A year ago, the Health Commissioner, who works within the office of the Ombudsman, published a “Final Opinion” entitled “Entitlement to the Free Supply of Medicinals under the Social Security Act.” The document exposes gaps in the distribution of medicine which need to be addressed.
In my work as shadow minister for health, I have come across several similar cases to those exposed by the Health Commissioner.
One of the main concerns in this field is the interpretation of which patients are entitled to a specific medicine. Along the years, protocols have established the entitlement rights of a patient. After reading the report, and from my contact with patients, I can say that there are serious anomalies in the system which need to be addressed meticulously and urgently.
Such protocols and criteria are (and should be) established by the competent health authorities. They should always be driven by the fundamental criteria already established by the Health Act.
Primarily these criteria should consider the impact on the patients and other guiding principles, which include: international evidence, health technology assessments, consultation with relevant stakeholders, capacity within the public health system, social and epidemiological considerations, and affordability and sustainability.
It is not just one but all (repeat: all) of these criteria taken together which must determine if a patient is entitled to a particular medicine.
In his report, the Health Commissioner clearly mentions examples which should have been considered throughout this year. Unfortunately, we have not heard anything from the government on the outcomes of these (and other) cases.
Take one example. Glargine insulin, which is a type of human insulin indicated to improve glycaemic control in patients with type-1 or type-2 diabetes, was introduced in our country under the previous government. It was indicated strictly for patients with type-1 diabetes, namely children and young patients who needed a better insulin regime than the one they were using at the time.
The Health Commissioner points out that, in one of the cases published in the report, a consultant diabetologist certified that a type-2 patient needed Glargine insulin because the other types of insulins “failed to control him adequately.”
Of course, the costs to administer Glargine insulin are higher than the costs to administer other types of insulin. The obvious question here is, “What are the long-term costs for treating this patient?” Should we stick to the existing protocol and allow this insulin to be used only by patients with type-1 diabetes?
In my opinion, we should assure ourselves that this patient (and possibly others like him/her) needs this insulin now and this decision will save our NHS costs which will definitely arise in the future.
The effects of mismanaged and uncontrolled diabetes can lead to any (if not all) of the following consequences: cardiovascular disease, nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), foot damage and much more. We must consider the costs of curing these consequences which are so much bigger than the treatment of the patient using the insulin which, according to the official protocol, he/she is not allowed to access.
According to the Health Commissioner, “once the medicinal is available within the health service provided by government and is indicated for the patient’s condition, the department is wrong in insisting to give it only to Type 1 diabetic patients on the basis of a protocol which is not based on purely medical considerations and which in effect deprives the patient of his entitlement under the Social Security Act.”
Of course, I look forward to what the government has to say about the Health Commissioner’s report and the outcomes of the cases indicated, even if we have already waited for a year.