Dear Sir,

Thank you for your email of 7 April to the Department of Health about funding of anti-tumour necrosis factor (anti-TNF) drugs for the treatment of ankylosing spondylitis. 

I was sorry to read of your health problems.  I can appreciate how anxious you must be to ensure that all possible options for treatment are explored.

As you are aware, three anti-TNF drugs (adalimumab, etanercept and infliximab) have been referred to the National Institute for Health and Clinical Excellence (NICE) for appraisal.  NICE issued a Final Appraisal Determination (FAD) to consultees in November 2007.  NICE received two appeals against aspects of the FAD issued as part of its appraisal.  These were heard on 31 March.  Subject to the outcome of these appeals, NICE expects to issue final guidance to the NHS shortly.

I should point out that the Government is not prohibiting the use of these drugs on the NHS while final guidance from NICE is awaited.  When a patient is being treated by a hospital, the consultant can arrange for the supply of any drug or other substance, even one not normally available on NHS prescription, provided the Primary Care Trust (PCT) or NHS Trust agree to supply it at NHS expense.  The consultant would, in those circumstances, have to retain clinical responsibility for the patient while prescribing the drug in question.

However, although the NHS budget is at record levels, it is not infinite.  Some of these treatments cost thousands of pounds, so NHS bodies must find a balance between funding expensive drugs for a limited number of patients and providing services and treatments that will benefit many.

In December 2006, the Government re-issued best practice guidance to the NHS, which states that it is not acceptable for the local NHS to cite a lack of NICE guidance as a reason for not providing a treatment.  The Department made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable, therefore, doctors can prescribe anti-TNF drugs without NICE guidance if they believe these are the right treatment for their patient.

The responsibility for local health services lies with the local NHS and it is for PCTs in conjunction with Strategic Health Authorities (SHAs) and other local stakeholders to plan and develop services to meet the needs of their local populations.  As such, it is not appropriate for Ministers to intervene in local decision making.  However, PCTs should not refuse to fund treatment solely on the grounds of cost but should consider all the circumstances before making a decision.

You may therefore wish to contact your local SHA.  Contact details for SHAs are available at www.nhs.uk.

The availability of these medicines in Scotland is a matter for the Scottish Executive which makes its own decisions.

I hope this reply is helpful

Yours sincerely,
 

Customer Service Centre