It looks to me like the wheels are coming off. I'm talking about the cancer drugs fund. Effectively it has halved the number of treatments it covers because it is overspent.
The present fund was started by the Prime Minister and has been in trouble since the off. There have been rows about what drugs should and should not be included. Big Pharma getting airyated, patients getting upset... horrible.
Then; there's the application process. Groan. As if having a rare cancer isn't worry enough, patients are put through the palaver of getting their consultant to make application to the fund.
It is an atrociously stressful process. Asking for permission to live another six months. The decision handed down by someone who will never look you in the eye and tell you why they said no.
Set up in 2011 because none of the really expensive drugs could satisfy NICE's value for money requirements and the Government found the criticism from the tabloids unsustainable; originally it was the interim cancer drugs fund.
In 2010, each SHA was funded, from a total of �200m pa, to kick it off. By 2014 it was overspent by �30m. In 2014 another �80m was added; the fund just kept running out of money.
In 2014 the FT attacked the fund as 'populist'. In 2015 York Uni research concluded it was poor value for money. The drugs are often new, eye wateringly expensive and little more than experimental.
Last July the NHSE's independent cancer task force said the fund was no longer sustainable or desirable.
That's all well and good until it's your Mum, your daughter, your husband or you. How can you put a price on an extra six months to see your daughter married, your son graduate, put your affairs in order and say goodbye.
What's to do?
Think what you like about big-pharma; greedy, fat-cats and all the rest. The fact is unless Prime Minister Jeremy Corbyn nationalises them, we are where we are. Most of us have a pension fund, that is probably, in some way, dependent on pharma shares. We have to grow up a bit.
We have to figure out smarter ways to sort this mess out.
We need R&D and new, effective medicines. In the last ten years average bed-stays have halved. Partly because of medical technology and in large measure, better drugs.
There might be a solution. We have to start with the fact that modern drugs take years and years to develop, clinical trials get more difficult as the cohort of patients they can recruit gets smaller and harder to find.
As soon as they discover a new molecule Pharma has to register a patent, in case it shows promise. The clock is then ticking and they have 20 years to bring a safe drug that works, to market.
It can take 14 or 15 years of that patent period to finesse a new drug, meaning the company has 5 years to amortise its R&D and marketing investment that could run to $2.5bn. And don't forget; no profits... no more investment in R&D and no next generations of drugs.
In the meantime, if you happen to be strumming your guitar one day, or tinkling a piano key board and come up with a great song, you can copyright it for 50 years.
Popular song protected for 50 years, lifesaving drug, 20 years. Errr?
If we gave pharma the same protected period as a song, giving them longer to recover their investment, it might mean drugs would come to market at more manageable prices.
I can hear the howls of abuse and argument: yup companies might cheat; they make enough money out of us already and blah, blah. It's not a perfect solution.
However, if the Prime Minister was looking for something to renegotiate in his EU package, a reworking of European patent law, for drugs, might benefit all countries... not just us.
What's the alternative? Tax breaks for competing pharma companies who share R&D> An anonymised repository of undevelopable molecules that someone might, later, be able to take on and make useful?
Or we could set up a cancer drugs fund....
