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Dr. Stephen Ladyman (South Thanet): The hon. Member for North Thanet (Mr. Gale) speaks with
great passion. He talks about the mathematical possibility of the Labour party occasionally being able to carry the day if it bussed in all its hereditary peers. He completely overlooks the fact that the 3:1 Conservative majority in the other place would mean that the Conservatives could simply bus in more than we could. He forgets that 300 hereditary Conservative peers were bussed in to carry the Maastricht treaty, which he now says is wrong. He forgets that we could not pass legislation against fox hunting in this Parliament because of the hereditary peers, and that is a campaign for which he has fought all his political life.
In the few moments that remain before 10 pm, I want to refer briefly to the comments made by my right hon. Friend the Member for Chesterfield (Mr. Benn). I have been a member of the Labour party for a very long time. In 1987, I attempted to stand for Parliament. I can remember members of the Labour party, who were then very much its leaders and spokespeople, telling us about the policies that Labour was espousing. They included the notion of getting rid of hereditary peerages. I remember being told that the only way we would get that legislation through the House of Lords was by creating 3,000 new Labour peers, that the Conservatives would put every obstacle in our way, and that the House of Lords would not allow itself to be abolished. Now, my right hon. Friend the Member for Chesterfield tells me that the Prime Minister is going to be profligate in creating just 91 in order to succeed in doing what he--for it was he--said could be done only with 3,000.
Mr. Benn:
It was not 3,000, but 1,000. The difference is that the 1,000 would have abolished the House of Lords; the Prime Minister's appointments will be for a "transitional" stage, which I believe will last for a generation or more.
Dr. Ladyman:
My right hon. Friend and I must agree to differ. Time will tell which of us is right. I
Sir Nicholas Lyell:
I want to make one point in the minute that remains--[Interruption.] In the minute that remains tonight. The big question that I pose to the Leader of the House is whether the Committee is to be allowed the opportunity seriously to consider what form the interim Chamber should take, pending the findings of the royal commission and the subsequent debate; or whether we are to be landed with the 91-peer amendment, which we are not permitted to debate in this place and which the upper Chamber will be permitted to debate only in the event of good behaviour. There is much talk of democracy on the Labour Benches, but we are not being allowed a full-scale democratic debate on this vital issue.
Amendment No.--
It being Ten o'clock, The Chairman left the Chair to report progress and ask leave to sit again.
To report progress and ask leave to sit again.--[Mr. Kevin Hughes.]
Committee report progress; to sit again tomorrow.
Ordered,
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Kevin Hughes.]
Mr. Paul Burstow (Sutton and Cheam):
I am pleased to initiate this debate on the treatment of multiple sclerosis sufferers. I sought it because I believe that the way in which the national health service cares for MS sufferers is a crucial test of some of the Government's NHS reforms. As things stand, MS sufferers get a poor deal from the NHS and, for want of joined-up policy making, taxpayers' money is being spent on sustaining dependency rather than on promoting independence.
I have not sought this debate simply to raise concerns about the postcode rationing of beta-interferon, although I have some questions on that. I hope that the Minister will give the House, and many thousands of people outside, a sense of the Government's approach and attitude to the treatment of MS. In that context, beta-interferon is only part of the picture. There is also a need to address diagnostic services, rehabilitation and nursing services.
MS is a disease of the central nervous system and the most common disabling disease among young adults. This week alone, 50 people will be diagnosed with it. The symptoms often result in problems with mobility, vision, speech and fatigue, and can cause severe pain. One thing is certain about MS: the unpredictability of how it affects people's quality of life.
Because MS is both degenerative and multi- symptomatic, it requires a co-ordinated, multi-agency approach. The sad fact is that services for MS and MS sufferers are subject to wide geographical variation. The variation in availability of service between one postcode and another was confirmed last year in research by the Association of Quality in Healthcare. It found that few health authorities know how much beta-interferon they are funding or how many patients are eligible for treatment in their areas, and showed that most under-prescribe. Even more disturbingly, it revealed that few health authorities work through specific contracts or have detailed service specifications in respect of MS.
