its chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A& E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere. No patients will be given a hospital appointment in less than 8 weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for. The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks - expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, said that the trust would not pay for elective operations on smokers until they had attended smoking clinics. Summary by Keep our NHS Public of Times 4 January 2007
• Herceptin improves some breast cancer survival rates, says study. Giving women with certain breast cancers the drug Herceptin improves survival rates two years on, a study reports today. Previous research has shown that Herceptin stops breast cancers returning for the 15-25% of women who have a type of early breast cancer called HER2-receptor positive. But this is the first time a reduction in the number of deaths has been recorded. The drug has been hailed as a "miracle" treatment for women who can use it and is available on the NHS at the cost of £20,000 a year after the National Institute for Clinical Excellence fast-tracked approval. But the Herceptin Adjuvant (HERA) study, reporting in today's Lancet, also found further evidence that the drug can cause cardiac damage in some women. Polly Curtis, health correspondent Friday January 5, 2007 The Guardian
• Dosage loophole restricts Herceptin for NHS patients. Thousands more women could benefit from the life-saving breast cancer drug, Herceptin, at no increased cost to the NHS, by reducing the dose and duration of treatment, researchers suggest today. But there is no mechanism for the Government's watchdog on medicines, the National Institute for Clinical Excellence (Nice), to consider a lower dose, even though it was set up to promote cost-effective use of drugs on the NHS, they say. The disclosure reveals a flaw in the process for assessing new drugs, at a time when mounting NHS trust deficits have led to increasingly grim projections. Summary by Keep our NHS Public of Independent 5 January 2007
• Surgery on smokers 'is wasted'. Smokers should be denied surgery on the NHS unless they kick their habit, a leading doctor has said. Professor Matthew Peters, the head of thoracic medicine at the Concord Repatriation General Hospital, Sydney, Australia, claims that five non- smokers could be operated on for the cost of four smokers, and that their outcomes would be better. Summary by Keep our NHS Public of Times 5 January 2007
• NHS watchdog rules out Alzheimer's U-turn.  Head of Nice defends drug ruling as legal fight begins.  Vow to remain rational amid 'corrosive criticism'. The head of the NHS drug watchdog said it would not be forced into approving medicines it had doubts over yesterday as the body came under fresh pressure over the use of a controversial Alzheimer's treatment. Andrew Dillon, chief executive of the National Institute for Clinical Excellence (Nice), said it was right to rule that the drugs cost too much and do not work well for most Alzheimer's patients and warned that having to fight a legal battle would tie up time and resources that should be spent ensuring the NHS gets treatments that are value for money. Sarah Boseley, health editor Tuesday January 9, 2007 The Guardian
• NHS cash crisis deprives thousands of treatment for blindness. A legal campaign, spearheaded by former Labour MP Alice Mahon, is to challenge regional inequalities in the NHS that mean thousands face going blind for lack of treatment. The condition concerned is age-related macular degeneration (AMD) which affects 500,000 people in the UK. Mrs Mahon suffers from the "wet" form, of which there are 27,000 new cases a year in the UK. Two treatments, Lucentis and Mucagen are under consideration by the National Institute for Clinical Excellence (Nice) but, while some primary care trusts are using the treatment, others such as Mrs Mahon's are refusing to fund it. Campaigners say that 50 people a day go blind because of the refusal to fund the treatment. Mrs Mahon said: "I have been an ardent supporter of the NHS all my life and now feel totally let down. The excuses that PCTs are giving for not funding treatment are scandalously lame. Everyone has a right to free treatment on the NHS for a condition that results in blindness and devastates lives. Supporting people who are blind or partially sighted, who may need home help and suffer injuries from falls, is far more expensive than the treatment. The Chancellor must ensure the NHS budget is large enough to fund such a basic health care need." She was joined yesterday by MPs in tabling an early day motion to provide funding for the treatment. Even if both drugs are approved by Nice there is no guarantee that they will be provided with large discrepancies in what trusts will fund across the country, a situation which is likely to get worse as trusts struggle with their budgets. The Department of Health said last night that patients should not be refused a treatment simply because Nice guidance does not exist yet. Summary by Keep our NHS Public of Independent 30 January 2007
