Thank you for your post John and the same to those of you who replied. Your post was timely because on Sunday NHS England (NHSE) confirmed that second allogeneic stem cell transplants for relapsed disease will no longer be what’s called ‘routinely commissioned’.
As some of you may know, the NHS is an internal market composed of buyers and sellers. In this case the buyer (technically called a commissioner) is NHSE and the seller would be one of the hospital Trust specialist units that undertakes stem cell transplantation in England. What NHSE is saying is that they are no longer prepared to pay for second transplants.
This means a specialist unit would have to secure agreement from the hospital (Trust) they are part of to internally fund a second transplant or, alternatively, a doctor could attempt to secure funding via what’s called an Individual Funding Request (IFR) but to do so would have to demonstrate his/her patient was ‘exceptional‘ in that their particular profile was so unusual that it clearly differentiated their patient from the group they would normally be associated with.
Meeting this requirement is almost impossible especially since the initial screening of applications is not undertaken by doctors with expertise in this area of medicine but by those who manage this part of the healthcare system.
Since the overwhelming majority of hospital Trusts are in deficit the possibility of their agreeing to internally finance an expensive procedure they will not be paid for is highly unlikely and almost unimaginable.
This particular saga has dragged on since early summer when it was first announced. In the interim NHSE lost a legal challenge about another decision it made and, as a consequence, decided to re-run the decision making process (usually called the annual prioritisation round) that resulted in its initial decision not to pay for second transplants.
I spoke to someone yesterday from the Anthony Nolan who, amongst other activities, manage the largest (transplant) donor registry in the UK and who have taken the lead role in putting the patient group and patient perspective to NHSE and he said they would make another attempt to persuade NHSE to rescind its decision.
If that were not successful they would attempt to secure a reversal of the decision for children and young people whilst also participating in next year’s (2017/18) prioritization round to reinstate commissioning for all ages.
You are correct John about treatments increasingly not being judged to be affordable. A key driver for this is that the UK population is growing in size, especially in England, as is demand for healthcare and the more so as the age groups who make the greatest demand on healthcare are growing in size at a faster rate than other groups.
Unfortunately budgets to pay for that healthcare have not increased at the same rate. Over the next few years, the proportion of our national income that we set aside for healthcare will fall from its already distanced state from that of equivalent European economies.
So we should expect to see more healthcare service reductions over the next few years.
I should stress that first allogeneic transplants for CML patients, who do not respond or who are persistent poor responders to TKI therapy, will continue to be routinely commissioned and I cannot envisage there being any change to provision of this service other than a possible reduction in the number of specialist units offering it.
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