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Dr. Ladyman: NICE's judgment on Relenza was only an interim one, based on current evidence, and was based not on the treatment's cost, but on the difficulty of ensuring that patients present at the right time to ensure that the treatment is effective. Other than Glaxo,
Relenza's manufacturer, pharmaceutical companies--at least the ones that I have spoken to--think that NICE got the decision right.
Dr. Harris: I have not heard that view expressed before by the industry, but shall deal with that later.
Other treatments may be affected by the affordability criterion, but are seen by Ministers and Labour Members as more desirable--and less as low-hanging fruit--than flu treatments. If NICE said that, on the basis of affordability, beta interferon should not be prescribed or that taxanes should not be used as a first-line treatment, I would bet that Labour Members would find it much more difficult to dismiss Relenza as simply a flu treatment and to insist on vaccination.
In "Faster Access to Modern Treatment", we were promised transitional arrangements for companies. The paper stated:
A drug that has been judged to be clinically effective should be innocent until proven guilty. Particularly in the transitional phase, drug companies--which invest hugely in the United Kingdom--should be treated fairly and should not be asked, after the fact, to provide cost-effectiveness data.
I think that Ministers will find that a consequence of decisions based on affordability--such as the one on Relenza, but also future ones--is that products are not launched first in Britain. Britain is an important market, and other countries watch to see what we do. There has been grave concern in the pharmaceutical industry that decisions made by the national institute will be emulated by other countries.
Drugs may also not be launched early in Britain. Therefore, British patients may have slower, rather than faster access to modern treatment. It is well recognised that, in NHS clinical trials, some data even on clinical effectiveness, but especially on cost effectiveness, are extremely difficult to obtain and may be obtained only after the drug is in use in the NHS. The Government have to allow drugs to be used in the NHS. If they do not allow them to be used on the basis of affordability, Ministers should clearly say that and not seek to hide behind NICE.
I fear that clinical trials will not be performed in the United Kingdom, as companies will not plan an early launch here for the treatments. Currently, many new treatments in my health authority are being provided cheaply in ethical clinical trials.
Mr. Paul Marsden (Shrewsbury and Atcham):
I am grateful for the opportunity to contribute to this important debate and I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing it. I have the utmost respect for the hon. Gentleman and must confess that we have spent many a night together. Before the media start to ring my wife, I hasten to add that that was during the long debates in the Standing Committee that considered the Health Bill.
I pay tribute to my hon. Friend the Minister of State and the ministerial team for making the National Institute for Clinical Excellence a reality. No more of the rhetoric or excuses for unfair treatment, no more the spiral of decline of our much-loved national health service, and no more one patient receiving a treatment and another being declined--in short, no more Tory Government.
Instead, we have a national institute that provides access to a single source of quality information for health professionals. It assists them to make complex decisions about patient care and ends the current state of confusion over treatment. Among other things, NICE's programme of work includes beta interferon for multiple sclerosis, taxanes for ovarian and breast cancer and inhalers for childhood asthma. Patients will receive greater consistency in the availability and quality of NHS services. NICE guidance covers all aspects of management of a condition, from self-care to care by the family doctor, the hospital and specialist services.
First, on the constant and rather sad argument that comes from the Tories and Liberal Democrats, who mention the "R" word rationing. In spite of what the hon. Member for Oxford, West and Abingdon said, they try to paint a picture of people holding ration books, counting their coupons, terrified of not being treated when those run out. They fear they will be told, "Sorry, Madam, we can't prescribe any more painkillers because you've exceeded your quota. Come back next year when your ration starts again", or, "No, Sir, we can't admit you. You've already been here twice this year. I'm afraid your ration is two visits a year." The picture painted by the Opposition would be patently daft, except that it is blatant scaremongering, which frightens people, especially the elderly.
The NHS has always set priorities for treatment and worked within cash limits. The difference between this Government and previous Tory Governments is that Labour is investing £21 billion more over three years in the NHS. Just as importantly, it believes in the concept of the national health service, unlike the Tories.
