Conservatives claim that national insurance freeze will save NHS £200m

By Dr. Ananya Mandal, MDApr 7 2010

The Conservatives have claimed that a halt in the Labour planned rise in National Insurance (NI) could mean £200 million in savings for the NHS and provide doctors more power to choose which drugs especially those treating cancer are made available.

At present these decisions are made by health trusts once the National Institute for Health and Clinical Excellence (Nice) has issued a recommendation on their effectiveness. Shadow Health secretary Andrew Lansley said that doctors should be the decision makers and wanted to deal with manufacturers for cost cuts. He said, "If people have a cancer [and] maybe some of the existing treatments haven't worked and their doctor, their specialist, says a particular new cancer drug should be provided for them, we believe that should happen." He continued that primary care trusts were budgeting for making increased NI payments. "It is a saving compared to where they expect to be," he said.

But John Appleby, from the King's Fund, said cash was "not there to be saved". Appleby said that the money would come from some other service funded by the annual budget, “The £200m they say will be needed to fund extra cancer drugs essentially has to come out of the current budget. That means stopping something else for other people… It's a ‘sleight of hand’ in the sense that the money is not there to be saved." He said that there was usually a lack of consensus between oncologists treating cancers who wanted to try out newer therapies and authorities who wanted to wait for approval regarding efficacy. He said that the Nice tends to approve most drugs anyway.

The King’s Fund however in a statement later made it clear that Appleby did not mean there was anything dishonest in the proposals saying, "If the phrase 'sleight of hand' used when commenting earlier today suggested this, he would wish to withdraw it."

According to Douglas Alexander, Labour's election coordinator, "There's no doubt that the Tory messaging has got headlines in recent weeks – they started the year promising austerity and tough action on the deficit, but having come under pressure they have now changed their tactics, with a series of improbable rabbits out of seemingly bottomless hats...In the last week, the Tories have promised to cut taxes for employers, for employees, for married couples, and even the NHS; they've promised new cancer drugs for anyone who wants them and a new programme to create an army of community activists; and all at the same time as they have kept up their rhetoric on cutting the deficit faster and deeper than Labour. The words are cheap but the cost to the British people will be staggering."

Dr David Jenner, a GP’s representative and policy adviser for the NHS Alliance which represents primary care trusts also supported this move saying that specialists deciding on which drugs to use and get funded from NHS especially for rare cancers was a good idea. However he said that funds for cancer needs to be justified. He said, "Expenditure on cancer drugs can be very high-cost, low-volume; [you are] spending a lot, sometimes to give people a few months' extra life…When it's not a bottomless pit you've got to see how many other procedures you could buy for the same amount of money, like how many hip replacements you could fund, how many educational programmes for diabetes, for example." He said GP’s need to be better equipped to diagnose cancer. Funds to that end may be beneficial.

Mr. Lansley continued to say that the party did not intend to spend more than £200m and more would not be needed. Shadow chancellor George Osborne said the pledge amounted to a "clear difference of priorities" from Labour and that the savings were not being "magicked from nowhere". He continued that, "This comes on top of our commitment to provide real increases to the health service budget... and our commitment to make sure that there isn't wasteful government spending in the NHS”. "I think it comes down to priorities. Do we want the money going on additional national insurance in the NHS or on new cancer drugs?" he said.