|Previous Section||Index||Home Page|
The Minister of State, Department of Health (Mr. John Denham): The National Institute for Clinical Excellence has extended the time scale for its appraisal of beta interferon and glatiramer acetate to commission further economic modelling. NICE will review the outcome of the new modelling in the summer, and unless there are further appeals, it expects to issue its guidance by November.
Mr. Winterton: I ask this question as president of the Macclesfield branch of the Multiple Sclerosis Society. Is the Minister aware that it is 18 months to the day since NICE was given the task of appraising beta interferon and disease-modifying drugs such as copaxone in the treatment of multiple sclerosis? Is he really saying to me, and to the rest of the House, that it is tolerable that some of the 85,000 people who suffer from MS should not be able to get the drug that will give them a better quality of life today, when this drug's effectiveness is already proven and it is licensed in many other countries?
Mr. Denham: As the hon. Gentleman will know, under the policies introduced by the previous Government there was a wide disparity in the availability of beta interferon, precisely because there was not agreement and consensus about its clinical effectiveness and cost-effectiveness. That is why it was so essential to refer it to the National Institute for Clinical Excellence, which has put a great deal of work into this important appraisal.
Mr. Bercow: Given the frustrating delay that has already occurred and to which my hon. Friend the Member for Macclesfield (Mr. Winterton) has referred, will the Minister go a bit further and confirm that November 2001 will be a firm deadline and not a rough aspiration? How many people does the right hon. Gentleman estimate will be untreatable by November 2001 who could be successfully treated now? Finally, will he explain why copaxone is, in effect, being treated as an interferon for the purposes of NICE's study and appraisal, even though it is chemically and pharmacologically different, has been successfully tested over eight years and has reduced relapses by 70 per cent?
The hon. Gentleman asks about the November date that I mentioned earlier. That is the date towards which NICE is working, but as he will understand, NICE has to follow proper legal process. Timing can be affected by whether, for example, appeals or even legal challenges are mounted at any stage. However, November is the date towards which the institute is currently working.
Mr. John Cryer (Hornchurch): Does my right hon. Friend agree that there are three MS syndromes? Evidence already exists to show that beta interferon is very successful in treating the relapsing-remitting syndrome at least. Several of my constituents need beta interferon and cannot get hold of it because we are waiting for the NICE decision. Is it not unacceptable that NICE is extending the time for that decision? Could not the institute at least make a decision on the treatment of the relapsing- remitting syndrome?
Mr. Denham: We have to accept the judgment reached by NICE. As constituency MPs, we all receive representations from constituents, clinicians and others about this drug. With all due respect, I very much doubt that anyone in the House has spent the same time and effort as NICE on detailed consideration of the range of evidence that has been presented. It is precisely because the institute does not believe that the evidence resolves those important questions that it has decided to commission new economic modelling. That is NICE's decision, since we entrusted it with a choice about how to handle these matters. The institute's decision suggests that the issues are not as clear-cut as we would all like them to be.
Mr. Robin Corbett (Birmingham, Erdington): As the chairman of the all-party multiple sclerosis group, may I say that it is a welcome development that NICE is starting to listen to MS sufferers--having changed its initial view that it was minded not to recommend the prescription of beta interferon to those who were said to be able to benefit from it? In the period until NICE makes its recommendation--it is to be hoped by November at the latest--what extra investment are the Government making in neurological services throughout the country? As well as the postcode prescribing of beta interferon, we have to contend with the fact that neurological services are extremely patchy from one region to another.
Mr. Denham: On the two points raised by my hon. Friend, it would be wrong to speculate on reasons other than those given by NICE as to why it is commissioning extra economic modelling. NICE would say that it has always tried to understand--especially through the Multiple Sclerosis Society--the opinions and experiences of MS sufferers.
My hon. Friend makes an important point about wider neurological services. Everyone would accept that even for MS, and certainly for other conditions, other forms of care and support are important; sometimes, they may be the only forms that are important. The extra investment now going into the NHS gives it the capacity to plan improvements in services in ways that have not been
Mr. Nick Harvey (North Devon): Although I regret the delay, may I at least express the hope that NICE's willingness to consider a new methodology holds out the possibility that it will reach a favourable verdict on beta interferon?
What reassurance can the Minister give to patients waiting for a verdict, either on beta interferon or on herceptin, about which we heard earlier, that, when it issues the guidelines, NICE will indeed prove to have been the answer to the postcode lottery, as the Minister for Public Health claimed again today? Are the Government not concerned that, even where NICE guidelines have been issued, local health authorities are still choosing to ignore them? Is he aware that patients in Wiltshire are living with a health authority that will not implement the guidelines on Alzheimer's; that those in certain parts of Devon will not be able to get relenza; and that Hillingdon--the largest primary care trust--has decided to ignore NICE guidelines on cardiac care?
If NICE is to be the answer to the postcode lottery, what steps do the Government propose to take to ensure that, when the guidelines are issued, patients throughout the country can benefit from such treatments?
Mr. Denham: It would be wrong not to recognise, or to cast doubt over, the very significant achievements that NICE has made in tackling postcode prescribing--on taxanes for the treatment of breast cancer, on the use of stents in heart surgery, on the introduction of glycoprotein inhibitors for acute coronary heart syndromes and on the significant recent announcements about Alzheimer's drugs. All those achievements will bring thousands and thousands of extra people into treatment who were not being treated under the system of postcode prescribing. Indeed, independent judges have suggested that, overall, NICE's work is undoubtedly leading to an increase, rather than a decrease, in NHS expenditure on the treatments and drugs that have been referred to it. All health authorities and all parts of the NHS have to take full account of NICE guidance in reaching their decisions. I would simply say that, with the investment that we are putting into the NHS, finance cannot be given as a reason for not implementing NICE guidance.
Mr. Kevin Barron (Rother Valley): Does my right hon. Friend agree that the introduction of guidelines under the previous Government did not provide equal treatment throughout the country and that it is vital that NICE does not just a quick job but a comprehensive one, so that we can get rid of the inequalities that now exist and so that people, no matter where they are, can truly benefit from a national health service rather than a postcode one?
Mr. Denham: My hon. Friend is absolutely right. He and I remember that the introduction of the policy of postcode prescribing by the Conservative party was a cynical political device that enabled them to say, "It's nothing to do with us" whenever something went wrong in the NHS. I am proud that we have had the courage to set up the National Institute for Clinical Excellence.
Mr. Philip Hammond (Runnymede and Weybridge): Will the Minister tell the House whether the new modelling that NICE is seeking to put in place will allow it to take account of wider economic and social costs and benefits rather than just the economic costs and benefits to the NHS? Does he not think that that should have been the basis from the outset on which NICE appraisals were conducted? Will he consider reopening appraisals that have already been completed on the basis of that narrow definition alone?
Mr. Denham: The appraisal approach taken by NICE has been set out very clearly. NICE will directly take into account the impact on NHS and personal social services budgets, but it is open to NICE to take into account a wider range of factors and it is open to those who submit evidence to include evidence on a wider range of factors. One of the things I welcome about the way in which NICE is undertaking the current exercise is the open and transparent way in which it is seeking to commission the new economic model. The way in which it intends to do that is set out in a consultation letter issued on 25 January, which has been on the NICE website since 29 January.