NICE helps the health professionals to make judgments on treatments with thoroughly researched information--informed judgments instead of the patchwork quilt of best guesses of the previous Tory Government. The hon. Member for Runnymede and Weybridge (Mr. Hammond),
who is not present--I note the acres of green space on the Tory Benches today--said on 14 June:
We must put an end to the situation in which one health authority supports a treatment, but another does not because then the question of who is right and who is wrong arises. NICE is about rational thinking, not rationing treatment.
As usual, the Liberal Democrats struggle to find a single consistent argument. The hon. Member for Oxford, West and Abingdon said in 1998:
Tory solutions lie in the private sector. They want to run down the national health service and force more and more people to take out private health insurance. That is rationing health care. Those who can afford private insurance get a limited health care, those who cannot have to watch a Tory NHS being reduced to ruins.
Perhaps the Tories would like this country to introduce a similar health care system to that in Germany. German workers have to sign up to an insurance company. Each worker pays 6.5 per cent. of gross pay and the employer has to match that. How about the Belgian system of patients paying up to 25 per cent. of the cost of their treatment? I am sure that the British people and British businesses would be interested in the Tory pledge to inflict a new health tax rise on the nation.
Private health care has an important role to play for some people who can afford it, but it cannot deliver the depth and quality of care that the NHS and all its staff deliver every day. NICE is an important step forward. It has been welcomed by 37 community health councils and by royal colleges. Together with other initiatives such as the modernisation programme for accident and emergency departments, NHS Direct and the largest hospital building programme in history, this Government are delivering a
modern health care system for the 21st century. I asked for local views in my constituency. The Royal Shrewsbury hospital said:
"Transitional arrangements will be needed over the next few years, in particular for medicines, since any clinical research needed to satisfy the licensing requirements will already be underway. Under these circumstances it would be unreasonable to require information which was not obtainable from the research already underway, since that would imply new research and might delay, perhaps by several years, the launch of the product. We believe that this would be unrealistic for many companies, especially those with international markets."
It would be incredibly unfair if a company spent up to 12 years on developing a drug--including years in clinical trials, to reach phase 3--but the Government subsequently said, "You should have got this data on cost effectiveness". The transitional arrangements were therefore crucial. However, those arrangements were ignored in the Relenza decision--they were not heeded.
"For the record, there was rationing within the NHS during the period of the previous Conservative Government. We do not deny it, and have not sought to deny it."--[Official Report, 14 June 1999; Vol. 333, c. 88.]
There we have it, the Tories are proud of their policy of denying treatment to patients through the chronic underfunding and unfairness of the internal market.
"It is difficult to see how we can secure the new evidence . . . for the National Institute of Clinical Excellence".--[Official Report, 9 July 1998; Vol. 315, c. 1315.]
I took that to mean that there was no need for NICE. However, on 10 March this year, he said:
"NICE is necessary to iron out inequalities in health--I accept the Government's thinking on that".
That was only column 10. By column 12, he said that he could give only,
"half a cheer for the establishment of NICE".--[Official Report, Third Standing Committee on Delegated Legislation, 10 March 1999; c. 10-12.]
Up and down, round and round--that is the Liberal Democrat policy. However, it is not the Tory's policy. They are clear cut--no ambiguity, no praise for the national institute. Speaking for the Tories, the hon. Member for Runnymede and Weybridge said on 10 March:
"This NICE will be nasty"--[Official Report, Third Standing Committee on Delegated Legislation, 10 March 1999; c. 3.]--
a nice sound bite.
"NICE will promote clinical and cost effectiveness through guidance and audit, to support our frontline staff."
Shrewsbury health authority said of NICE that it welcomed
"its establishment and look forward to the role it will play. The NHS has long needed such an organisation which is able to evaluate current and new treatments including drugs . . . It will certainly prove extremely valuable to Shropshire . . . and is warmly welcomed by the Authority."
Australia, Finland and the Netherlands have set up similar organisations. It seems that only Tory politicians claim to know better than clinicians which treatments are best.
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