All those findings confirm the anecdotal evidence that many hon. Members will have encountered in their casework and surgeries that services are poorly organised and planned. An open letter from a group of16 distinguished neurologists published in November stated:
While it is difficult to obtain hard numbers, it is estimated that some 800 people receive beta-interferon. That is about 1.5 per cent. to 2 per cent. of MS sufferers.
As I understand, as many as 10 per cent. of MS sufferers qualify and would benefit from such therapy. Indeed, evidence from trials suggests that treatment with beta-interferon can reduce the number of attacks by up to one third, increase the length of remission and reduce the progression of disability. Beta-interferon is not a cure for MS; nor is it a wonder drug. I acknowledge that it does not necessarily apply to every MS sufferer. However, far too many people who would benefit from it still do not have the opportunity to do so.
Mr. Andrew Lansley (South Cambridgeshire):
Is the hon. Gentleman aware that a distinguished clinical neurologist thought it appropriate that my constituent, Mrs. Jacky Boswell, should receive beta-interferon, but Cambridge and Huntingdon health authority denied that treatment purely on the grounds that it is not resourced sufficiently to do so?
Mr. Burstow:
The hon. Gentleman has drawn attention to a problem that a number of hon. Members encounter. Constituency casework tells us that there are people for whom neurologists have recommended the prescription of the drug for whom--through no fault of their own or of their neurologist, and purely by dint of the fact that the local health service does not have sufficient resources--treatment cannot be provided. As a consequence, as I shall describe later, other parts of the welfare state wind up picking up the cost, and informal carers share the burden.
Prescribing patterns suggest that financial, not clinical, considerations are denying neurologists the freedom to prescribe, as the hon. Member for South Cambridgeshire (Mr. Lansley) rightly suggested. With the recent European licensing of beta-interferon to treat the more severe secondary progressive form of the disease, the need for clarity and direction from the Government is more urgent than ever. As Stephen Thornton, the chief executive of the NHS Confederation, said,
A series of statements and so on by Ministers has begun to call into question the efficacy of beta-interferon. Indeed, in November, the then Minister of State, the right hon. Member for Darlington (Mr. Milburn), said that the Department would be
In a letter to the hon. Member for North-East Derbyshire (Mr. Barnes) in January, which I am grateful
to have had the opportunity to see, the present Minister of State said:
When will the new guidelines be issued, especially for the secondary progressive condition? Will beta-interferon continue to be available, albeit under the unsatisfactory regime, outside the rules of the proposed national trial? How long will the national trial last before new guidelines are published, in order that there may be greater consistency, which the Minister promised at the Dispatch Box only in November?
That Mr. Andrew Dismore be discharged from the Accommodation and Works Committee and Mr. Colin Burgon be added to the Committee.--[Mr. Keith Bradley, on behalf of the Committee of Selection.]
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10 pm
"We believe that the National Health service has failed to respond adequately to the needs of people with MS and that services to them, with some shining exceptions, are seriously deficient in most parts of the country."
In this short debate I want to cover three issues: prescribing, other services for MS sufferers, and cost-effectiveness, which seems to inform much of the Government's thinking on the issue. Guidance on prescribing beta-interferon was issued by the previous Government to health authorities in 1995. It suggested that it should be prescribed only by neurologists; and that patients should be over 18, have the relapsing-remitting form of the disease, and have had two attacks in the past two years. Finally, patients should be able to walk.
"To avoid the charge of postcode prescribing, we need urgent Government clarification."
We need Government clarification not just of current prescribing for relapsing-remitting MS, but of future prescribing policy.
"commissioning new research into the appropriate usage of beta-interferon, and we will be issuing new guidelines before too long to ensure greater national consistency in the uptake of the drug."--[Official Report, 10 November 1998; Vol. 319, c. 132.]
I am sure that hon. Members on both sides of the House would welcome that, and hope that that guidance is on its way. In a subsequent written answer in response to a question that I tabled, however, the Minister said that there are still many unanswered questions about the drug's appropriate use.
"There are still continuing doubts over the clinical and cost-effectiveness of the drug arising from soundly based clinical trials. Proposals for a national clinical trial into Beta-interferon are at an advanced stage, and a final decision will shortly be taken".
Those statements raise some questions. I hope that the Minister can give some answers.
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