The past 50 years have produced an amazing blossoming of the biological sciences. But there is a little problem. How is a country with a healthcare system principled to provide care for all, able to afford the drugs that will cure all?

One solution is “top-up” fees. Where NHS funding is not available it has been suggested that patients be allowed to buy the drugs that they need. Mike Richards, the National Cancer Director, will report today and by exempting certain classes of patient (ie, those with conditions associated with the most pathos) recommend the principle to the country.

How do we doctors feel about this? Very uncomfortable. Just imagine the conversation: “You will be pleased to know that we can cure you. We have a marvellous new treatment.” “Great, doc.” “Oh by the way, have you got £50,000?” “Ehmm, OK . . . I’ll mortgage my house.”

What about those patients who don’t have a house to mortgage? Are we saying that health is available only to the rich?

There is, however, fat in the system and it could be trimmed. The National Institute for Health and Clinical Excellence (NICE) is already too costly and unnecessary, with a role largely filled by the European Medicines Agency, which licenses treatments in the first place. We have 150 primary care trusts making 150 decisions on the same healthcare issues – including whether patients should receive high-cost drugs – at a cost of £5 billion.

Our country can have all the treatments that it needs for all the people that we treat by cutting bureaucracy. Surely it is better to slam a few fingers in desks and provide the band aids than forget the poor?

Jonathan Waxman is a professor of oncology at Imperial College, London

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