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Mr. Kenneth Clarke (Rushcliffe): I am grateful to the Minister for his courtesy in giving way. He is giving some helpful general information, but he has touched on the immediate point that is affecting a lot of people across the country. When an experienced consultant wants to prescribe specific treatment for a patient, and he thinks that that patient will benefit, is it justifiable for the health authority to refuse to finance all patients for whom he has prescribed? Is it right to restrict on financial grounds treatments recommended by experienced consultants?
Mr. Hutton: The right hon. and learned Gentleman will not be surprised to hear that I will come on to that part of my speech in a few minutes and I will deal specifically with the important point that he has made.
That is why we are setting up--
Mr. Burnett:
Will the Minister give way?
Mr. Hutton:
No, I will not. I have only six minutes left in which to respond to a number of points.
That is why we are setting up the National Institute for Clinical Excellence. The proposals for a new national institute mean that, for the first time, patients and NHS staff will be able to turn to a single authoritative source of clinical and cost-effectiveness advice.
Internal markets and the postcode lottery that they inevitably created were never an acceptable way to run a health service. NICE guidance will provide a common effectiveness foundation for the NHS to inform and assist decision making about care at all levels--national, local and individual. By identifying which new developments will most improve patient care, it will help spread good value new treatments across the NHS. That, in turn, will promote and encourage successful innovation and, by sorting out the wheat from the chaff, it will be able to target treatments on patients who will benefit most, as well as protect patients from outdated and ineffective treatment.
Guidance from the NICE does not remove the need to take account of genuine, good clinical reasons for tailoring the care provided to individual patients. That will always be an issue to discuss with the individual patient in the consulting room. Better-informed patients and professional staff can only help lead to better-quality care for everyone, wherever they live.
The hon. Member for Sutton and Cheam expressed concern over the availability of beta-interferon, both for patients with the relapsing-remitting form of the disease and for patients with the secondary progressive form. We need to be clear that complex issues are involved. There is certainly evidence that beta-interferon can benefit some patients, but it appears that only a small proportion of those receiving treatment benefit from beta-interferon and it is impossible to predict which patients are likely to benefit. That is why many professionals involved in providing or commissioning health care are genuinely uncertain whether beta-interferon treatment represents a responsible use of NHS resources.
Those are precisely the sort of issues that we have set up the new National Institute of Clinical Excellence to advise on. I am happy to confirm that, subject to the outcome of consultation on the discussion document that we issued last week, we are minded to refer beta-interferon treatment to the NICE as one of its priority tasks. I hope, therefore, that by later this year we shall have clear, authoritative advice on the role of beta-interferon in the treatment of patients with this most distressing condition--[Interruption.] I thought that the right hon. and learned Member for Rushcliffe (Mr. Clarke) was seeking to intervene again.
Mr. Clarke:
I simply wanted to say that I am glad that the Minister got around to dealing with that point. I thought that he would not, but I am grateful for what he said.
Mr. Hutton:
I do not want to turn this into a love-in, but I am grateful to the right hon. and learned Gentleman as well.
Many people are aware, too, of the use of a rather older drug by patients with MS--cannabis. The Government receive a lot of correspondence from people with MS about their problems with pain and how cannabis seems to help alleviate the symptoms. The hon. Member for Sutton and Cheam did not refer to the use of cannabis, but I thought that the House might welcome one or two comments about how we view the use of cannabis in these circumstances.
We are not unsympathetic to the plight of those who cannot be helped by existing medication and I can appreciate the desire of people with severe pain to explore
every avenue to seek relief. However, it would clearly not be of benefit to those people for us to come to a hasty decision on such an important issue. At this stage, there is insufficient evidence to demonstrate the effectiveness of cannabis as a therapeutic agent.
I am sure that the hon. Gentleman appreciates that the Government cannot condone the use of an illicit drug with unproven therapeutic benefit. Under the Misuse of Drugs Act 1971, possession of cannabis is, and will remain, a criminal offence. However, the report published in 1997 by the British Medical Association, "The Therapeutic Use of Cannabis", surveys the scientific evidence to support the use of cannabis as a medicine. The report shows that there is no reliable, well-conducted research evidence to support the therapeutic use of cannabis.
The hon. Gentleman is probably aware that the Royal Pharmaceutical Society has been working to improve the quality of research methodology for cannabinoids--the unique constituents of cannabis. Any therapeutic effects that cannabis may have are thought to rest in cannabinoids. The society is undertaking work to see whether it can establish that cannabinoids have therapeutic benefits in controlling pain and in improving
the functioning of people with MS. Successful completion of that work will lead to the publication of guidelines to help researchers produce methodologically sound results.
I should have liked to say much more, but unfortunately I shall soon run out of time.
We are providing significant funding in a number of different centres to support research on the treatment of MS in a number of ways. I assure the hon. Gentleman that that support and funding will continue. The fundamental point that he raised, however, concerned NHS resources and their use to support effective programmes for MS. As he would be the first to acknowledge, NHS resources are not limitless. Priorities still have to be set, but we are taking the necessary action to raise the quality of treatment and care to ensure a fair distribution of resources across the NHS and to end the postcode lottery, which became all too common under the previous Administration.
Those actions and many others will help improve the national health service and ensure that it responds more effectively to the needs of patients, including those who suffer from multiple sclerosis.
Question put and agreed to.
15 Feb 1999 : Column 711Adjourned accordingly at half-past Ten o'clock.
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