HEALTH PRIORITISATION FILMS

 Prioritisation decisions can affect the health of  patients, the public or whole communties. They can occur outside the heath services for example when the environment becomes polluted affecting peoples health or within  health care when services are commissioned or de-comissioned or expensive drugs are  available or not on the health service. These decisions need to be open to scrutiny and challenged if found to be suspect. This section of the website directs you to a series of films and videos illuminating the issues

We invite you to send in your own videos or tell us about informative ones that you have come across

Films on access to expensive drugs

USA

UK

The role of the Institute for Clinical and Economic Review  (ICER) in the USA

ICER, the Institute for Clinical and Economic Review, is a non-profit research organization that evaluates evidence on the value of medical tests, treatments and delivery system innovations. ICER was founded over 10 years ago with an ethical goal in mind:  to try to provide a fair and objective analysis of evidence as the starting point for bringing all stakeholders—patients, doctors, drug makers, insurers, and others— together to seek better ways to help patients gain sustainable access to high-value care. They aim to help create a health care system in which innovation is rewarded fairly, but without breaking the bank, so that all patients will be able to benefit from the very best treatments at a price they can afford.

  “The lottery of Devolved Cancer Care”

 

          (this is the 20 minute version)

 there is 40 minute version with more patient interviews:

  

 

 

 

 

The film uses variation in access to expensive cancer drugs in the four home countries of the UK (health care is a devolved responsibility for England, Wales, Scotland and Northern Ireland ). It is based on the circumstances that led a cancer patient Irfon Williams moving from Wales to England to get his treatment.  He established a charity to raise the issues of differential access to treatment. Irfon died 3 months after being interviewed and before he could see the final film but Becky his widow said on viewing it "I think it is beautifully filmed and thought provoking to those who are outside this bubble of cancer treatment ".  His autobiography is coming out in April.

 

 

 

 

 In the film he highlights very specifically that he accepts that not all treatment can be available but considers that a fair process needs to be in place.  If this was the case then he feels that patients, even if they did not receive their treatment, would accept that priority setting is inevitable. This is an aspect that was not covered at all during the many hours of news coverage of his circumstances and will be used to raise awareness of the need for public participation in these processes.  

Films on Public Health issues where profit has been prioritised over the public health

Environment Films from Peru

Alavaro Sarmiento was born in 1982 in Peru, and is a filmmaker, screenwriter and producer. He is Founder of HDPERU, an independent production company focused in the defense of native peoples’ rights and environmental conservation in the Andes and the Amazon of Peru.

Alvaro's film: “CERRO DE PASCO: DEEP GRAVE” 

 

Synopsis: Everyday, Cerro de Pasco citizens suffer the impact of lead in blood, TNT explosions, and other abuses of the Peruvian mining enterprise Volcan. As a consequence of the mining, the city and its 80,000 citizens need to be relocated to another area while the company will continue its operations on top of their homes and buildings.

Alvaro's film: “LA OROYA: FULL METAL AIR”

Synopsis: The inhabitants of La Oroya Antigua (Junin, Peru) daily breathe the gases emitted by Doe Run Peru, an American refinery for heavy metals. 
Children and expectant mothers are the most vulnerable to the effects of leads and other gases including metals.


These films are available to view by students on the KCL Masters in Public Health course

https://www.kcl.ac.uk/study/postgraduate/taught-courses/public-health-mph.aspx

 

and the new Online MSc and Diploma in Public Health course

https://www.kcl.ac.uk/study/postgraduate/taught-courses/public-health-msc-pg-dip-pg-cert.aspx

The Aberfan Disaster was the catastrophic collapse of a National Coal Board colliery slag tip in the Welsh village of  Aberfan near MerthyrTydfil on 21 October 1966. The tip slid down the mountain above the village at 9.15 am, killing 116 children and 28 adults as it engulfed the local junior school and other buildings in the town. The collapse was caused by the build-up of water in the accumulated rock and shale tip, which suddenly slid downhill in the form of slurry.

Films demonstrating how the public can participate in difficult  health prioritisation decisions

This is how specialised services are commmisioned in the NHS in the UK

Specialised services support people with a range of rare and complex conditions. They often involve treatments provided to patients with rare cancers, genetic disorders or complex medical or surgical conditions. They deliver cutting-edge care and are a catalyst for innovation, supporting pioneering clinical practice in the NHS. For a quick overview of specialised services watch  this animation.

 

These services include a range of treatments, from interventions that most of us have heard of, such as chemotherapy, radiotherapy and kidney dialysis, through to pioneering procedures that are currently only carried out in small numbers, such as using a patient’s own tooth to restore their sight, and hand transplants. We also support trials of treatments, such as PrEP (Pre-exposure prophylaxis, a drug to prevent HIV), and an evaluation of mitochondrial donation, a form of IVF in which the future baby’s mitochondrial DNA comes from a donor egg to avoid passing on inherited diseases.

There is a legal duty to fund certain new medicines and devices recommended by the National Institute for Health and Care Excellence (NICE), but there is also available additional funding each year for other new treatments. 

For these new treatments,  complex decisions  have to be made about which represent the best value for patients and taxpayers.  There is a  duty to ensure that new treatments are supported by convincing evidence of safety and effectiveness, that they are affordable and offer value for money, and that decisions about them are fair and transparent. Doctors, other healthcare professionals, and patient and public representatives are involved at every stage of this decision-making process.

See the 2nd video on how new interventions are prioritised.

Visual Article of research into end of life care in the UK

When deciding which treatments publicly funded healthcare systems should provide, medicines that extend terminally ill patients’ lives are among the most hotly debated – particularly for advanced cancer. The National Health Service (NHS) spent an estimated £17 billion on medicines in England in 2016-17, roughly 13% of its budget. This was up from £13 billion in 2010-11, with the medicine bill currently increasing at over 5% a year as new drugs get ever more expensive. Underlying this is a controversy many people probably aren’t aware of. The relevant authorities – the National Institute for Health and Care Excellence (NICE)) in England and Wales, and the Scottish Medicines Consortium (SMC)) north of the border – take a more generous approach to approving end of life drugs than all other drugs. Yet according to our research, most people are not in favour. This raises searching questions about why it happened and what to do in future.

Send  me your film or video

The more films that we have the more we can understand how we can improve health prioritisation 

ABOUT WEBSITE

This website was developed as part of a Rockefeller Academic Residency  in February 2018 by Peter Littlejohns. It  collates the research endeavors of the Social Values Group that was a joint venture between Kings College London and University College London and the research  programme supported by the Collaboration for Leadership  in Health and Research Care South London funded by the National Institute for Health Research in the UK. It features vistas of the Bellagio Centre to celebrate that man made structures can enhance rather than detract from the natural environment

For more information contact Professor Peter Littlejohns

peter.littlejohns@kcl.ac.uk

Peter is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) at King’s College Hospital NHS Foundation Trust. The views expressed on this website and research articles are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The first workshop was supported by the Wellcome Trust and Nuffield Trust and the second workshop by the Brocher Foundation 

Website designed February 2018 at the Rockefeller Foundation  Bellagio Centre by Peter Littlejohns as his Residency Project