| Previous Section | Index | Home Page |
Mrs. Bottomley: Essentially, the hon. Gentleman has just defined rationing. That is what the hon. Member for Oxford, West and Abingdon has been saying.
Dr. Ladyman: I have not defined rationing--I have defined prioritising. I said that, on this matter, I am on common ground with the hon. Member for Oxford, West and Abingdon. There are things that the NHS currently funds which it should not be funding. If NICE can help us to resolve that problem, it will have performed agreat benefit, and the hon. Gentleman will have to congratulate it.
Dr. Harris: May I dissociate myself from your proposal not to fund certain treatments that you think--
Mr. Deputy Speaker (Mr. Michael Lord): Order. The hon. Gentleman must use the correct parliamentary language.
Dr. Harris: May I dissociate myself from the hon. Gentleman's suggestion that certain treatments should not be funded because he feels that the conditions are not debilitating? That puts a whole new complexion on the seriousness of some skin diseases.
Dr. Ladyman: I made it clear that I was referring to non-serious uses of drugs. I said that even if we eliminated half of the budget, we would save £500 million. I accept that there are many uncomfortable and serious skin conditions which need treatment. However, if the hon. Gentleman can sit tell me with his hand on his heart that, as a GP, he never wasted a penny of his drugs budget or gave antibiotics to someone with a sore throat or a cold, I will congratulate him on being the only GP of his kind.
Mr. Paul Burstow (Sutton and Cheam): I congratulate my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) on securing a debate that he has been seeking for some time. The debate has demonstrated
the importance of the issue, and more time is needed to allow more hon. Members to have a say.
The crux of the debate is whether NICE is to be a vehicle to enable the Government to pass off their responsibility for decisions on prioritising or rationing health care, or whether it is to be a vehicle for making decisions about the efficacy and clinical effectiveness of various treatments. Until the agency starts its work seriously and we see the product of its labours, the jury is out.
My hon. Friend the Member for Oxford, West and Abingdon is right to draw attention to the order introduced in this House on 6 August, which made it clear that the question of affordability will be at the heart of NICE's work. In Committee in May, we pressed the Government on whether they would use their powers of direction and their order-making powers in this respect. We were left with the impression that they would not go down that path on affordability.
I hope that the Minister will state that when NICE comes to a crunch decision about the availability of a particular treatment or drug--and if it comes down to resource availability--the decision and the announcement will come from the Minister, and that the Minister will be seen clearly in this House and outside as the person who has taken that decision. It must not be a matter that the Minister can distance himself from, using NICE as a shield behind which he, the Department and his colleagues can hide.
The independence of NICE is crucial to its effectiveness. It is crucial also to its standing and to whether clinicians will comply with its guidance. If clinicians do not believe that NICE is acting independently, how can we expect them to respect and follow what it says? It is essential that Ministers make it clear from the outset that they are not intending to use NICE as a vehicle to deny a range of treatments on grounds of affordability.
In August, the Department set out, in terms, that beta interferon
There is much ambiguity about the definition of clinical and cost-effectiveness. There is no clear definition. Could the Minister begin to put one on the record so we all know where we stand? On savings, we are unclear as to whether the Government will allow NICE to look at the wider picture of the costs to UK plc.
In a letter that I received a few days ago, in response to correspondence that I initiated with the Department in March, I was told:
My constituent, Mrs. Josephine Timms--I raised her case with the Minister in March--is still waiting for beta interferon treatment. She is still being told that she is a perfect candidate, and that there is no waiting list. However, she is waiting, and I am waiting for an answer from the Minister. What is being done to ensure that Mrs. Timms gets the treatment she deserves?
In conclusion, many patients groups are concerned about NICE. The Multiple Sclerosis Society has said:
Dr. Phyllis Starkey (Milton Keynes, South-West):
According to the hon. Member for Oxford, West and Abingdon (Dr. Harris), the Liberal Democrats' view of NICE seems to be that it is primarily a device for limiting access to health care. I want to argue that the opposite is the case. It is a mechanism for ensuring that the maximum number of people have access to the most effective health care.
I wish to allude to the issue of postcode rationing, which is, essentially, an aspect of the inequity of access to health care. The greatest cause of inequity of access to health care is not at the level of hospital services--it is a public health debate. If one is poor, lives in poor housing and experiences air pollution, one is likely to have much poorer health than someone rich who lives in decent housing and clean air. The Government's White Paper on public health will address that agenda and will make the most difference to health inequalities in this country.
The second contributor to health inequality is the variation in the quality of treatment that individuals receive for the same condition, depending on their GP and local hospital. That variation has nothing to do with drugs budgets or the limitation on the drugs being prescribed. It will be addressed partly by NICE and partly by the Commission for Health Improvement, which will make a huge contribution to reducing health inequalities.
So-called postcode rationing is only the third contributor to health inequalities. The right hon. Member for South-West Surrey (Mrs. Bottomley) alluded to the contradiction in opposing different health authorities having different spending priorities if we believe that the role of a health authority is to react to the needs of its region. Either we want to get rid of that and have national uniformity, with decisions taken nationally that do not take account of regional variation, or we have to stop talking about postcode rationing necessarily being evil. In a given area, it may be right that greater priority is given to one service rather than another, while a different decision is taken in another area.
