Whither the cancer drugs fund?
The Cancer Drugs Fund has been the subject of much debate in recent weeks following the decision by NHS England to limit the number of drugs which can be financed.
Demand grew as more drugs became available and the £200m of original annual funding was under severe strain. That has been increased to £280m but with a cap on the number of drugs which can be made available.
It has not been clear before now what might happen to the Fund, which is run for patients in England, after the 2015/16 financial year, the last in which firm financing has been committed.
Labour has now come out with a pledge, if elected in May next year, to continue the work of the Cancer Drugs Fund (CDF) but to rebrand it and include treatment such as advanced radiotherapy as well as drugs.
The annual budget, under Labour's plan, would be increased from £280m to £330m.
Labour's Andy Burnham argues that it is perverse for the CDF to pay for expensive drugs which are not available on the NHS but not treatments.
Labour that 40,000 cancer patients each year stand to benefit from radiotherapy which they don't currently receive.
But Labour 's plan raises the question of how rising demand can be met if the Fund is expanded to include treatments as well as drugs. Mr Burnham's extra £50m a year might be accounted for quickly and still leave oncologists and their patients feeling short-changed.
The funding for these cancer measures has come under scrutiny.
Labour wants to use a rebate from the pharmaceutical industry after a deal with the companies to cap the NHS medicines budget. But the Conservatives say the money has already been committed to the NHS. In other words, if Labour wants to re-direct it to the newly relaunched Cancer Drugs Fund, something else will have to be cut.
So what's the Conservative plan for the next parliament?
The Fund is of course David Cameron's baby, his personal initiative after taking office in 2010.
Government sources make it clear that Mr Cameron is committed to continuing the Fund from 2016 if he is still Prime Minister after the election. Technically, though, it is not yet a Conservative manifesto pledge.
All this begs a question - what do the pharmaceutical industry think? Some drug companies don't like the Cancer Drugs Fund. They believe the watchdog National Institute for Health and Care Excellence (NICE) should authorise a wider range of new drugs to bring availability of cancer drugs on the NHS into line with many other countries. Other pharma players are happy to do business with the CDF, aware that the prices they can charge are not controlled (though that will change when the restrictions take effect next year).
Another complication has just emerged.
I understand that the Association of the British Pharmaceutical Industry, the trade body for drug companies, is not happy that politicians pledge money from the rebate deal to specific schemes. They say the arrangement was for the money to be ploughed back into general front line NHS services. Their unhappiness is both towards Labour for earmarking cash for their Cancer Drugs Fund plan and the Government for increasing the CDF from £200 million to £280 million. Watch this space.