Tuesday, 11 March 2014

Politics: Is the Australian healthcare system better than the NHS?

Australia has sorted-out healthcare rationing and universal healthcare. Can the NHS do the same? #MSBlog #MSResearch

In response to a post on Fampridine last week and the following comment from Helen Scott:

Helen ScottThursday, March 06, 2014 12:29:00 pm

'In Australia, it has been possible to trial Ampyra, known as Fampyra here for four weeks free. This is effectively sufficient time to ascertain whether this drug will work for the individual - as the reported data suggests around 35% of MSers will benefit. I took the drug for the four week trial, and yes, I am one of the fortunate persons for whom this drug was very successful, it did increase my walking speed by a measurable 25%. I could not attest to any benefit for fatigue. What I did observe, curiously, was a return to sharper vision in one eye that was a little blurry. Biogen makes this drug cost prohibitive for most MSers in Australia, around $600 per month. There is a current application before our Pharmaceutical Benefit Scheme to have Fampyra this listed on this scheme, which will reduce the price to around $5.90 for concession card holders and $33.00 for non concession.

So, you may ask - what has happened to those of us who have successfully completed the trial and cannot afford the $600.00 per month? Solution - a number of our neurologists are prescribing scripts for the active ingredient 4-aminopyridine in slow release which we source from compounding pharmacies who make up the scripts. There are slightly more risks with the variability in compounding, but for me, I sourced an excellent pharmacy that made me a dedicated batch for six months supply for $96.00 whilst awaiting PBS listing. I trialled the Fampyra in November -December and commenced the compounded version immediately after the Fampyra limit was exceeded. I am happy to report that I have not found any difference in function between the Fampyra and the compounded 4-aminopyridine.'


"The same scheme is available in the NHS and the following form is the one you need to get your neurologist to agree to sign."




In signing this form, I understand/acknowledge that:
  1. I will be initially prescribed and supplied with up to 4 weeks of Fampridine, during which my response to treatment will be assessed.
  2. Fampridine (including delivery) will be provided free of charge by Biogen-Idec for the initial treatment period (up to 4 weeks), and that I will be responsible for any additional costs imposed by local groups/bodies (such as, but not limited to; dispensing fees, tariffs, duties, etc.).
  3. Should I not respond to Fampridine, treatment will be discontinued.
  4. Should I respond to Fampridine and wish to continue with therapy after the initial treatment period (up to 4 weeks), I understand that, as a private patient, this will be by private prescription for which I will be required to pay.
  5. Biogen-Idec has no involvement in, or funding responsibilities beyond, the supply of Fampridine during the initial treatment period (up to 4 weeks).
  6. My physician has explained this process to me and I have had the opportunity to have any questions answered fully.
  7. I agree that my personal details can be shared with the homecare delivery company for the purpose of supplying Fampridine.
"This private access scheme for fampridine, and a similar one for Sativex, is the catalyst for our ongoing debate on private prescribing in the NHS. The founding principles of the NHS are that it is free at point of access and equitable, i.e. it does not matter who you are (rich or poor) you will have the same level of care under the NHS. These access schemes, or the change of policy that allowed them, destroys both these principles in one foul swoop. If you respond to the fampridine trial you will then have to pay for the drug privately. As you are essentially receiving the prescription for the drug via an NHS clinic, and being monitored in the NHS, the principles of your healthcare being free at point of access and equitable don't exist."

"If you are interested in this debate you may want to read our previous posts on private prescribing in the NHS and the results of our survey on this topic. As a consultant who looks after MSers I am in a quandary; I look after individuals with MS and I am obliged to do the best I can for them. At the same time I work in the NHS and cherish its values. As a nation it appears we can't afford the NHS any more. It is changing so fast that I am preparing myself for a two-tiered system of haves and have-nots. It is clear from what the politicians are saying, or not saying, is that universal healthcare is too expensive to maintain in this time of austerity. It is a great pity that the coalition government didn't tell us this when they allowed private prescribing in the first place. I suspect they want to privatise the NHS by stealth. I also suspect that there is cross party consensus on this as none of the major parties made a noise about it. I suppose the threat of bankruptcy focuses the mind and in this case policy as well."

"Please note that Australia has a two-tiered healthcare system in place and there are tax incentives in place to encourage the wealthy to receive their healthcare in the private sector. The system also allow individuals to take their state-funded, or NHS money, into the private sector to cover a proportion of the healthcare costs. What the private sector is doing is essentially topping-up the what the state is prepared to pay for healthcare. This allows the country to afford universal healthcare. The Australian system acknowledges the need for rationing at a state level, but also the need for a basic level of universal healthcare. It does mean there is a difference between what you can access based on your income. I suspect this is what Whitehall Mandarins, and the political parties, want in the UK. The survey results below support this. May be you disagree?" 



