NHS refuse to fund drug treatment for mother

May 6 2008 by Chris Robinson, The Journal

A TERMINALLY ill mother is facing an agonising wait for the third time as she fights for life-enhancing treatment rejected by health chiefs.

Karen Gault, who has incurable bowel cancer, has been told by bosses at North of Tyne NHS that she is not an “exceptional case” for drug Avastin.

The 44-year-old, who lives in Jesmond, Newcastle, is appealing for the treatment in the hope of extending her life so she can spend more time with husband Paul and three-year-old daughter Grace.

The couple have been forced to pay for the drug themselves, so far raising £36,000 through constant fundraising, after initially not being able to receive it through the NHS. They have enough money to fund the treatment until July.

Health body the National Institute of Clinical Excellence (Nice) refused to fund the treatment on the NHS, saying the drug was not cost-effective.

The move meant Mrs Gault was classed as a private patient and no longer able to receive even standard treatment free.

The couple pay £4,500 a month for the treatment, including chemotherapy drugs, blood tests and scans as well as surgery.

Last night Gateshead Council engineer Mr Gault said: “We are still in negotiations and are hoping to get another appeal. The first two stages of the process, we were told that we weren’t going to get it.

“It has been absolutely treacherous. It’s not a very transparent process. In a way, even though we seem to be working a way through the process, we are still in the same position as last September.

“We are very fortunate that people have helped us and are extremely fortunate and very grateful that at the moment she has the full treatment.”

The couple, of Jesmond Dene Road, have been told twice by North of Tyne NHS that Mrs Gault’s application has failed because she is not classed as an “exceptional case”.

Because they have funded the treatment themselves, the NHS now deems its former employee to be a private patient and will not fund the chemotherapy and drugs she was receiving before starting the £25,000 Avastin treatment last November.

Father of one Mr Gault, 48, said they have fallen into the trap of “co-payment”.

He added: “Karen is doing reasonably OK, physically she is fine.

“It is still the waiting game. She has had her ups and her downs and has had quite a lot of infections because her immune system has been compromised.

“We could make a legal challenge but like us, most people in our circumstances can’t afford to do that. We would have to pay and that money could be spent on a another month’s worth of treatment. What do you need to be ‘exceptional’? Their argument is that it is not value for money, but how do you put a value on someone’s life? These drugs are frontline treatment in most European countries and in Canada and America, and we are supposed to be one of the most advanced countries in the world.

“We’re just trying to be as realistic as we can and hope that they see sense.”

A spokeswoman for NHS North of Tyne said it could not comment on individual cases.

She added: “The decisions about funding cancer drugs are always very difficult and we accept how distressing it is for patients and their families when funding is not available in the NHS for particular drugs. However, when approval hasn’t been given by Nice for particular drugs, we have processes which we follow to consider, very carefully, individual requests by patients.”