Access to treatment
Some bowel cancer treatments haven’t been approved for use on the NHS (in England, Scotland and Wales) or the Health and Social Care service (in Northern Ireland). Your cancer specialist can apply for funding for a treatment if you both agree that you would benefit from it but they will have to show that your circumstances are exceptional. This page describes the application process for each nation in the UK.
Applying for treatment funding can be a difficult process and it’s not always successful. If your request is turned down, you may find the decision difficult to cope with. Macmillan Cancer Support has information on what you can do if a treatment is not available. One option may be to find out if there are any clinical trials you can join.
The National Institute for Health and Care Excellence (NICE) reviews all new cancer drugs and makes recommendations for their use on the NHS. They will give one of five recommendations:
- Yes – recommended for use on the NHS
- No – not recommended for use on the NHS
- Only in research – recommended for use in a research study
- Optimised – recommended for a small group of patients to test
- Recommended for use in ‘Cancer Drugs Fund’
If the drug is given condition approval it will move into the ‘Cancer Drugs Fund’ (CDF) for up to two years while more evidence is collected (if the pharmaceutical company agrees). After this period NICE will review their decision and will make a final recommendation on whether the treatment meets the criteria for use on the NHS. Details of treatments funded via the CDF can be found on NHS England’s website. Speak to your specialist if you would like to apply for a treatment on the CDF.
If a drug is not routinely available on the NHS, your clinician may submit an individual funding request (IFR) for you. Your clinician will need to show that your clinical circumstances are exceptional, and that you might receive benefit from a treatment or service that isn’t routinely offered by the NHS. The NHS England website has a downloadable PDF factsheet on IFRs.
Cancer Research UK have more detail on the cancer drugs fund
The Scottish Medicines Consortium (SMC) decides whether treatments should be available on the NHS. If you and your specialist think you would benefit from a treatment or drug that hasn’t been approved by the SMC, your specialist can apply to the Peer Approved Clinical System (PACS) Tier Two Panel in your health board. If this request is turned down, your specialist can ask for the decision to be referred to the National Review Panel.
Full details on the National Review Panel can be found here, at NHS Healthcare Improvement Scotland.
NICE decides whether to recommend a treatment or drug for NHS funding. If NICE haven’t made a decision, the All Wales Medicines Strategy Group (AWMSG) will decide whether to make the drug available on the NHS. This decision could be changed if NICE produce guidance in the future.
You or your cancer specialist can apply to your Local Health Board for a drug that hasn’t been approved, if you both agree that you would benefit from it. This is called an individual patient funding request (IPFR). Your specialist will need to show that you have an exceptional need for the drug, that you will receive significant clinical benefit from the medicine or treatment and that it provides reasonable value for money. There is more information on the IPFR process in Wales available from the All Wales Therapeutics & Toxicology Centre website.
The Department of Health, Social Services and Public Safety looks at whether NICE has approved a drug for use in the NHS. They then decide whether to follow NICE’s guidance and whether to make the drug freely available in Northern Ireland.
If a drug isn’t funded, your specialist can apply to the Health and Social Care Board for you to have it. This is called an individual funding request.
Reviewed November 2019