• Primary care trust backs down on decision not to fund eye medication. Public and political pressure yesterday forced an NHS trust to review its decision not to fund the purchase of a sight-saving drug for a former Labour MP. Kirklees and Calderdale primary care trust responded to a challenge by Alice Mahon, highlighting NHS inequalities that deny treatment to thousands facing blindness, including herself. The PCT said news that the drug had received its European licence meant it would reconsider. Summary by Keep our NHS Public of Independent 31 January 2007
• Epileptic boy, 13, denied treatment. A DEVASTATED mother has criticised penny-pinching health bosses after they turned down funding for potentially life-saving treatment for her teenage son. Doctors treating 13-year-old John Love had applied for £7,500 for a nerve stimulating device which could help treat his severe epilepsy. However, Warwickshire Primary Care Trust has turned down the application, claiming it was not 'cost-effective'. John's mother, Eve, of Smeaton Lane, Stretton-under-Fosse, said the decision - which she claims is the first refusal of funding of its kind 'for years' - had ruined his chance for an improved life.  Rugby Advertiser 1 February 2007
• Fears over NHS rationing. Cancerous skin conditions may be the first victim of a new list of low priority treatments banning GPs from referring some patients to hospital specialists. Patients groups and doctors fear those needing varicose vein or or a specialist opinion on asthma or skin conditions could have to pay for their own treatments at private hospitals when the plans come into force. GPs will be overruled if they refer patients that fall under the new low priority list to hospital specialists. Camden PCT revealed the list at a board meeting. The list includes: asthma, grommet surgery, carpel tunnel surgery, minor skin surgery, various cosmetic surgery, gender reassignment surgery, viral warts, eczema, acne and psoriasis. The list includes: asthma, grommet surgery, carpel tunnel surgery, minor skin surgery, various cosmetic surgery, gender reassignment surgery, viral warts, eczema, acne and psoriasis. Dr Jacky Davis, founder member of the Keep our NHS Public Campaign, said: "It's the thin end of the wedge. It looks like a huge amount of bureaucracy. It's the beginning of a very explicit rationing. While some of it may be appropriate who knows where it will end ?" She added: "It's going to be much more difficult to get a specialist opinion for any of these things. It used to be that if a GP thinks you deserve a second opinion they just referred you, now they have to jump through all these hoops. If your GP can't argue your case strongly enough you could end up having to go private." Last week the New Journal revealed how the Royal Homeopathic hosptial in Bloomsbury is under threat because of the new rules. Cosmetic surgery, including treatment for alopecia (hair loss) and correction of some facial deformities, are deemed inappropriate for NHS provision. Under the new plans, GPs will have to justify all referral decisions to a panel and if unsuccessful, patients will have to either see a nurse or GP with specialist knowledge in their condition. Patients unhappy with this may turn to private medicine to get a second opinion. Summary by Keep our NHS Public of Camden New Journal 5 February 2007
• Don't operate on smokers and the obese, says Hewitt. Patients could be denied treatment because they smoke or are overweight, Patricia Hewitt has said. The Health Secretary insisted it was right for those whose lifestyle choices could make treatment ineffective to be refused care in some circumstances. It is the first time a minister has explicitly endorsed the controversial policy, which has already been adopted by some health trusts. Opposition MPs and some medical experts predict the move could encourage rationing of treatment for vulnerable groups, particularly when many NHS trusts are struggling to balance their books. Health trusts in Suffolk were among the first to announce that obese people would be denied hip and knee replacements on the NHS. The ruling was part of an attempt to save money locally. Doctors say the risks of operating on obese patients are higher and the treatment may be less effective, with replacement joints wearing out sooner. Smokers could also be denied heart bypasses on similar grounds. But Dr Colin Waine, chairman of the National Obesity Forum, questioned the criteria being used to judge the appropriate weight for surgery. He said some trusts were denying surgery to those with a body mass index of over 30 - around one in five adults. "This is nothing less than a cop-out, frankly," he said. "There is absolutely no evidence that people should be refused treatment if they have a body mass index of 40 or below. Turning down hip or knee replacements for those people has no scientific basis whatsoever. In fact, some of them - because of their arthritis in hips or knees - can't actually exercise to help themselves lose weight. So you are really dealing them a double whammy by denying them an operation that would help them to get healthier." Miss Hewitt insisted the Government wanted to see people taking greater personal responsibility for their health. A British Medical Association spokesman said: "We would not want to see blanket rules. What about people who diet down from a body mass index of 40 to a BMI of 30 - would they still be denied surgery ?" Summary by Keep our NHS Public of Mail 12 February 2007
