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Reform of cancer drugs fund must consider benefits to patients

5 February 2016

A fund set up to improve patients' access to cancer drugs has not been managed effectively, the Public Accounts Committee has found. In its report, the Committee also says it is "unacceptable" that the government is still unable to properly assess the benefit to patients of the Cancer Drugs Fund.

The Government established the Fund in 2010 to improve access to cancer drugs that otherwise would not be routinely available on the NHS.

The Committee finds that while about 80,000 people have received drugs through the Fund, "the Department of Health and NHS England do not have the data needed to assess the impact of the Fund on patient outcomes, such as extending patients' lives, or to demonstrate whether this is a good use of taxpayers' money".

Questionably effective buying power

It questions whether the Department and NHS England are using their buying power effectively to pay a fair price for cancer drugs, and calls for clarity over the extent to which regional variations have been reduced "so that people across the country have equal access to the Fund".

The Committee concludes:

"NHS England overspent the Fund's £480 million budget for the two years 2013–14 and 2014–15 by £167 million. The cost of the Fund grew from £175 million in 2012–13 to £416 million in 2014–15, an increase of 138% in two years, but NHS England did not start to take action to control the cost until November 2014.

There is agreement that the Fund is not sustainable in its current form and NHS England and the National Institute for Health and Care Excellence (NICE) are currently consulting on proposals to reform the Fund from April 2016.

We expect NHS England, in making changes, to take account of our recommendations and apply the clear lessons from the last five years to ensure that the new Fund is managed better in the future."

Put in place clear objectives

The Committee's recommendations to government, set out in detail below, include putting in place "clear objectives" for what the reformed Fund aims to achieve.

It urges NHS England to "be prepared to take tough decisions to ensure that the Fund does not overspend" and the Department to "set out how it ensures that it pays a fair price for drugs and that the limit in the Pharmaceutical Price Regulation Scheme provides value for money for the taxpayer".

Regarding health benefits, the Report calls on NHS England to report back to the Committee by June 2016 "on what the available data indicate about the impact of the Fund on patient outcomes".

Chair's comment

Meg Hillier MP, Chair of the PAC, said:

"Cancer is a devastating disease. More than one in three people in England are expected to develop it in their lifetime and its impacts will affect the lives of many more.

Against this backdrop the Cancer Drugs Fund has enabled thousands of people to receive drugs not normally available to them through the NHS. While this is welcome it's also clear the Fund requires significant and urgent reform if it is to be sustainable.

A vital step in addressing the financial challenges must be to properly evaluate the health benefits of drugs provided through the Fund.

If cancer patients seeking its support are to get the best possible treatment then there must be confidence that public money is being spent on the right medication, and at a fair price.

We will be closely monitoring the progress made by the Department and NHS England in the months ahead."


All cancer drugs must receive a marketing authorisation, confirming their quality, safety and medical effectiveness, before they can be prescribed by NHS clinicians. For drugs to be available routinely to patients on the NHS, they must also be recommended by NICE, which appraises their clinical and cost-effectiveness.

The Government set up the Cancer Drugs Fund in October 2010 to improve access to cancer drugs that have not been appraised by NICE, are still being appraised by NICE, or have not been recommended by NICE because they do not meet its clinical and/or cost-effectiveness thresholds.

£1.27 billion lifetime budget

The Fund was initially managed for the Department of Health by the then 10 strategic health authorities, and expected to run until March 2014, with a total budget of £650 million. Since April 2013, the Fund has been managed by NHS England. 

In 2013, the Government extended the Fund until March 2016. The Fund now has a total lifetime budget of £1.27 billion. In April 2015, 39 cancer drugs, covering 67 different licensed uses (which are called indications), were available through the Fund.

Report summary

Survival rates for cancer patients in England have generally been worse than those in other high-income countries in Europe, mainly because patients in England tend to be diagnosed later and have poorer access to treatment.

In the last five years about 80,000 people received drugs through the Fund. However, the Department of Health and NHS England do not have the data needed to assess the impact of the Fund on patient outcomes, such as extending patients' lives, or to demonstrate whether this is a good use of taxpayers' money.

Further information

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