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11.39 am
Mrs. Virginia Bottomley (South-West Surrey): I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this important debate. I declare my interests, as set out in the register, particularly with Wyeth, the firm involved in the meningitis C vaccine campaign.
NICE's recent announcement on Relenza will have greater long-term implications for science in the NHS and for the pharmaceutical industry than the Government may yet realise. I have no financial relationship with Glaxo Wellcome, but I am indebted to Sir Richard Sykes because five years ago we launched a campaign to win for Britain the European Medicines Evaluation Agency. This is not the time to set out why our pharmaceutical industry is such a leader among the creative industries. We are low prescribers per head, and overwhelmingly the industry invests in research in Britain and uses this country as a springboard for exports. It would be dangerous to put the long-standing partnership between the industry and the NHS in jeopardy.
When we launched the campaign for the European Medicines Evaluation Agency, it was to be a magnet for inward investment. Britain was advanced as a location for
the agency because of our record for integrity and probity and our commanding position in pharmaceutical research, with four out of the top 10 medicines prescribed having been discovered in the UK.
Above all, our drug regulation agency, the Medicines Control Agency, deals with more drug applications more quickly than any other European licensing agency. A Department of Health press release of 29 October 1993 said:
If a product has been licensed by the Medicines Control Agency or the EMEA, it has been approved for safety, quality and efficacy. The message that has gone to the industry from the announcements on Relenza is that there is a mysterious new delaying tactic that will prevent new products from reaching the market. The industry has just faced a 4.5 per cent. price cut and is often sceptical about the pharmaceutical price regulation scheme. I support the PPRS, with all its difficulties. However, the Minister should be aware of what is being said in the industry, particularly by those from overseas, about the new, unaccountable way of delaying new products reaching the market.
I was prompted to speak today partly by the concern expressed by the industry and the real danger of the withdrawal of inward investment. I know, for example, what major pharmaceutical inward investment means to people in Thanet, in Scotland and throughout the United Kingdom. It is essential that the Government understand the message that is being taken from the announcement on Relenza. However, the main factor that has prompted me to speak is the growing concern in the scientific community, particularly among those whom I most respected when I was Secretary of State for Health. They have no political partisan commitment. They work in the health service because they are fascinated by medical research and they argue that the contribution of the industry to science in the NHS has been formidable.
The Government do not have a proud track record. The first thing that they did in their first year was cut the NHS research budget. Research is all too easily too low a priority. My concern is that the implications of what has been happening at NICE may threaten not only a successful industry but, even more important, the nature of research in the NHS.
It is fashionable for politicians on both sides to condemn postcode prescribing. It was an attempt to allow different health authorities to set their own priorities and make different decisions. That allows diversity, which,
when different areas are compared, becomes a springboard for innovation. It is hard to explain and to justify, but the effect was to create diversity. It is as old as the NHS.
Mr. James Gray (North Wiltshire):
I apologise to my right hon. Friend for not necessarily agreeing with what she says about postcode prescribing. I was not here earlier in the debate, but I know that we have talked about beta interferon. Does she agree that the situation is a terrible tragedy for constituents such as mine, who could be prescribed beta interferon if they lived in Bath or Oxford, but not in Wiltshire?
Mrs. Bottomley:
All Members of Parliament have been affected by the campaign on beta interferon, and sufferers of multiple sclerosis feel understandably anxious and alarmed about the availability of new products and the best products for their condition.
The problem is that NICE is seeking to make premature decisions. It is well established that many new technologies or drugs end up being used for conditions and in circumstances that were not previously anticipated. The danger is that NICE will clamp down on innovation too soon.
As my hon. Friend the Member for North Wiltshire (Mr. Gray) made clear, there is mounting anxiety that new products are not being made available. We have first-class people working in a second-class service. The hon. Member for Shrewsbury and Atcham (Mr. Marsden) spoke euphorically about changes in the health service. I ask him to come to west Surrey, which has not had a ministerial visit in two and a half years. The news is very bad, and there has never been a time of greater despair and concern about the ability to provide treatment and care for a range of patient needs.
Dr. Stephen Ladyman (South Thanet):
I seldom congratulate the previous Government on anything, but, picking up on the comments of the right hon. Member for South-West Surrey (Mrs. Bottomley), I congratulate them on her successful campaign to win the European Medicines Evaluation Agency for the United Kingdom. In many ways, the agency was given to the United Kingdom as a second prize, because we did not get the European Bank. In the long term, it may well turn out to be the first prize and will probably make more money for the United Kingdom, one way or another, than the European Bank would have done. To that extent, I agree with the right hon. Lady.
However, when the right hon. Lady talks about prescribing guidelines and the way in which the NHS decides which drugs to buy, she forgets that the NHS is
not the Government or the marketplace--it is only a purchaser. In the United States, where there is a private marketplace, the equivalent to the NHS is the health management organisation with which one's insurer happens to be tied up. The United States may not have a National Institute for Clinical Excellence, but I bet my life that each health management organisation has an internal group that makes decisions about prescribing guidelines and drug purchase. For it, cost and cost-effectiveness are not tangential but direct matters. It must decide whether the health management organisation will prescribe a particular drug in a particular way.