• Doctors who ban surgery for smokers are right, says Hewitt. Patricia Hewitt, the Health Secretary, has given her blessing to the policy of denying operations to smokers until they kick the habit. Endorsing a position adopted by some health trusts, the minister also voiced support for doctors who order patients to lose weight before treatment. However, she added that it would be "dreadful" to deny treatment on the basis that patients were to blame for their condition. Hip and knee replacements are among the operations likely to be denied to those who are overweight, while smokers could miss out on heart bypasses. The Health Minister's views on the issue, which mirror those of a growing number of medical experts, are based on what she describes as "best practice" - because operations are less likely to be successful when the patient is very fat or a heavy smoker. However, some doctors have expressed concern that the stance could be used by some NHS trusts as a means of saving money, while others have questioned the criteria that will be used to judge an appropriate weight for surgery. Summary by Keep our NHS Public of Telegraph 12 February 2007
• Shock as doctors admit to ageism. Doctors in Britain regularly discriminate against older patients by denying them tests and treatments they offer to younger people. GPs, heart specialists and doctors who care for the elderly were all found to be influenced by a patient's age when making their recommendations -and older doctors were more likely to discriminate than younger doctors. The study in Quality and Safety in Health Care, a specialist publication from the British Medical Journal, found that half of doctors in each of the professional groups treated elderly patients differently. Prof Ann Bowling, of the department of psychology, at University College London, led the study. She said: "Resources are limited and doctors have to make difficult decisions. Maybe they have run out of options and are using age as an excuse. When we spoke to the doctors they were quite ready to justify their reasons. They may see older people as less deserving". Summary by Keep our NHS Public of Telegraph 14 February 2007
• Drug firms urged to stop blocking blindness cure.  Hewitt wants NHS to get treatment used elsewhere.  Expensive alternative costs £1,000 a shot. The health secretary Patricia Hewitt has taken the unprecedented step of telling two drug companies that are blocking a cheap cure for blindness from use in the NHS that they should put it through clinical trials and seek a licence. Ophthalmologists in the US and the rest of Europe are successfully using a bowel cancer drug called Avastin, split into tiny doses, to save the sight of thousands of people with a common condition that quickly leads to a loss of vision. The injections can cost as little as £10 and often only a couple are needed to treat the illness, wet macular degeneration. But Genentech, the manufacturer, and Roche, which markets it in the UK, will not put the drug through the trials necessary for it to get a licence in the UK. Instead, Genentech has produced a far more expensive version called Lucentis, which costs more than £1,000 a shot and needs monthly injections. Lucentis recently got its European licence and is now being appraised by the National Institute for Clinical Excellence. But the bill to the NHS, if it is approved for general use, will be huge. According to consultant ophthalmic surgeon Michael Lavin from Manchester Royal Eye Hospital: "If all patients with wet AMD in the UK were treated with standard dose Lucentis costs to the NHS by year two would be approximately £1,008m a year; if Avastin were used the cost would be about £4m a year.  Sarah Boseley, health editor Thursday February 15, 2007 The Guardian
• NHS 'Postcode lottery' fails boy. 'RIDICULOUS' health chiefs have been accused of playing 'postcode lottery' after refusing a youngster's potentially life-saving treatment. As already reported in the Advertiser, Warwickshire Primary Care Trust has turned down a £7,500 application for an epilepsy-treating device for 13-year-old John Love, of Smeaton Lane, Stretton-under Fosse. The application for the Vagus Nerve Stimulator - which could help alleviate John's severe drug-resistant condition - was deemed by the PCT as lacking 'cost-effectiveness'. However, in a letter to the group, John's consultant, Dr. Sunny Phillip, said every single PCT in the West Midlands requesting the treatment for the past three years had been granted.  Rugby Advertiser 15 February 2007
• Stopping needless operations could save £100m, says London Health Observatory. Stopping unnecessary operations could save London's NHS almost £100m, according to new research. The London Health Observatory has studied 34 selected procedures for which the clinical case is sometimes debatable, and drawn up 'access criteria', which would sharply restrict their use. Its report found 'significant and unexplained variation in planned surgical care in London for procedures where there is evidence that service access criteria should be in place'. Summary by Keep our NHS Public of Health Service Journal 15 February 2007
