THE Welsh Government will next month be called upon again to create a Cancer Drugs Fund like that in England, to pay for treatments not usually paid for by the NHS. Health reporter ANDY RUTHERFORD looks at opposition to, and support for, the idea and how 'people power' is keeping the issue on the political agenda.

APPROPRIATELY perhaps, the National Assembly for Wales will debate funding for cancer treatments on November 5.

The fireworks the debate is likely to ignite may be metaphorical, but the issue is very real for patients at the sharp end of decisions about whether the NHS will or will not fund the cancer treatment they and their doctors believe may benefit them.

The November 5 debate will be preceded by the handing over of a petition that by then may have attracted more than 100,000 signatures.

Intended for health minister Mark Drakeford, its request is simple: Give all cancer patients in Wales access to a cancer drugs fund.

Its organiser is Julie McGowan, from Usk, its inspiration her friend Ann Wilkinson, a bowel cancer patient whose application to receive the potentially life-prolonging drug Avastin was initially turned down earlier this year.

Though she was subsequently granted three courses of Avastin, another application is required after three months for further treatment, with no guarantee of success. Yet had she lived in England, the drug would likely have been available through the UK Government’s Cancer Drugs Fund set up in 2011.

Established to pay for cancer drugs not approved by treatments regulatory body NICE (National Institute for Health and Care Excellence), or that have not yet been evaluated by NICE, it is worth £280 million a year and will run until 2016.

Wales does not have a Cancer Drugs Fund, the Welsh Government consistently refusing to bow to pressure to introduce one.

All NICE-approved medicines are routinely made available for patients in England and Wales, and the All Wales Medicines Strategy Group (AWMSG) also appraises and decides medicines’ availability.

In Wales, Individual Patient Funding Requests (IPFRs) can be made for new treatments not appraised or approved for NHS use, if a patient and their doctor feel they will benefit because of exceptional circumstances.

With the NHS in Wales under scrutiny - some would argue attack - as its role as political football is exploited by opposing parties on either side of the England-Wales border, a Cancer Drugs Fund has become a key issue in an increasingly venomous debate.

It also highlights that the NHS in Wales, 15 years after devolution, is an increasingly different service to that in England and how, whatever the pros and cons of such a fund, the perception of a postcode lottery has developed.

The very fact a Cancer Drugs Fund can exist in one part of the UK but not another creates a situation where in some areas but not in others, certain drugs will be made available to treat certain cancers.

NICE and AWMSG have necessarily high profile roles to play in treatments regulation, and the Cancer Drugs Fund in England does make available some drugs to patients there that are not available to patients in Wales.

The Welsh Government however, has issued figures highlighting that AWMSG has to date appraised 19 cancer medicines covering 23 clinical circumstances, with all 19 routinely available to eligible patients. Only nine of these drugs, it claims, are available in England through the Cancer Drugs Fund.

To date, AWMSG has also, says the Welsh Government, appraised 22 medicines ahead of NICE, 14 of which have been for cancer medicines.

The latest cancer drug cleared for use on the NHS in Wales is Abraxane, for patients with metastatic pancreatic cancer.

The Welsh Government emphasised that the decision means Wales is the only part of the UK where Abraxane, a chemotherapy drug, is now routinely available on the NHS.

It may be that under England’s Cancer Drugs Fund Abraxane would be made available for patients who requested it - speeding up the process for those with limited time while NICE makes a decision.

But the differing timescales to which the various regulatory bodies work also creates, albeit often temporary, inequality in medicine availability - a shifting postcode lottery.

SUCCESSIVE health ministers in Wales have defended the stance of not setting up a Cancer Drugs Fund.

Back in May 2012, then health minister Lesley Griffiths told AMs such a fund would not improve the health and well-being of cancer patients in Wales.

“Any money put into such a fund must be taken away from the treatment of other serious and potentially life threatening conditions, as is the case in England,” she said.

“We, collectively, have a duty of care to all citizens in Wales and this unfairness conflicts with our core values.

“There is no evidence a Cancer Drugs Fund improves the quality of life or survival rates of patients. The available evidence shows survival is closely linked to early diagnosis and also to timely and high quality surgery and radiotherapy.

“Countries with high levels of access to cancer drugs do not always demonstrate high survival rates.

“A Cancer Drugs Fund would undermine the world renowned work of NICE and AWMSG, and creat unacceptable inequalities in our health system.”

It is a stance that at least partly reflects the differing political values of the Labour-run Welsh Government and its Tory-Lib Dem Coalition counterpart in England, but also alludes to the financing of the NHS in Wales, the budget for which has not been ringfenced as it has in England.

Professor Drakeford, Mrs Griffiths’ successor, is equally firm in his opposition to setting up a Cancer Drugs Fund.

“To do so would prioritise cancer over other life threatening conditions and divert money away from medicines which are proven to work,” he said.

NHS expenditure figures released earlier this year showed that the spend per head on cancer care in Wales was £117.41 in 2012/13, £10 more than in England, and Professor Drakeford said investment is being made in clinically effective cancer treatments with a proven evidence base.

WHEN Julie McGowan began her petition for a cancer drugs fund for Wales earlier this year, she hoped it would attract 1,000 signatures.

That it has now reached more than 97,500 is a reflection, she believes, of the unfairness of her friend Mrs Wilkinson’s position regarding treatment for her bowel cancer.

“It struck a chord with so many people that the petition escalated,” Mrs McGowan told the Argus last week.

“People believe that having paid into a UK National Health Service all their lives, they are going to get equal treatment when they really need it, and then are shocked to discover that it’s not the case.”

After an initial refusal, Aneurin Bevan University Health Board has approved an IPFR enabling Mrs Wilkinson to receive three courses of Avastin, appraised by NICE for use in the treatment of certain cancers but not for routine NHS use in England or Wales.

The health board’s decision was a relief, but Mrs Wilkinson is angry that others might not be so lucky.

“I still have to go through the process of applying for more treatment at the end of three months, with no guarantee of success,” she said.

Other patients across Wales have had similar experiences. One was Pamela Northcott, from Denbighshire, whose daughter Kate Spall set up the Pamela Northcott Fund seven years ago during a protracted battle to get her mother the cancer drug she needed.

Mrs Northcott has since died, but her daughter has subsequent lobbied for improved access to a drug for kidney cancer patients and now runs the Why Not Wales? campaign, calling for a Cancer Drugs Fund here.

She also supports patients’ battles for cancer drugs funding across the UK.