We’ve had news today that NHS England and the government are taking steps to make the Cancer Drugs Fund more sustainable and operate smarter. This includes an additional £80 million per year being added to the fund, taking some drugs off the fund, negotiating with pharmaceutical companies to link price more closely to effectiveness and using data from the drugs funded to inform the National Institute for Health and Care Excellence's decisions in the future.

What is the Cancer Drugs Fund?

When the coalition Government took office in 2010, they promised to reform the system to ensure that all patients can access the drugs and treatments that their doctors think they need. As a temporary measure, they established a £200 million Cancer Drugs Fund,  to allow patients in England to access drugs that have either been rejected or not yet assessed by the National Institute for Health and Care Excellence (NICE).

Drugs available through the Cancer Drugs Fund are assessed by a panel of expert clinicians and patient representatives and are approved according to their clinical effectiveness, not cost effectiveness. There are currently 80 drugs or indications (some drugs are used for multiple types of cancer, known as ‘indications’) available for use on the Cancer Drugs Fund, including six drugs for breast cancer. Drugs can and have been rejected for use on the Cancer Drugs Fund, but they are rejected because the clinical evidence is not strong enough to recommend their use, not on the basis of cost.

The Cancer Drugs Fund was introduced in 2010 and was originally due to expire in March 2014. However, in September 2013 Prime Minister David Cameron announced that the fund would be extended for a further two years, guaranteeing the security of the fund until March 2016.

Is the Cancer Drugs Fund beneficial?

There’s no doubt that the Cancer Drugs Fund is providing real benefits to patients who are currently accessing treatments that they wouldn’t have otherwise had access to. However, nothing is perfect and the Cancer Drugs Fund certainly has its flaws.

Firstly, it’s only available to patients in England. Patients in Wales, Scotland and Northern Ireland can’t access drugs available through the fund. In Scotland there is a different system of drug appraisal which is still bedding in – we are waiting to see whether the new system will allow drugs that NICE have rejected to be used on the NHS in Scotland. However, the authorities in Wales and Northern Ireland usually follow NICE recommendations but also have no way of accessing the drugs available in England through the Cancer Drugs Fund.

Secondly, £200 million a year is a lot of money. But it’s not enough. Cancer drugs are increasingly expensive and the Cancer Drugs Fund is now overspent. Latest data suggests that the fund overspent by £40 million last year and is predicted to overspend by even more next year. And that’s without adding any more drugs to it.     

And finally, it’s time-limited. The Cancer Drugs Fund is due to expire in 2016 and currently there are no plans, from the government or the opposition, to extend it or replace it with a system that will guarantee access to cancer drugs in the future.

What does today’s news mean for patients?

The changes announced today are an attempt by NHS England to make sure that the Cancer Drugs Fund operates within budget and can continue to allow patients access to the most innovative new medicines at a price that the NHS can afford.

Much of the success of the plan relies on the pharmaceutical industry agreeing to offer their drugs to the Cancer Drugs Fund at reduced prices. There are some incredibly expensive drugs available through the Cancer Drugs Fund that are also incredibly effective. We very much hope that the manufacturers of these drugs will be able to be flexible on their pricing as it would be a travesty if patients were denied access to very effective drugs simply because of cost. NICE has been forced to reject drugs based on cost for some time and the Cancer Drugs Fund was implemented to allow patients access to these drugs. If the Cancer Drugs Fund is also forced to make decisions on the basis of cost, it would appear that the sticking plaster solution is starting to peel off.

What next?

While this is certainly a positive step for the Cancer Drugs Fund, it does not solve many of the problems with access to drugs:

  • Patients in Scotland, Wales and Northern Ireland still cannot access the drugs available through the fund
  • The fund is still due to expire in 2016
  • Pricing of new drugs is out of control and not sustainable for the NHS

Here at Breakthrough, we’re going to be working with other charities, the government and NHS England to make sure that we have a sustainable system that allows breast cancer patients to access the best possible treatments at a price that is acceptable to the NHS, now and in the future.