The politics of cancer care

I went on a date with an oncologist last night. Not a very good date – she showed no interest in me or what I do (‘you’re a blogger?’ she asked incredulously, as if I said I was a plate-spinner) – but she was quite interesting talking about herself and what she does. So I let her talk!

She told me that cancer patients get all their prescriptions free, as of 2009. This isn’t the case for patients with any other disease – heart disease, motor neurone disease, AIDS. Only cancer patients. Why is that, I asked. ‘Because Macmillan [the leading cancer charity] successfully argued that cancer is the worst thing that can happen to someone, so cancer patients should be treated differently to any other patients’.
In fact, if you are on benefits and can’t pay your prescriptions, you only have to pay £100 a year for all prescriptions, so under the new cancer prescriptions law, patients save £100, but it will still cost the NHS £13 million a year altogether. And it is built on the strange suggestion that cancer patients are somehow more stricken and more worthy of care than patients suffering from other serious illnesses.
How did this come about? Through lobbying. Macmillan is a very powerful organisation, with an income in 2010 of £133 million, of which £43 million comes from wills and legacies. And that, in turn, comes from a neat strategy that Macmillan pursues, of putting its own lobbyists and fund-raisers inside hospitals: they’re called Macmillan nurses.
Macmillan goes to NHS oncology departments and offers them the use of their specially-trained Macmillan nurses for free, for three years – as long as they are branded as Macmillan nurses. After three years, the NHS has to pay for the nurses themselves if they want to continue employing them, but they must still be branded as Macmillan nurses. Around 3,500 of the 6000 cancer nurses in the UK are branded Macmillan nurses.
This has a huge impact on Macmillan’s income. When a person survives the trauma of cancer, and has been cared for by a Macmillan nurse (even if that nurse is actually being paid for by the NHS), they typically leave a lot of money to Macmillan – it received £43 million in legacies in 2010.
All this income gives Macmillan a huge amount of lobbying clout. When lobbying to get cancer patients free prescriptions in 2008, Macmillan used nearly 1000 active campaigners, sent letters to 4,100 local newspapers, secured 474 pieces of media coverage, held 28 meetings with ‘public influencers’, and secured the support of 125 MPs in the ‘early-day motion’ in the House of Commons. The lobbying was actually nominated for an award at the Chartered Institute of Public Relations, and has since been held up as an example of ‘good lobbying‘.
But is it? I am sure readers in the UK will know of people who have been greatly helped by Macmillan nurses. But why should cancer patients be treated differently from any other patients, like those with Alzheimer’s, motor neurones disease, or schizophrenia – diseases where the patients are not necessarily in the financial or mental position to lobby, fund-raise or advocate for themselves as powerfully as Macmillan?
Is our health policy being distorted by the power of a non-governmental organisation, which acts to protect both cancer patients but also itself? ‘Most oncologists think the policy is nonsense’, I was told. ‘But no one’s going to stand up and say that.’
I know this is a very emotive area, and am not saying I know the answers – I am interested to hear your thoughts on this topic.

Comments:

  • shana says:

    This is tough, as it's hard to be against free medication and quality treatment for a particular illness, on the grounds that the same does not go for other illnesses (I'm also an American, which means the idea of ANY kind of institutional assistance with healthcare costs, for any reason, seems incredible and hard to argue against).
    But I see your point, and the dangers of healthcare costs being determined by the sort of free-market successes (or failures) of lobbying groups that form around particular diseases.
    Medical research is already structured in this way, to some extent, with funding directed toward diseases that have the best lobbying groups, 'awareness campaigns,' and celebrity spokespeople.
    Although I can't make a case against cancer patients receiving these treatments, the assumption or implication that cancer 'trumps' all other diseases and conditions is definitely troubling and problematic.

    sorry about the bad date, better luck next time :)

  • Anonymous says:

    thanks

  • Harry says:

    I have an actos bladder cancer and I am not loosing hope. With all the awareness campaign about cancer is what gives me strength. knowing what to expect and making plans for how to proceed can help make this stressful time easier.

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