Cancer: the postcode lottery that saved Brian of SO42 and doomed James of CB2

IoS investigation: Drugs that can prolong lives are being denied to patients because of budget cuts and bureaucratic bungling

When James Tyndale and his wife first moved to Cambridge in the mid-1980s, he had no idea their choice of home would cut his life expectancy.

The chartered accountant is dying, at the relatively young age of 54, from a cancer of his bone marrow. If he had lived in another town, such as Southampton, Mr Tyndale* would have been prescribed a powerful new drug, Velcade, which could prolong his life for up to two years.

But Cambridge City Primary Care Trust (PCT) has so far refused to sanction the treatment because it would cost about £15,000. Unless it changes its policy on Velcade, he probably has several months to live.

His case is the latest example of the drugs rationing imposed by health trusts across the UK, reported last week in The Independent on Sunday, which determines whether cancer sufferers live or die.

In a letter to the IoS last week, Mr Tyndale put it simply: "It is appalling that patients whose thoughts should be focused on their treatment need to waste time worrying about how to obtain the drugs which will give them a last lifeline. For these vital drugs, we need countrywide consistency. "

If he had lived in the New Forest, next door to Brian Jago, another victim of multiple myeloma, he would now be getting Velcade on the NHS. Velcade is yet another new cancer drug which many Britons are being refused because of a lengthening backlog of vital treatments which are still to be cleared for routine use in the NHS. As a result, health trusts across the UK use this as an excuse for failing to authorise their use by local GPs and hospitals.

And in other cases, PCTs are even failing to prescribe drugs which are already cleared for routine use, claiming they cannot afford to. Mr Tyndale is a victim of the "postcode lottery" affecting thousands of cancer sufferers nationwide.

The drugs crisis has been worsened by spending cuts at the main agency which authorises all new drugs, the National Institute for Clinical Excellence (Nice). After an outcry over the backlog last year, a number of cancer drugs are now being "fast-tracked" by Nice so they can be authorised for routine NHS use this summer. But that has led to a two-speed system for assessing new treatments.

As a result, authorising other key drugs which can dramatically slow down or treat life-threatening cancers have been delayed by up to four months.

The health charity CancerBacupbelieves that Nice is the victim of government bungling over health service finances. Joanne Rule, the chief executive of CancerBacup, said the institute's reforms would take months to complete. Nice, she said, had become the "fall guy" for the health trusts.

The trusts, in turn, complain that they are too underfunded to cope with the escalating costs of funding new drugs. The trusts are even ignoring the drugs that Nice has authorised for routine use.

"There's clear evidence of significant geographical variation," Ms Rule said. "The trusts won't pay for anything until it has been fully authorised by Nice, but even when that happens, there is no one whose responsibility it is to say that prescribing those drugs must happen. This is beginning to impact on people's chances of survival."

Mr Tyndale is waiting to hear if Cambridge's trust will listen to his consultant's demands to prescribe Velcade. "I feel that I'm caught in a game of bureaucratic tennis. I don't know the rules of the game, but I know my life is at stake."

* SOME NAMES IN THIS ARTICLE HAVE BEEN CHANGED

RIGHT ADDRESS: An extra two years of life in a syringe

BRIAN JAGO can enjoy life now. Four months ago, he was given his first injection of a powerful new cancer drug, Velcade. It had an immediate effect, suppressing the bone marrow cancer called multiple myeloma that is slowly killing him.

But he had to fight to get it. It was only after his MP, the Conservative frontbencher Dr Julian Lewis, raised his case in the Commons that his health trust in Southampton changed its policy and allow his consultant to prescribe the £15,000 treatment.

His earlier treatments - a stem-cell transplant and a course of Thalidomide - had failed. But Mr Jago, 70, is now looking forward to up to two years' remission - time to enjoy at least one more Christmas with his seven grandchildren.

The trust's reversal means Velcade will be available to other multiple myeloma sufferers in Southampton too. "It's ludicrous. If I had lived in Dorset, where the pot is a little bit bigger, I wouldn't have had any problem."

WRONG ADDRESS: The £15,000 price tag on a man's future

JAMES TYNDALE is unsure whether he will survive the year. He is dying from multiple myeloma, but his health trust has refused to pay for a course of Velcade - the only drug that will prolong his life.

A former chartered accountant, Mr Tyndale, 54, was also given a stem-cell transplant and Thalidomide. Neither worked. A month ago, his consultant at Addenbrooke's Hospital, Cambridge, told the city's health trust that Velcade was his last hope.

Last week Mr Tyndale wrote to the IoS setting out his plight (extract above) and his MP, the shadow Health spokesman, Andrew Lansley, has taken up his case. The trust, however, has insisted that the decision to spend £15,000 on Velcade rests with the hospital. Addenbrooke's is adamant that it needs the trust to agree.

Cambridge's Primary Care Trust yesterday hinted it could reverse its opposition to funding his Velcade.

"In exceptional circumstances, we can review this on request," a spokeswoman said.