A selection of related posts of interest:
  1. Multiple Sclerosis Research: Access to fampridine in England
  2. Multiple Sclerosis Research: Private prescriptions within the NHS
  3. Private prescribing in the NHS - Multiple Sclerosis Research - Blogger
  4. Survey results: private prescribing in the NHS - Multiple Sclerosis ...
  5. Politics: the Birth of the NHS....Is the Death of the NHS Coming?

9 comments:

  1. Prof G, it is clear from your comments on your recent visit to Australia that you are impressed that Australian neurologist have access to all the DMTs as first-line therapies. Is this why you think Australia has a better healthcare system than the NHS?

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    1. RE: ".. you are impressed that Australian neurologist have access to all the DMTs as first-line therapies. Is this why you think Australia has a better healthcare system than the NHS?"

      Yes, I am impressed. It means that you can treat-2-target of NEDA, In the UK we are not allowed to switch, and/or escalate, on MRI activity, but only clinical activity and the latter in the case of natalizumab has to be two disabling relapses in a 12 month period. We are simply letting MSers down; we are watching smouldering MS shred the brain. I have no doubt that MSers in Australia will do better than MSers in the UK. This is why we need to get our proposed NEDA study done ASAP so that we can show NICE and NHS England why we need to treat this disease eraly and aggressively.

      We are hosting our first UK NEDA meeting this Friday. I am hoping we can all agree to get behind the proposed study. The following post explains it:

      http://multiple-sclerosis-research.blogspot.co.uk/2014/01/clinic-speak-treat-2-target-of-neda-vs.html

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  2. I wholeheartedly support your campaign to treat early and aggressively. At the moment I feel quite well but I know I am sitting on a time bomb.
    With regards to Fampridine, I don't have many walking issues at the moment, heavy leg feeling sometimes but my main MS issues are balance (slight) and visual. Would someone like myself with relatively minor (at the moment) symptoms benefit from Fampridine? Would it prevent further nerve damage?

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  3. I understand that in the UK it isn't possible to have the active ingredient in Fampridine prescribed by a neurologist (or anyone else?) in order to have tablets made up as described by Helen Scott, and which is also happening in Holland. Would you please explain why this isn't possible, and what the objections to doing so are.
    Thank you, I'd really appreciate it as currently, yes, I am paying for Fampridine.

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    1. If there is a licenced drug then neuros have a duty to use it. But should we been getting 4-AP on the agenda? In austerity Britain it would seen a logical thing to do. However as pointed out in my ramblings on friday, have the authorities the will to do this? Do any neuros have the spine to do this? (or do they know better) and have the authorities thought how to do this?. Probably no is the answer otherwise the NHS would not have been sued by big pharma for trying to save money?.

      There needs to be a solution and one such approach is the Big Pharma Alternative....Maybe this will invigorate ProfG. By re-inventing old drugs as has been done with Movecrotro, tecfidera, laquinimod and Fampryra it exposes the fact that the cheap generic parent drug will do the same thing. What is a barrier to using this things maybe tthings such as licencing-Insurance and as for chemical supply it needs to be from a reputable source where drug is manufactured to exacting standards as contaminating compounds could have disastrous side effects.

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    2. Re: "I understand that in the UK it isn't possible to have the active ingredient in Fampridine prescribed by a neurologist (or anyone else?)..."

      It is illegal in Europe to prescribe and unlicensed version of a drug when there is a licensed version. I am not sure if the Dutch formulating pharmacies are still plying their trade? I had heard that they had been threatened with legal action, similar to the ones doing this in Switzerland. You have to remember that there is a quality issue with formulating 4-aminopyridine. There was a case in Canada who nearly died due to persistent problems with the formulation. The EU rules are there to protect patients from exposure to poor quality drugs and to protect pharma industry to make sure they can make a profit from their drugs. The EU vision is a healthy Pharma industry is a healthy drug pipeline and hence healthy EU citizens in the future.

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    3. Ok, thanks for your explanation. When you are not a practising doctor/neuro it is not part of everyday experience to know these things. It would just be helpful to pay 'usual' prescription charges rather than £190 every 4 weeks. It sounds like you are saying that the way Fampridine is formulated is as safe (as 'usual') but that when made by other pharmacies it is not necessarily as safe, is that right?

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    4. Pharma have to spend alot of money to ensure that their drug falls within tight and defined limits as part of its quality control, non-legitimate sources could cut corners to cut costs and maybe the impurity profiles may differ between differnt batches

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    5. Thanks all for your explanations re Fampridine

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