Access to new medicines is in the news and Audrey Birt blogs on a widening discussion.
“In the middle of difficulty lies opportunity” Albert Einstein
If I’m honest I have hesitated before writing this blog. Talking about access to medicines is politically something of a hot potato. And if there is, on the face of it, a difference between England and Scotland it’s a case of light the blue touch paper and stand well clear. But it’s important we explore the issues away from party politics but as a necessary question for contemporary health and social care. And this blog is my personal attempt to widen the discussion.
When we set up the Long Term Conditions Alliance in Scotland one of the first things we looked at was access to medicines and in particular prescription charges for those with long term conditions. There were huge anomalies with people with conditions like diabetes being eligible for free prescriptions (although not if treated with diet alone) whereas those with asthma or arthritis for example had to pay. I worked with Diabetes UK then but felt it was important to argue for a principle of equity. And when I then moved into the cancer field it similarly felt too simplistic and self-serving to only argue for better access to cancer medicines; having no appetite for a “my illness is worse than your illness” argument.
The return to free prescriptions in Scotland has created the opportunity for people to have better control of their long term conditions, with less angst ridden conversations at pharmacies, people no longer having to ask “which one is really necessary” when presented with the bill. Of course it’s controversial like any universal benefit. But ultimately if it has enabled people to self manage their condition better and that’s good news all round at both a personal and economic level.
So it is right that it shouldn’t be the individual who is concerned as to the cost of their prescription but while the prescriptions may be free, the treatments are not. We still hear tales that some people aren’t getting access to the treatments they need in an equitable way. How widespread this is, is very hard to know. I welcome that systems are being redesigned, especially being made more open and accountable. I welcome that debate is happening. But I wonder – are we having the right debate yet? Whatever the process is, one of the questions needs to be how much money is in the system to meet the need now and even more in the future?
Person centred healthcare means not only designing services around the person but also increasingly it’s about more and more personalised medicine too. The recent discussion about genetics and breast cancer is the tip of the iceberg of the discussion we need to have to understand the implications of personalised medicine. Targeted therapies mean they can be tailored to need but profits from the drug that benefits all are different from the one that benefits a niche group only. Is the impact on price therefore inevitable perhaps?
What does that mean for cash squeezed healthcare systems? Rather than solutions that rob Peter to pay Paul do we need to have the debate about how much we each are willing to invest in our health system? Person centred approaches mean that when people are fully informed about their options when the chips are down, they make different and individual decisions. One cancer patient declining treatment, prioritising their quality of life while another’s goal is to prolong life at any cost, giving them precious time. But we have new drugs in the wings for many people offering potentially fresh choices. And who of us will want to risk being denied the choice of treatment should the time of need come for ourselves- or those we love?
So are we willing to tackle this challenge in fresh ways? Are we willing to pose the difficult questions? Like exploring if we are willing collectively to pay more for our healthcare (and not in a way, like prescription charges, which simply charges for illness)? And are we willing to discuss an open approach to rationing as costs rise and what’s available to invest doesn’t? Would increased taxes for example be part of the answer to ensuring that the best care and treatment is available to all equitably? My prescription is: let’s have the real discussion we need to have, about how much as a society we are willing to invest, to change, to do differently in order to have world leading quality health and social care for all?