• Patients denied cancer treatment. Up to a third of patients who want one of the latest treatments for cancer at a Derby hospital are unable to get funding for it on the NHS. Derby City General Hospital is one of only five UK hospitals offering the high-intensity ultrasound procedure for prostate cancer. People from all over the country have taken advantage of patient choice and visited Derby for the treatment. But others have missed out as their local primary care trust will not pay. Summary by Keep our NHS Public of BBC Online 28 February 2007
• Health chiefs 'restrict treatment'. A survey of health chiefs for the Health Service Journal has found that trusts are closing wards, delaying operations and withholding treatments in an effort to break even. 73% of primary care trusts are restricting access to treatments, half are delaying operations and 61% of acute trusts are closing wards. Almost one in eight acute, primary care and mental health trusts are operating recruitment freezes with almost half have already made, or intend to make, redundancies. Despite the moves, government figures published last month show more than one in three hospitals expecting to record a deficit. The deficit will be offset by those trusts making a surplus and funds held back for expenditure on such things as education. The survey reveals Patricia Hewitt as the least popular health secretary in the last ten years with a score of 4.4 out of ten. Summary by Keep our NHS Public of Chester Chronicle 1 March 2007
• IVF treatment in England a lottery, MP says. Couples in England struggling to conceive face a postcode lottery over whether they qualify for fertility treatment on the NHS, an MP said today. The eligibility criteria for free IVF vary widely across England, with some local health trusts refusing to provide any fertility treatment, according to survey by Grant Shapps, a Conservative. Many of the primary care trusts that run local health services are not following guidelines on the provision of IVF set by the National Institute for Clinical Excellence (Nice). Nice decides the treatments that are available on the NHS. But Mr Schapps said the Department of Health's "muddled" approach to the guidelines, along with record NHS deficits, were leading couples to seek IVF in areas of the country other than where they lived. Staff and agencies Friday March 2, 2007 Guardian Unlimited
• GPs slam delay on brittle bone drugs. 'Treatment blight' hits millions as Nice waits five years to issue a ruling. Thousands of women with the brittle bone disease osteoporosis have been denied the necessary drugs to ease their condition because the medical debate about the most cost-effective treatment has taken five years to complete. Sufferers in some areas have been faced with 'treatment blight' - the reluctance of doctors to prescribe drugs because no decision has been made by Nice, the independent body that decides which drugs can be used. Fewer than 500,000 of the three million people with brittle bone disease have received drugs that reduce their chances of sustaining a fracture, according to evidence assembled by the National Osteoporosis Society. 'The upshot must be that more patients will have suffered broken hips than were necessary because some of the patients that might have had their bone density improved haven't been able to get hold of drugs,' said a spokesman. Nice is finally due to reveal its findings tomorrow, although it is expected to impose age conditions on treatment. Critics have warned that this is likely to force the NHS to spend even more than the existing £1.73bn a year on treating the affects of osteoporosis when a course of drugs that costs as little as 27p a day can reduce the risk of fracture by up to half. Denis Campbell, social affairs correspondent Sunday March 4, 2007 The Observer
• Trial not error: Sophie Petit-Zeman on how rules on drug trials can prevent GPs finding the best treatments. When you take your rash to the GP and he prescribes a cream, do you wonder why he's chosen that one? Assiduous doctors will trawl the evidence to be sure they're giving the perfect treatment for your ailment. Others prescribe what they've sworn by for decades, or something brand new and touted as state-of-the-art. Cynics might suggest that a refreshing conference in Monaco paid for by the drug company and a pen flashing a product name as the doctor reaches for the prescription pad will be as close as some get to evidence-based judgment. The truth is, most clinical decisions are based on a mix of education and experience. Sir Iain Chalmers, a medic and guru of evidence-based medicine, spoke of a much more uncomfortable truth at a recent Economic and Social Research Council conference: doctors may not know what best to do because the evidence isn't there. Tuesday March 6, 2007 SocietyGuardian.co.uk
