By Peter Littlejohns, Professor of Public Health, King’s College London, Deputy Director CLAHRC South London<\/p>\n
It seems a long time ago but the House of Commons rose on Thursday the 25th July for its summer recess they returned on the 3rd<\/sup> September. \u00a0Politically this was always considered the silly season as MPs disappeared for their summer holiday and the vacuum was usually filled with unpredictable news stories. I remember it well as back as in August 2008, NICE launched its negative guidance for renal cancer (I remember David Cameron had promised the Renal Cancer charity that he would sort it).\u00a0 http:\/\/news.bbc.co.uk\/1\/hi\/health\/7544927.stm<\/a>\u00a0\u00a0 With everyone else from NICE on holiday I remember having to explain the QALY<\/a> to Evan Davis on the Today Programme and why there is a moral imperative for the NHS to challenge the Drug Industry on the prices they set. \u00a0Cameron\u2019s promise resulted in the creation of the Cancer Drugs Fund. The initial version soon ran out of cash and a new approach was developed which is administered by NICE and NHS England. While not as morally dubious as the first version it still has to prove that it can be sustainable in the long term. \u00a0https:\/\/www.thelancet.com\/journals\/lanonc\/article\/PIIS1470-2045(16)00100-5\/fulltext<\/a> What still remains a challenge is ensuring that these high profile schemes\u00a0 do not take NHS money away from equally deserving but what I have called \u2018hidden patients\u2019 https:\/\/blogs.kcl.ac.uk\/clahrc-south-london\/2018\/10\/18\/portrait-of-a-hidden-patient\/<\/a>. This continues to be an active ethical debate. While at NICE I always felt (probably because of my initial clinical background) that knowing the individual patient makes a difference. I remember many heated arguments with eminent professors of Health Economics and Public Health who said that it was irrelevant. Neither side was able to convince the other.<\/p>\n Well seven years after leaving NICE I was just about to face the dilemma again. Sunday 28th \u00a0<\/sup>\u00a0July saw me travelling to a celebratory BBQ for Professor Paul Cosford near Milton Keynes. Not a birthday or a wedding anniversary but to celebrate that modern healthcare had once again rewritten the rules – Paul was still alive two years after being diagnosed with terminal lung cancer. The Medical Director of Public Health\u00a0 England\u00a0 https:\/\/publichealthmatters.blog.gov.uk\/author\/paul-cosford\/<\/a> having lived his message of non-smoking, moderate exercise and good diet found he could not finish his long charity cycle race and investigation revealed he had\u00a0 succumbed to a supposedly \u2018life style cancer\u2019. Yet despite the poor prognosis modern drugs (through the Cancer Drugs Fund) are having their effect and he is alive today and quietly resolute. Responding to Dylan Thomas\u2019s \u00a0hope about his own \u00a0father that he would\u00a0 \u2019not go quietly into that good night https:\/\/www.youtube.com\/watch?v=NlvAW2RIvXo<\/a><\/u><\/p>\n Paul is using every opportunity to highlight two issues. The first being the public health issues around the potential cause of his disease https:\/\/www.thetimes.co.uk\/article\/pumping-out-dirty-fumes-is-worse-than-smoking-around-children-fs958tmw3<\/a>\u00a0 We will be responding to his challenge when the new NIHR funded Applied Research Collaboration is established on the 1st<\/sup> October. There will be a Public Health and Multi-morbidity theme which will be developing new interventions aimed at community action on air pollution and healthier streets to foster active travel, both within an evaluative framework<\/p>\n