Health budgets in the developed world are under pressure from an ageing population with greater health needs, increasing obesity, and the cost of new drugs and technologies.
Flash glucose monitoring by Free Style Libre has rightly been hailed as a major advancement in diabetic care for type 1 diabetes. A sensor in a patch measures glucose levels and patients can get glucose readings by scanning it with a mobile phone app. It avoids the numerous finger prick tests that a diabetic needs to make in a day and an provide continuous readings over 24 hrs thus illustrating the blood sugar control much more accurately than before. Patient can adjust their insulin requirements accordingly, However like most advancements it is expensive. It has been available on prescription privately. There was an outcry when Theresa May, who is a Type 1 diabetic was shown wearing it with many stating that it should be funded by the NHS so that those poorer than her could benefit.
Last month it was agreed the NHS should fund it. However most CCGs [clinical commissioning groups who are responsible for budgets in an area] will only fund it for those with poorly controlled insulin dependant diabetes, not other diabetics and some CCGs will not fund it at all. NICE [the National Institute of Clinical and Care Excellence] was set up to look at the evidence regarding drugs and technologies and to produce guidelines for their use. It takes into account the cost of such drugs or devices. If it meets NICE criteria CCGs are supposed to prescribe it. It was formed to achieve consensus on treatment and funding to avoid what is termed the postcode lottery. However as the rows over Freestyle Libre show, this has not really ended.
In all health systems there is not the money to cope with rising demands. There is a limited budget for the NHS and if more money needs to be spent in one area, it means less in another, unless taxes rise substantially. What gets funded by the NHS is often an ethical dilemma. The fourth pillar in medical ethics is the one of Justice which includes the fair distribution of resources. We usually state that the NHS should pay for peoples needs, not necessarily for their wants. Should the NHS pay for IVF – is a baby a need or a want, gastric bypasses for obesity, cosmetic surgery, Viagra? What do you think?