The health service must have something equivalent to that and, in setting up NICE, the Government have taken a logical step which they are perfectly entitled to take. With some refinements and improvements it will have nothing like the impact on the United Kingdom's pharmaceutical industry that the right hon. Lady fears.
I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this debate. I agree with a number of points that he made, but I cannot let his speech go without noting once again, as I did in my intervention, that the Liberal Democrats' manifesto contains not a word about medicines. I have read it thoroughly, and if the hon. Gentleman has forgotten what is in it I shall gladly give him my copy. It contains not one extra penny for the drugs budget.
The hon. Gentleman says that prescription charges are not ring-fenced for the drugs budget, and he is right. They were in the supplementary costings document that went with the Liberal Democrat manifesto. Of the £570 million extra for the NHS this year identified in that manifesto, £200 million was to go to the Treasury to freeze the cost of prescription charges, and only £370 million was additional money for the NHS and was identified for hospitals, an additional carers allowance and dentistry. There was not a penny extra for drugs. Had the hon. Gentleman been the Minister replying to today's debate, he would have been trying to justify a Liberal Democratic Government's plans for limiting the availability of drugs on a smaller budget than the Government have currently made available. Liberal Democrats need to be a little more honest about that.
There is a serious debate. Liberal Democrats talk about rationing and the Government talk about prioritising. Like the line in the song,
In an Adjournment debate on 13 April, I highlighted the cases of two constituents who were not at that time receiving beta interferon--Ms Lesley Jordan and Mrs. Noreen Heffer. The first of those two ladies is now receiving beta interferon, but the second still is not, and I continue to campaign for her to receive it as soon as possible. But in east Kent the amount of money allocated
to beta interferon is much greater than in equivalent sized health authorities elsewhere, yet we have a long waiting list.
The hon. Member for North Wiltshire (Mr. Gray) said that in some areas there is not a waiting list, but that is because the prescribing guidelines there are different. The money might be available and there might be no waiting list, but a person might not be put on the waiting list because the doctors there might not consider that beta interferon was a suitable treatment. On that basis, creating NICE must be right. It is the right organisation with the right task, and its guidelines will be invaluable in solving such problems.
I said earlier that NICE requires some refinements. One thing that NICE has not publicly said that it will do, but which I hope that it will, is to look at the regulatory process and advise the Government and the EU on how it is working. Hon. Members may not realise it, but in America the Food and Drug Administration takes raw data from pharmaceutical companies and carries out its own expert analysis. In the United Kingdom, the pharmaceutical companies analyse the data and produce their own expert reports on efficacy, toxicology and so on. Our drugs agencies assess those expert reports to see whether the analysis is correct and whether the appropriate conclusions have been drawn. It is a different process.
NICE should be looking at that process and asking whether there is a point at which it should intervene or enter into negotiations with the pharmaceutical companies at an earlier stage in order to influence what goes into the expert efficacy report so that decisions can be made more effectively and rapidly once licensing approval has been given. Could NICE perhaps write an additional expert report, requesting the raw data in order rapidly to produce such a report? Discussions between NICE and the pharmaceutical industry could resolve many of the problems that have been highlighted today, and I encourage NICE to continue with such discussions.
At the end of the day, however, even with common prescribing guidelines across the country--here I am on common ground with the hon. Member for Oxford, West and Abingdon--there will still be pressures on the budget. We cannot fund everything. Therefore, decisions have to be made about what will not be spent. I have said publicly on many occasions, not least in the Adjournment debate on 13 April, that we can make those decisions relatively easily because, within the drugs budget, there is a huge amount of money that does not need to be spent.
"London offers precisely the right conditions for the Agency: the UK's record for probity, integrity and swiftness in medicines regulation is second to none. The EMEA will be crucial to the development of safe and innovatory medicines for all EC citizens."
That success was followed by a major campaign entitled "Prescribe UK", which involved the pharmaceutical industries, led by Sir Richard Sykes, the Department of Trade and Industry and the Invest in Britain Bureau. It was an attempt to encourage more Japanese, American and other pharmaceutical companies to invest in Britain. The Government declare themselves to be champions of the pharmaceutical industry and to want to promote inward investment. It is a shame that there is no representative here today from the Department of Trade and Industry or the other Departments which, in the age of so-called joined-up government, should be watching the situation carefully.
"I say tomato, you say 'tamater'",
it is a matter of semantics, which I do not want to get into. What the Government have done, and on which they should be congratulated, is to pool the community health service moneys, the hospital expenditure moneys and the drugs budget moneys, making them available to the health authorities in their entirety so that health authorities can prioritise locally as they wish. Such local prioritising must be right. However, that has probably highlighted the differences in prescribing guidelines throughout Britain.
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