AA Gill, the award winning writer and restaurant critic who died on Saturday of cancer aged 62 was denied cutting edge treatment that could have prolonged his life, as the NHS deems it too expensive.
Writing about his experience of being diagnosed with what he described as the “full English” of cancers in his final article, Gill revealed that he was denied immunotherapy, the “biggest breakthrough in cancer treatment for decades”, because of the cost to the NHS.
Gill’s consultant told him that the treatment was “particularly successful” with his type of cancer, adding “If you were in Germany or Scandinavia or Japan or America, or with the right insurance here, this is what you would be treated with.”
The treatment costs around £60,000 – £100,000 a year for a lung cancer patient, about four times the cost of chemotherapy. Unfortunately, the National Institute for Health and Care Excellence (Nice), which rules on which treatments to offer on the NHS, has deemed the figure too high for NHS patients.
“What Nice doesn’t say about the odds is that immunotherapy mostly works for old men who are partially responsible for their cancers because they smoked,” Gill noted.
“Thousands of patients could benefit. But old men who think they’re going to die anyway aren’t very effective activists. They don’t get the public or press pressure that young mothers’ cancers and kids’ diseases get.
He added: “As yet, immunotherapy isn’t a cure, it’s a stretch more life, a considerable bit of life. More life with your kids, more life with your friends, more life holding hands, more life shared, more life spent on earth — but only if you can pay.”
Although diagnosed privately, paying for his x-rays, Gill had previously declared that he was determined to be treated on the NHS. “What I always look for is the spark of human connection in everything, and that’s one of the reasons why I’ve always wanted to be in the NHS,” he told the Times in November.
Yet in his final article he confronted the fact that the UK lags behind other European countries in international oncology rankings.
“The NHS has one of the worst outcomes for cancer treatment in Europe,” he wrote.
“It was the first question I asked my oncologist, Dr Conrad Lewanski. “Why is this such a bad place to get cancer, when we have lots of hospitals, when we teach doctors from all over the world, when we’ve won more Nobel prizes than the French?”
““It’s the nature of the health service,” he says.”
As GPs are separate from hospitals, the system creates a series of delays. Waiting times for a GP appointment are at least a week and last on average seven minutes; If the GP decides the patient’s symptoms do require a specialist opinion there is a further month’s wait to see the consultant, or two weeks if cancer is suspected.
Further appointments, for tests, x-rays, scans, can add “months” to a diagnosis.
“It’s not the treatment, it’s the scale of the bureaucracy and the Attlee-reverential, immovable-but-crumbling structure of a private-public doctor-consultant arrangement, which was the cornerstone laid down by the 1945 government at the insistence of doctors,” Gill wrote.
Eventually Gill opted to take the immunotherapy treatment privately, but to the end remained wedded to the idea of the NHS.
“The NHS represents everything we think is best about us.
“We know it’s the best of us. The National Health Service is the best of us. You can’t walk into an NHS hospital and be a racist. That condition is cured instantly. But it’s almost impossible to walk into a private hospital and not fleetingly feel that you are one: a plush waiting room with entitled and bad-tempered health tourists.”