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Mr. John Burnett (Torridge and West Devon): Will my hon. Friend give way?
Mr. Burstow: I had better not. I have already given way once.
The study compared a group of MS patients who were being treated with beta-interferon with a group to whom the drug had been refused. In just one of a number of case studies dealt with in that detailed research, it was found that the lost tax revenues and the increased benefit payments accounted for about £10,000. A further £2,500 was being allocated to cover social care costs during relapses.
The conclusion of the study was clear. The researchers stated:
I sought the debate tonight because of a number of cases that came to my attention in my constituency. I expect that other hon. Members are present to listen to the debate because of cases that have been brought to their attention. In preparation for the debate, I spoke on Friday last week to the chair of our local MS society to discuss some of the issues of concern to its members.
The local group has 140 members, including90 sufferers of MS, none of whom are prescribed beta-interferon. Indeed, I was told that at least two had been told that they are eligible under the existing guidance, but that no money is available to pay for the therapy. They went on to say that the problem was not just the drug, but the lack of planning by the health authority and the lack of awareness of the everyday experiences of MS sufferers.
Because there is inadequate provision in the health service to fund the treatment, the cost ends up being borne in other parts of the welfare state. In effect, we are funding dependency, rather than shifting the resources to fund greater independence.
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton):
I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on his good fortune in securing a debate on this timely and important subject. I express my gratitude to him for his thoughtful and clearly well-researched comments. I am sure that he will not object if I begin by putting some of his comments about resources in the right perspective. The hon. Gentleman will be aware that, over the next three years, an additional £21 billion will be spent on the national health service. That is a 4.7 per cent. real-terms increase
I say to the hon. Gentleman and to other hon. Members who are present--I am pleased to see so many right hon. and hon. Members taking an interest in the debate--that, within those overall budget figures, we expect expenditure on new drug treatments to increase significantly. We fully expect that a greater share of NHS resources will be spent on good-value new drug treatments over the next three years. I hope that the hon. Gentleman will not mind if I decline to accept his criticism of the Government record on investing in the NHS. I think that we can safely withstand any attack from the Liberal Democrats.
As the hon. Gentleman said, multiple sclerosis is a chronic, disabling disease which affects the central nervous system, causing damage to the nerves in the brain and spinal cord. It often strikes people when they are young. It is understood to arise from scarring and inflammation of the myelin sheath. This acts as insulation to the nerve fibres and helps conduct impulses through the central nervous system. When that happens, disabilities can vary from impairment of speech, vision and movement to continence problems or even complete paralysis. Because of its prolonged course, and the disability that can result from it, it is extremely distressing for those who suffer from the disease, and their families. It often has a profound effect on the lives of others in the family as well. We estimate that multiple sclerosis affects, as the hon. Gentleman rightly said, 80,000 to 90,000 people in the United Kingdom.
The disease course in MS is unpredictable. People most often present with relapsing-remitting MS, in which relapses or acute attacks of neurological disability are followed by periods of remission. Later, as chronic problems accumulate, the disease may become more progressive, with more acute relapses. Some people have the progressive form of the illness right from the start. Management of MS therefore involves a number of things, including treatment of relapses caused by increased disease activity, a proper care programme to minimise and control specific problems such as spasticity, bowel and bladder problems and fatigue, and specific treatment aimed at influencing the disease's progression.
People with MS have a wide range of health and other needs. These needs, particularly for health care, will nearly always change over time. Patients with long-term conditions such as MS require different levels of support and health care. An annual approach to their health care is not always appropriate. Our White Paper "The new NHS" presents us with good opportunities to develop innovative care approaches for people with long-term care needs, including those with multiple sclerosis. In the White Paper, we made clear our ambitions for a modern, dependable service that will provide first-class treatment and care for all those who need it. I want to make it clear at the outset that that applies just as much to those suffering from MS as to anyone else with long-term health care needs.
