Over at the joepublic blog on the Society Guardian’s site, medical student Alex has written a post titled ‘Expensive drugs on the NHS are not a right’, saying that

“Many things vex me about my chosen vocation. The unending exams, having to walk through bloodstains and armed policemen on my way into lectures in the morning, and the constant doom-mongering in the press are just a few. But what irks me most is the flood of litigious patients taking the NHS to court for refusing to pay for their medication. “ 

Who should pay for medications and even procedures is a contentious issue and one I hope I never have to battle, but fear I will. Alex continues

“There is usually a sob story attached, often ‘life-saving treatment’ or drugs essential for quality of life. May drugs cost upwards of £10,000. The NHS is not a bottomless pit of money and these patients seem to think it is. A line has to be drawn somewhere and it is indeed unfortunate if you are to be found on the other side of that line. But in the words of my consultant, “tough shit”.

The problem is that there are far too many people queuing up for extremely expensive treatment. There simply is no money to pay for them all, regardless of whether these drugs will save lives. If there’s no money, then there’s no money, end of story. The treatment might be the most important thing in the world to the patient, but that particular patient is not by any means the most important thing to me, the NHS or the country.”

This arrogant, ignorant attitude made me angry so I registered on the site in order to leave the following comment:

“Well you obviously don’t know much about NHS spending!

MY PCT’s priorities are to spend vast sums of money on things they think they can get quick results in league tables and waiting times lists with. Such as drug and alcohol abuse, smoking cessation and a roll-call of chronic illnesses that often have self-induced harm as a major factor (Diabetes Type 2, Smoking related lung diseases, etc).

They CHOOSE to spend their money on people who have spent their own money to ruin their health. If they then don’t have enough money to pay for drugs to save lives and restore quality of life to people who have been merely unlucky, then I think the patients have every right to sue.”

The important thing to the NHS is targets. And the Government likes to set targets for things that grab headlines. 1 million people stopping smoking is a headline; ongoing care given half a million people with chronic neurological illnesses is not. The Berkshire West PCT’s Commisioning Strategy may have neurological conditions as a priority when it comes to spending on long-term conditions, but it is running a poor third behind Diabetes Type II and COPD. They even forgot neurological conditions entirely when presenting their commissioing strategy on more than one occasion (I went to the talks). And long-term conditions is the poor cousin, in terms of spending priority, behind smoking cessation, drug and alcohol abuse and sexual health.

If the NHS cannot afford drugs for people with neurological conditions and other serious illnesses that people get through no fault of their own, then I consider it perfectly reasonable to effect them to spend less on people who have been doing their best to ruin their health. If they won’t then I consider they are failing the patients, so why shouldn’t they sue? Nicotinell patches are available in Boots, one session with a stop-smoking hypnotherapist costs a lot less than what most smokers spend on cigarettes in a year, WeightWatchers classes are available all over the place and there are numerous ways to get free condoms. If patients with neurological conditions (often the ones suffering in the cases Alex refers to) cannot get the medicines they need on the NHS, then not only do they have to pay the cost of the medicine if they are not to lose their functionality – aka quality of life, but functionality is what it comes down to – or even their life), but they would usually have to pay for appointments with private doctors. And these are often people who are unable to work or earn a good salary, through nothing more than their bad luck in developing a neurological condition.