• NHS doctors 'gagged by a culture of fear'.  BMA survey of consultants finds many under pressure. · More than half say cuts or targets halting treatments. The British Medical Association accused the government yesterday of instilling "a culture of fear" across the NHS to stop doctors revealing how health service reforms are putting patients' lives at risk. The BMA surveyed senior consultants in hospitals throughout England and found 56% knew of clinically effective treatments being withdrawn by their NHS trust to save money or comply with policy directives. John Carvel, social affairs editor Wednesday March 7, 2007 The Guardian
• Health reforms abandoned due to lack of funds, say hospital doctors. Eight out of 10 hospital consultants in England initiated changes aimed at improving patient care during the past year, according to a British Medical Association survey. But six out of 10 (61%) say planned services had been abandoned or delayed, and 41% reported that patients were now waiting longer for some treatments or procedures. More than half (56%) said that they or their colleagues were also having problems because clinically effective treatments or procedures were no longer available or were restricted. More than 260 lead consultants took part in a snapshot survey carried out by the BMA, which is gathering evidence of the effects of government reforms as part of its "Caring for the NHS" campaign. Doctors were asked for views on key government health policies, including patient choice, independent sector provision and Payment by Results. Summary by Keep our NHS Public of British Medical Journal 9 March 2007

• Trust scales back many minor operations. Croydon's Primary Care Trust is slashing the number of minor operations it carries out in a bid to save money and resources. Surgical procedures such as hysterectomies, grommet installation and varicose vein treatments have been reduced by the PCT. New criteria has been set out by the trust which mean treatment for complaints such as tonsilitis will not be routinely available through GP referrals. Procedures will still be offered to patients where evidence shows it would be "of benefit" and the new arrangements - which have already been implemented - will not affect people who need specialist care, a PCT spokesman said. Dr Tim Crayford, medical director and director of public health at Croydon PCT, said: "It is, in part, due to money but it is more about wasting money on treatments that will not be beneficial to the patient. This does not mean it will be more difficult to get referrals. Neither does it mean people will have to wait longer for referrals, just that patients will be offered procedures if it will benefit them. If we have two treatments which do the same thing but have different costs we should be obligated to choose the cheaper one. We are, after all, a publicly-funded body." Cosmetic surgery may only be offered if there is an adverse physical side-effect to the complaint such as impaired vision, which could rule out birth marks and other skin complaints where a patient may benefit emotionally or mentally. Croydon PCT has reviewed its policy - called Clinically Effective Commissioning - along with other trusts in south west London following guidance from the National Institute for Health and Clinical Excellence. Summary by Keep our NHS Public of Croydon Guardian 9 March 2007

• NHS 'reforms' are not helping patients, say hospital doctors. Senior hospital doctors believe that major NHS reforms, such as payment by results and Patient Choice, will fail to improve the service patients receive, according to a British Medical Association survey. The poll of 265 consultants in England will be worrying for the government, coming at a time when ministers hoped to regain clinicians' backing for their reform programme. The survey showed they have much work to do to reduce doctors' scepticism - 53% said PBR would worsen or considerably worsen patient care. Only 11% said choice would improve patient care, while a third believed moving care out of hospitals and into the community would result in better services. Independent sector provision would make patient care poorer, according to 72%, while 58% said they had examples of patients being adversely affected by a national initiative. More than half (56%) said they or their colleagues had experienced problems because clinically effective treatments or procedures were no longer available or restricted. BMA consultants' leader Jonathan Fielden said senior doctors were implementing better services for their patients - 81% of respondents had initiated service improvements in the past year. However, their efforts were being hampered by funding constraints and poorly thought through government policies. 'The government is wasting millions of pounds on health reforms that have not adequately involved senior doctors and consequently fail to benefit patients,' he said. 'Consultants are going the extra mile to bring down waiting lists only to be told to slow down and be less productive. Meanwhile, work continues to be diverted away from NHS hospitals to under-performing independent sector providers at greater cost. Plans to increase recruitment or buy new, modern equipment are being put on hold or abandoned because of a lack of money.' He added that many of the doctors who took part in this survey felt unable to speak out openly. 'There is a culture of fear in the NHS and doctors are under severe pressure to meet targets and keep their mouths shut. Doctors want to