Thursday, October 14, 1999 Published at 16:50 GMT 17:50 UK
Trust defends itself from rationing claims
Mental health campaigners claim drugs are being rationed
A Sheffield health trust has defended itself against accusations that it is rationing drugs for the seriously mentally ill.
The National Schizophrenia Fellowship (NSF) says a leaked letter from Community Health Sheffield's chief pharmacist Peter Pratt suggests patients will not be allowed access to the latest treatments because of budget pressures.
He says that, if others decide to deny patients the drugs despite them having a clinical need, his system will make this clearer and will strengthen the argument for an increase in the mental health budget.
The letter, addressed to all psychiatrists in the trust, says the community drugs budget for mental health is "insufficient to meet the current expenditure".
It then proposes ways of restricting the use of newer, more expensive mental health drugs to those who have a clearly defined clinical need for them.
The older drugs are estimated to cost £98 per patient per year, compared with £2,000 a year for the newer ones.
The letter says the drug clozapine, introduced in the UK around 10 years ago, should continue to be prescribed for people who are currently using it for as long as they need it.
But new patients will need to have failed to respond to other treatments and have a strong clinical need for the drug.
If they have, their case will be submitted to the Mental Health Directorate with a request for additional funding to pay for the drug.
Mr Pratt says that, in 1% of patients, clozapine reduces white blood cells counts to dangerous levels, leaving people open to life-threatening infections.
This means patients on the drug have to have their white cell count monitored, adding to the expense of the drug.
The letter also states that other claims for new drugs will be submitted to a similar process to clozapine.
This includes olanzapine which the trust had previously agreed represented a clinical advance in the treatment of schizophrenia.
"Unfortunately, the financial pressures mean that we will change this position," says the letter.
The trust received extra funding for mental health drugs this year to make the newer drugs more widely available.
But Mr Pratt says this is still not enough because of overall pressure on the mental health budget.
Mental health campaigners say the newer drugs have fewer side effects than the older ones and are generally better tolerated by patients, making them more likely to stick to their drug regime.
Side effects associated with the older drugs include facial tics, acute muscle spasms and fidgety movements.
The NSF says the public often associates these with schizophrenia itself, increasing the social isolation of sufferers.
Mr Pratt says both old and new drugs have side effects and these are taken into account in deciding whether a patient has a clinical need for a drug.
"It is a balance between the advantages and the side effects," he said.
He added that eight out of 10 patients get some form of relief from any type of schizophrenia drug.
He believes that, because of its expense, clozapine should only be used for the two out of 10 who do not respond to any other drug and, even then, he says it only works in 50% of cases.
He also believes part of the side effects associated with older drugs is the result of overly high dosages being prescribed.
But he understands patients' concerns about rationing. "Mental health problems have always been at the bottom of the list," he said.
"That is one of the reasons we want to compile clear-cut evidence to support the newer drugs when and where they are clinically indicated.
"If rationing has to be done at least it will be clear on what grounds people are being denied the drugs."
The government's National Institute for Clinical Excellence is to consider the case for the newer schizophrenia drugs shortly.