One of the UK's leading cancer specialists warned last night that the NHS faced difficult choices over which diseases it would treat in the future.

John Smyth said in a speech at the Edinburgh International Science Festival that decisions would have to be made about the types of screenings, therapies and drugs that could be made available in the face of “relentless” public expectation and limited public funding.

Professor Smyth, who is professor of Medical Oncology at the University of Edinburgh, called for a wider debate on the issue which would involve lawyers, medical ethicists and others outside the medical profession.

His talk, entitled The Future of Cancer Treatment - can we afford it?, raised the question of whether funds should be spent on treating one illness in preference to another. He asked whether it would be more beneficial to pay for drugs to extend the life of a terminally-ill cancer patient, for example, than to spend the money on hip replacement operations.

Professor Smyth said before the event that the billions spent on treatments could not be sustained and choices would have to be made. The NHS was already stretched to its limit treating those suffering from cancer, heart disease and stroke, and the discovery of new technologies and medicines was putting increased pressure on the health service's limited resources.

An expert in ovarian cancer, Professor Smyth said: “Advances in medical science are taking place as the health service comes under increased pressure. We have an ageing population, with fewer people contributing to the National Insurance budget, and this is exacerbated by a financial recession.

“Medical research is not going to slow down in the years to come, and so we must determine a way to fairly distribute available resources to patients.”

He added that society was facing a moral dilemma over lifestyle issues such as obesity, smoking and substance abuse. Such issues must be taken into consideration when a patient was in need of medical treatment, he said. “We've reached the stage where these difficult issues can no longer be ignored. Fast-forward five years and this problem is only going to get worse.

“It's easy to say ‘I recommend treatment X or operation Y'. It's very difficult to say ‘I'm sorry but that treatment isn't available'. I think the public are aware of the problem, but it is an ‘us and them' scenario. There's an expection that everything must be the Government's fault. But I think the medical profession is up for this discussion.”

Professor Smyth said that the public had to understand money was limited, and cited the original decision not to supply Scottish patients with the cancer drug Herceptin on the basis of cost, which was subsequently overturned after a public outcry.

He added: “Public expectation is relentless - people want and expect more and more. But in the current economic climate there are fewer people earning money and contributing tax so the income for the Government goes down as the costs go up.”

A Scottish government spokesman said: “We welcome all contributions to the ongoing debate about shaping our future healthcare system.”

The demand for drugs that are unavailable on the NHS on the grounds of cost has been a huge source of conflict in recent years. The issue was highlighted by the case of Mike Gray, 53, a bowel cancer sufferer from Moray, whose health board refused to supply him with the drug Cetuximab to prolong his life.

He used his own funds to pay for the drug, at a cost of £3,400 a fortnight, after NHS Grampian health board initially agreed with the Scottish Medicines Consortium that the drug was not cost effective because it would not cure him. Mr Gray appealed to the Scottish Parliament's public petitions committee. NHS Grampian later agreed to pay for the drug before Mr Gray's death.

Tina McGeever, his widow, continued the campaign after his death and a report by the public petitions committee highlighted that there were discrepancies between health boards.

At the end of last month, after Mr Gray's case, Nicola Sturgeon, the Secretary for Health and Wellbeing, announced that NHS patients in Scotland would be allowed to supplement their treatment with private healthcare.

Although she said that there would not be a two-tier “top-up” system in place, she confirmed that new guidance would ensure that patients who wanted to pay for drugs in a “co-funding” agreement would not be excluded from NHS care.

She told MSPs that more flexibility would also allow some treatments to be prescribed even if they had not been approved on the grounds of cost.

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