The recent consultation exercise on arrangements for long-term service agreements which we proposed in guidance on "Commissioning in the New NHS" will ensure that commissioning arrangements cover longer time scales of between three to five years instead of at present only one. In this guidance, our proposals for
pathways of care will, where appropriate, link primary care, secondary care and social care, to which the hon. Gentleman referred. I believe that this is a better approach for people with long-term conditions such as MS. Discussions about these care pathways will involve users and carers as well as health professionals. However, we need to be realistic about making changes and we do not expect these new arrangements to happen overnight for all services, but to be developed on a rolling programme that replaces annual contracts.
Mr. Burstow:
Listening to the Minister's speech, it is quite difficult to find the appropriate point at which to intervene. That being so, it may well be that he will be taking up the point that I am about to make. However, I seek clarification.
I referred to the fact that 46 per cent. of health authorities have no contracts and no clarity in their planning of delivery of services for MS sufferers. Is the Minister able to say specifically whether the National Institute for Clinical Excellence will be asked to undertake work in this area and provide a service framework to guide the pathways that he was talking about?
Mr. Hutton:
I have some sympathy with the hon. Gentleman in respect of knowing what is the right place to intervene during an Adjournment debate, because it usually takes a bit of time to reach the specific points that have been raised. I can assure him that I will come on to the National Institute for Clinical Excellence, and--if he is okay with this--I shall refer to those issues when I reach that point in my remarks. The specific figure that he raised--that of 46 per cent. of health authorities not having any strategic approach to managing multiple sclerosis patients--is not one that I am familiar with. If he would like to make further representations to me, I should be happy to look into that.
We emphasised in the guidance that care pathways would be developed to cover a range of preventive, diagnostic, palliative, rehabilitative and supporting care components of an integrated programme of care. That applies in particular to long-term medical conditions where, following accurate and timely diagnosis, patient care will be managed outside an acute setting. That is likely to be the case for many neurological conditions and, given their complex nature, we plan to develop, with the help of the neurological voluntary organisations, a compendium of good practice on the commissioning of neurological services.
On services for people with MS, the hon. Gentleman will be aware that, last year, the Multiple Sclerosis Society published a survey of multiple sclerosis provision in England and a symptom management survey. The first survey was designed to establish how commissioners approach provision of MS services and to build a picture of service provision in England. The second looked at the experiences of a group of MS patients.
Under the present system, the organisation of health services, including services for people suffering from MS, and the manner in which they are delivered, are, quite rightly, matters for local health authorities. The moveto new commissioning arrangements will achieve improvements in services for people with conditions such as MS. Longer-term agreements, reflecting dialogue
between clinicians and focusing on health improvement and quality objectives, will increase the emphasis on programmes of care that cross the traditional boundaries to meet patients's needs best.
The White Paper "The New NHS" also underlines our commitment to working in partnership, which fully includes the voluntary sector. We are pleased to be supporting the MS Society in particular, under the section 64 scheme of grants, in respect of its emergent therapies project. The MS Society, together with the National Hospital for Neurology and Neurosurgery, have developed comprehensive guidance on standards for the provision of health care for people with MS. The society is offering formal recognition, as a benchmark of good practice, to centres and services that meet these standards. We very much welcome that helpful initiative.
"The study has been concerned to show that although the cash purchase price"--
15 Feb 1999 : Column 706
of beta-interferon--
I hope that in future, when work on the subject is done by the Department, these other issues will be taken into the equation. I hope that the National Institute for Clinical Excellence, which I understand will consider cost- effectiveness as part of its work, will take that wider view, rather than just a narrow health-related cost view. On the basis of the evidence that I have seen, and according to those who are far better informed than I am, it is clear that the drug can make a difference.
"has proved an initial barrier to some potential NHS purchasers, when other factors are considered, the true 'cost' of the drug can be viewed in a more advantageous light. These include the quality of life of the patient during treatment, the impact on the use of resources in hospital and in the community, the effect of the disease on the families and friends of MS patients and the economic cost to the community as a whole."
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