THOUSANDS of patients are being denied life-saving medicines that the government promised would be universally available on the NHS.

A report by the Audit Commission, to be published this week, will show that NHS managers are disregarding the instructions of the National Institute for Clinical Excellence (Nice).

Patients are being denied the best treatments for a wide range of illnesses, including breast, brain and ovarian cancers as well as arthritis and hepatitis C.

The public spending watchdog, which examined 200 trusts across England and Wales, is likely to single out for criticism the failure of trusts to pay for powerful new drugs for severe rheumatoid arthritis It will accuse trusts of not even bothering to calculate how much it would cost to provide the drugs before declaring them to be too expensive.

The report is expected to say that trusts could afford to pay for these medicines out of existing funds if they cut down on waste and managed their budgets properly. For many patients, recent advances in treatments for arthritis may as well not have happened, according to the commission.

Three years after Nice ruled that trusts should pay for a new generation of drugs known as anti-TNF alpha — which include etanercept, sold as Enbrel, and infliximab, sold as Remicade — a third of doctors are not able to offer the treatments to all of their eligible patients.

In a recent survey, more than half of those doctors said their paymasters at the NHS trusts had told them that there was no money to pay for the medicines, which cost about £10,000 a year for each patient. Doctors estimate that, because of this, almost 1,700 rheumatoid arthritis patients who should be benefiting from anti-TNF alpha drugs are missing out.

Kay Ford, 45, from Chingford, east London, suffers from severe rheumatoid arthritis. She was denied Enbrel for a year until the British Society for Rheumatology persuaded her local trust to pay for it.

“Enbrel has given me back some quality of life,” said Ford. “It dramatically relieves the pain and protects my joints from attack from my immune system. Previously, I needed surgery twice a year but, hopefully, that will now be reduced.”

Professor David Isenberg, president of the British Society for Rheumatology, added: “Nice guidance was developed to combat this type of inequality but it isn’t working for all of our patients. It is wrong that some people are being left with unnecessary pain and disability. The Department of Health should remind trusts they need to ensure people get the treatment they are entitled to.”

Similar bungles by NHS trusts are depriving women with advanced breast cancer of a drug which halts the spread of the disease and reduces their suffering. More than a thousand are being denied Herceptin three years after an instruction by Nice that the drug should be funded by NHS trusts. Nice described Herceptin — which costs about £20,000 for a year’s supply — as “a major step forward for women”.

Women needing the drug are at the mercy of a “postcode lottery”. Industry figures for the last year show that in northeast London, Arden and Mid-Trent, fewer than 50% of eligible patients are receiving the drug, while in some areas the figure is above 75%. Nice was created in 1999 to tackle such unfair regional variations.

Joanne Rule, chief executive of CancerBACUP, a charity lobbying on behalf of cancer patients, said: “It is appalling that trusts are still failing to provide this vital drug to every woman who would benefit. It can give many months, sometimes years, of new life to a woman with advanced breast cancer.”

The NHS Confederation, which represents hospital and primary care trusts, argues that managers are often faced with unrealistic demands.

Dame Gill Morgan, NHS Confederation chief executive, said: “Finance is an issue because, usually, no extra money comes with the guidance issued by Nice. If the cost of implementing the guidance is greater than anticipated or if Nice issues unexpected guidance, that is when trusts face financial difficulties.”

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