My View, Dr Nick Tupper - balancing the health books

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In last week’s column I explained how the Clinical Commissioning Group has managed to reduce long waits for non-emergency operations in Doncaster by using private sector healthcare to support local NHS hospitals and give them a helping hand.

It’s always a difficult subject to broach as such moves are popular or unpopular depending on your particular view.

This week I want to stick with the theme of ‘dilemmas’ and how they can impact on the NHS in light of the breast cancer drug Kadcyla which has been in the news recently.

Campaigners are urging the manufacturer, Roche, to lower the cost of the drug, as NICE, which sets guidelines for the NHS, says the £90,000 it would cost to treat each patient is unjustifiable.

The drug can reportedly add months of life to women dying of breast cancer and the manufacturer says the price reflects the investment it has made through years of research.

It’s a conundrum. How much easier it would be if the NHS had an endless supply of money and other resources. Sadly it hasn’t, which makes managing the dilemmas all the more challenging.

Trying to be fair is not easy as fairness can be subjective, depending on how decisions impact on individuals. Dilemmas crop up all the time: should we, for example, spend more on infertility treatment to help create life or should we allocate more of our budget to cancer services to help people survive the disease and add years to their lives?

The stark reality is that the NHS cannot say ‘yes’ to every funding request it gets.

This year, the CCG I chair has been given a budget of £420 million to pay for the health services used by over 300,000 patients who are registered with a GP practice based in the Doncaster area.

That works out at roughly £1,400 for every patient and covers local hospital services, such as A&E, planned operations, prescriptions, community services like district nurses, and much more. We have to juggle and assess the competing priorities for funding and finish at year end without overspending and with enough funds in reserve to meet the financial obligations the Government sets us. It can be a bit like trying to land a helicopter on a postage stamp in a sandstorm, but we manage to do it through prudent management.

We have to commission - organise and pay for - services across a huge population and consider the greater good. We have to get the best healthcare outcomes from our limited funds while being fair and considered.

Looking ahead, the NHS nationally faces many difficult decisions in trying to bridge a projected £30 billion funding gap. The patient’s voice will become more crucial in helping NHS organisations like ours determine where funding should be prioritised. It won’t be easy as it it’s impossible to please everyone all the time, but we will try our best.

* Dr Nick Tuppper, Chairman, Doncaster clinical commissioning group