Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 560 - 565)



Sandra Gidley

  560. I have one question, it is probably totally unrelated to anything, it is something that has been niggling away, really, frequently we see statements, I quote one here, it says, "we estimate that NICE'S work on drugs to treat breast and ovarian cancer is already benefiting about 9,000 women at a cost to the NHS of 30 million", that was dated February this year. When you say 9,000 women are already benefiting, it is not clear how that figure has been arrived at. How is that figure arrived at? Does that figure include the 4,000 patients who were, perhaps, already benefiting before the guidelines were produced and does that mean, in effect, only 5,000 extra are benefiting? To produce these figures and come up with these sums you have to have an idea of what was going on before. What is not clear to me is what work is done to assess drug usage before NICE and after NICE and, again, how transparent that process is? It would be interesting in the future if that information could be available and broken down on a geographic basis so that we can more accurately monitor whether, in fact, the post code prescribing, which everyone is so keen to get rid of, has been achieved?
  (Lord Hunt of Kings Heath) I will ask Mr McKeon to answer the details of that.
  (Mr McKeon) The 9,000 women would be the total expected number who would be treated by that particular drug, it would, therefore, include some who had been already been treated. We try to make estimates of overall usage, particularly if there is the drug has been on the market for some time, as, in fact, Herceptin had been on the market for some time. It was included in NICE's own appraisal document, and what the total of the additional cost would be for the NHS. Clearly where it is a new drug, perhaps a new drug near to launch, where there would not be any current use, I think we had an earlier discussion about the information that we have available and the way in which we seek to monitor the implementation of the NICE recommendations particularly in this area and in other drugs. Our information on hospitals prescribing is relatively important, which we are seeking to rectify. Having done that we will be able to give a better geographic breakdown of prescribing.
  (Lord Hunt of Kings Heath) The other thing I would add is, we have asked the Commission for Health Improvement when they undertake their regular review to pick up the issue to make sure guidance is implemented.

Mr Amess

  561. What are the Government's plans for the Council for Quality in Health Care?
  (Lord Hunt of Kings Heath) As you know, we have got a number of national agencies concerned with quality. It is going to have a co-ordinating role to make sure people talk to each other, that there is consistency of approach, that there is no duplication.

  562. How will we know you are talking to each other? How will that come out into the public domain that you are talking to each other?
  (Lord Hunt of Kings Heath) You will see it in the quality of the work that these various national organisations do.

  563. How will it be, most importantly, accountable to Parliament?
  (Lord Hunt of Kings Heath) The Council will obviously be responsible for meeting with these different organisations. I have no doubt it will publish reports from time to time and it may well report. That is way it will come out into the public domain.

  564. That does not sound as if it is going to be accountable to Parliament, does it, Lord Hunt?
  (Lord Hunt of Kings Heath) It is accountable to Ministers and Ministers are accountable to Parliament.

  Chairman: Who are accountable to you, Mr Amess.

Mr Amess

  565. Do you accept that the National Institute for Clinical Excellence has to refer to a de facto threshold of £30,000?
  (Lord Hunt of Kings Heath) We have discussed that. I think it has been made clear that it is a guideline and if you go above a certain QALY figure then that is a question for serious consideration but it is not a de facto absolute limit.

  Chairman: Are there any further questions? If not, Minister, Mr McKeon, thank you very much for your attendance. We are very grateful for your co-operation.

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