I shall explain how NICE will increase access for the maximum number of people to effective health care. For many conditions, a large range of potential treatments is available and new treatments continuously emerge. It is difficult for doctors in the health service, whether general practitioners or hospital doctors, to keep abreast of all the research and all the evaluation of existing treatments.
The doctors whom I know tend to stick to what they know works, or are rabid innovators and try the latest idea without necessarily being aware of the full evaluation or the basis of the treatment. There has been much talk about pharmaceuticals, but NICE also evaluates treatment protocols and other procedures. For example, hip replacement operations are fairly low technology and very important to the individuals who receive them. They give enormous pain relief and improve hugely the quality of life of the people who need them. About 40,000 are done a year. I understand that, on average, the procedure costs £4,000. Some 60 different implants are available to NHS doctors, their cost varying from £200 to £2,000. A recent study showed that, in terms of benefit to patients, there is almost no difference between the most and least expensive implants. If all doctors used that advice and went for the cheapest implant, there would be no diminution of the quality of service given to patients but many more operations could be done and more patients would receive a hip replacement sooner.
That is an excellent example of the way in which NICE will be able to get such information quickly and easily to those in the health service who need to take such decisions and ensure that the best possible use is made of public resources. NICE will effectively provide a single source of advice on the evaluation of existing treatments and the best guidelines and protocols to be used in various clinical circumstances. That will help to drive up quality in the NHS.
For example, protocols are drawn up on the criteria for out-patient referrals. One of the commitments that the Government have rightly made is that women who are believed to be exhibiting the symptoms of breast cancer will be referred to a consultant within two weeks. It is important that GPs have a clear protocol for deciding when patients present to them what indicates that the patient is at likely risk of breast cancer and the signs that mean that they are highly likely to have breast cancer but may have some other breast condition that needs to be seen by a consultant but not within two weeks. It is important that the protocols are clear and that GPs stick to them or it will be impossible to meet the Government's targets because consultants will get clogged up with referrals that need attention but not within two weeks.
There are similar issues in respect of the protocols drawn up and disseminated on the appropriate use of drug regimes in treating cancer patients. It is not simply a question of having unlimited budgets so that the most expensive drugs can be used, but of the correct drug regime being designed for the individual patient.
The other way in which NICE will help ensure that people get the most effective treatment is that it will help avoid unnecessary treatment. I want to consider glue ear, which hon. Members will remember occasioned a heated debate in the general election before last. I have had direct experience of it through my daughters. In many cases, the condition resolves itself, and operations have a pretty limited efficacy. Most protocols on glue ear suggest that it is best when the child first presents for the GP to wait before referring the child to hospital to avoid the risk of a child having to undergo a general anaesthetic. In talking about the efficacy of drug treatments, we must remember that every drug and clinical procedure has a risk attached. It is important that people are aware of that and are not exposed to treatment that is unnecessary or that has only a low probability of bringing an improvement.
It is now widely understood in the pharmaceutical industry and the health service that not all drugs are equally effective on all patients. There is enormous hope that improved knowledge of genomics and human genetics will enable doctors to identify from people's genetic make-up which drugs will be most effective for the individual patient in an individual condition, thereby much more effectively targeting the drug on those patients who would benefit and ensuring that the money is spent in the most effective way.
With several drugs, including beta interferon and proton pump inhibitors, it is already clear that only a relatively small proportion of patients with a given condition will necessarily benefit from them. Again, NICE will be able to ensure that all doctors are aware of such information and constantly updated on how to identify the patients who will most benefit from the drugs. That will avoid the more expensive drugs being sprayed around on all the patients who might benefit, and allow targeting on those who will benefit.
I strongly believe that NICE has the capacity hugely to improve the quality of health care, reduce regional variations and allow effective use of resources. I hope that all parties will recognise that that is its main object and will support that.
"is a controversial treatment for a patient group with poor prognosis. Many clinicians continue to have doubts over the cost-effectiveness of this treatment".
However, there was no balance in the Department's comments. There was no reflection of the fact that the Association of British Neurologists had issued guidance which suggested that the efficacy of the drug was sound. It makes no reference to the extensive research, published in The Lancet and elsewhere, which demonstrates that, particularly in terms of the relapsing and remitting forms--and the secondary progressive forms--of multiple sclerosis, the evidence is becoming overwhelming in terms of the drug's efficacy. The evidence from such a survey suggested that there was a "highly statistically significant benefit". I hope that the Minister will say more about that today.
"In relation to clinical and cost effectiveness, NICE's task is to assess the evidence of all the clinical and other health-related benefits of an intervention in a wide sense, and to reach a judgment on whether on balance this intervention can be recommended as a cost-effective use of NHS and Personal Social Services resources."
That was music to my ears, and a step in the right direction. I hope that the Minister will confirm that social services and social security resources, and the cost to the economy as a whole, can be taken into account by NICE.
"Both the statutory instrument on NICE tabled in August and the Institute's appraisal framework give a worrying indication that the Government may allow information about NHS resources to distort the Institute's conclusions about clinical and cost effectiveness.
I agree with that--it is a sound basis to go forward. NICE does not appear to be allowed to do that as of now. Can the Minister confirm that it will be allowed to do that?
Decisions about the effectiveness of a treatment should be entirely separate from the consideration of whether funds exist to pay for it. NICE should decide whether a drug is effective and good value for money compared with other forms of care available to patients. The Secretary of State should then decide whether the NHS can fund the treatment."
12.8 pm
| Next Section
| Index | Home Page |