Some are criticising couples counselling on the NHS – but in these times it is sound social strategy

The Amanjit Jhund NHS column

The news this week in the world of healthcare has been dominated by another instance of the National Institute of Clinical Excellence (NICE) refusing to authorise the use of a potentially life-prolonging drug in cancer care.

I personally have no problem with the decision on medical grounds; I recognise that the NHS does not unfortunately have unlimited funds at its disposal and that priorities have to be set and a judgement made on a drug’s cost effectiveness to the NHS. None of this makes it any easier, though, on those patients who would potentially benefit from an extra few months of life if they were to be allowed access to Nexavar.

It has been estimated that the cost of supplying the 700 or so people in the country with liver cancer with Nexavar would be £7-9 million this would be expected to produce a median survival increase of 2.8 months.

It’s easy from numbers to make the argument that Nexavar is not a financially feasible drug for the NHS to provide, but it’s much harder to make that case to the families suffering with liver cancer, for whom 2.8 months can be an eternity. Even such a short extension of life is precious and can enable both the patient and family and friends to gain closure and help cope with a loved one’s death.

As I say I have no problems with the economics of the decision made by NICE but when you consider that this week it was announced that we would have couples counselling available on the NHS then it becomes a much more difficult argument to make. While the patients’ association have already hit out at the decision – with vice president Michael Summers remarking that “as things stand, people are still waiting for urgent treatment, being denied drugs for cancer and dementia, and it seems inappropriate at the very least to start using public money in this way” I am inclined to take a different viewpoint. On this matter, I and support Andy Burnham and the proposals to introduce relationship counselling on the NHS.

But with the current economic climate, some very difficult decisions are going to be have to be made as to the future of the NHS. Depression is one of the primary causes of sick leave and unemployment. Our current pharmaceutical bill for fighting depression stretches to £12 billion per year. As a profession, medics have to be honest about the fact that we have in the past tended to medicate first and talk later. These moves by the government represent a genuine attempt to alter this approach, to create a service that not only benefits the patient but also the NHS itself. In order to maintain the principle of free at the point of use we will have to take these difficult long term decisions in, to maximise the return on investment in the NHS.

It is very easy to attack proposals such as the free counseling but the theory is sound. An individual’s marital (or relationship) status is an independent predictor of both depression and suicide, especially for males. Relationship break-up is often a triggering factor in the serious consequences of depression, from suicide attempts to self harm. By providing this service to patients we can help them through this difficult period in their life.

In turn, by helping couples stay together or to separate amicably we will help to reduce the number of incidents of depression in society. This will potentially have enormous benefits not just to the patient or the NHS but also to society as a whole, as we look to prevent what can often be an invidious cycle leading to unemployment and an increased burden on the state’s already limited resources.

In many ways, we have to consider that the £186 million Improving Access to Psychological Therapies (IAPT) fund, which is being used for such talking-based therapies, is an investment. If we invest it shrewdly then we may reap massive rewards in terms of the health and fiscal benefits.

This is an emotionally charged issue. But if we want to be able to offer treatments such as Nexavar in the future then we must take those difficult decisions today that will allow us to operate the NHS in a more efficient manner.

It is and will be a difficult argument, but it’s one that we must make.