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Mr. Nigel Dodds (Belfast, North) (DUP): I join my hon. Friend the Member for Lagan Valley (Mr. Donaldson) in paying tribute to my hon. Friend the Member for Strangford (Mrs. Robinson) not only for securing the debate and raising this important subject, but for her work on health matters in Northern Ireland, which is widely respected and admired.
Many hon. Members could also refer to letters that they have received that tell a terrible tale of emotional stress and anxiety caused by denying people the treatment to which they are entitled. That also imposes guilt on family members who cannot contribute to the private purchase of those medicines, as they may feel that they are letting their loved ones down. My hon. Friend is right to highlight that important factor.
Mrs. Robinson: I concur with my colleague. If the lady whose case I raised does not receive the appropriate drugs she may face the inevitability of selling her home and going into public sector accommodation. In this day and age, it is an utter disgrace that families should be put under such strain to obtain appropriate care for their loved ones.
The situation for rheumatoid arthritis sufferers is no better than it is for people with multiple sclerosis. Waiting times in Northern Ireland for anti-TNF medications such as Enbrel and Remicade are four times longer than they are in England, and are much worse than they are in the rest of the United Kingdom or Europe. Rheumatology provision in the Province is much worse than in Great Britain. The recent strategic review of rheumatology services in Northern Ireland called for root and branch modernisation. We have the lowest number of rheumatologists per head of population in Europe, and we need more consultant rheumatologists, specialist nurses and allied health professionals. We also need a properly resourced paediatric rheumatology service, because young people with juvenile arthritis currently have to wait four months for a first appointment. We need an appropriate paediatric rheumatology service with a lead consultant and a paediatric rheumatology nurse specialist.
We deserve parity with other UK regions in the provision of anti-TNF therapies. More than 440 people in Northern Ireland will have to wait more than two years for Enbrel or Remicade, while their condition worsens all the time. More than two thirds of consultant rheumatologists in England and Wales are satisfied that they can prescribe those drugs when necessary, yet on 31 October, at Musgrave Park hospital in Belfast alone,
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there were 365 people on the waiting list for anti-TNF drugs, 62 of whom have been waiting more than two years. Money that hospitals were led to believe would be made available this financial year has not materialised. The message from the Department is that there will be a generous allocation in the next financial year, but those hospitals were given to believe that that would be the case this year. Arthritis sufferers fear that the publicity over the breast cancer drug Herceptin will result in treatments such as anti-TNF medications losing out. As I said earlier, I would be grateful if the Minister confirmed that the £14 million of additional money that was provided in the recent announcement will aid the availability of those drugs.
A rheumatologist recently commented:
"I'm afraid we are getting pretty despondent again about this. The Boards were due to receive the Department's response to their Health and Wellbeing Improvement Plans about a month ago (which included additional allocations for high-cost drugs) but we haven't heard anything from them, and there are rumours that we may not get any additional anti-TNF funding this year. This is despite the fact that our anti-TNF waiting list now stands at well over 2 years. Indeed, we were led to believe that we would be getting additional funds in the current financial year to treat well over 50 new patients in Musgrave Park Hospital alone."
Velcade is another drug for which there is great demand across the Province. It is the only new licensed treatment for multiple myeloma in the past 10 years, but patients in Northern Ireland cannot gain access to it, even though patients in Scotland, Wales and England can. Velcade offers both increased life expectancy and improved quality of life for patients with myeloma, who would otherwise face a terminal decline in their condition. Myeloma receives much less attention than other more notable cancers, but is a far bigger killer than both testicular and cervical cancer. Survival rates for myeloma patients have not improved in the past 10 years, with only 23 per cent. of patients living for more than five years.
In Northern Ireland a very small number of patients would be suitable for Velcade. The cost would not be great, but the difference that it could make to the patient's quality of life and life expectancy would be immense. Velcade is a licensed drug. The decision to prescribe in Northern Ireland is not dependent on any assessment authority. Denying myeloma patients the treatment is a purely financial decision. Every year in Northern Ireland between 85 and 120 people are newly diagnosed with the disease. In 2003, 63 people died of it, including one young person in their 30s.
Velcade is prescribed for patients who have received at least two prior treatments and whose condition is worsening. It is undergoing trials as a second-line treatment, owing to the success seen in its current use. It has been appraised by the Scottish Medicines Consortium and the All Wales Medicine Strategy Group. It is funded and available on the national health service in Scotland and in Wales. Although universal access to Velcade is not expected in England until NICE produces guidelines, a number of trusts already prescribe the drug. Clinicians are free to make a clinical judgment to prescribe unappraised drugs such as Velcade. Indeed, Department of Health circular 99/176 makes that clear to all primary care trusts.
In Northern Ireland, funds for Velcade have not been made available because of the withdrawal of contingency funds to health boards, despite the fact that Belfast City
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hospital is the location for clinical trials for the treatment. Clinical trials for Velcade carried out in Northern Ireland were so promising that one trial was halted early to ensure that as many people as possible received the treatment. It is extraordinary, therefore, that the place where so much effort was put into testing the drug is the one UK region where it is not available. Many patients are left to wonder what the point is in conducting all that multimillion pound research, only to find that afterwards there is no money to fund the treatment.
Another drug on which I have been lobbied is Teriparitide for the treatment of established osteoporosis in post-menopausal women. I understand that boards have not identified funding for it in the current financial year. Is this another drug that the Minister had in mind when he announced extra funding for drugs in Northern Ireland?
Are the boards free to allocate the recent extra funding for drugs as they wish, or are there restrictions on which medications can be included? Can the Minister assure us that he will make the availability of essential drugs a priority in the Province, and that the Department will take responsibility for ensuring that there is adequate provision across Northern Ireland?
3.43 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Shaun Woodward): I congratulate the hon. Member for Strangford (Mrs. Robinson) on securing the debate on access to essential drugs in Northern Ireland. She is indeed a doughty champion, as I know from my own postbag. She passes on the letters of every constituent who writes to her and raises many of these matters in written questions. I am well aware that few MPs could claim to have such a proud record as she has in taking up the health needs of her constituents.
The hon. Lady asked me to make a number of guarantees, and she will understand that I may resist making them as guarantees. However, one of the questions that she posed was from a constituent, who asked, "What is the point of paying all my taxes?" Well, the fact of the matter is that health spending in the current year in Northern Ireland will exceed £3.5 billion. For the next two years, I have secured an additional £450 million for the health service, which is £50 million more than the previous budget. I recognise that even that sum of money, which matches the best figures in England, is not enough in Northern Ireland. In that context, I announced major reforms to the health service this week in order to find more efficiencies and put that money into front-line services.
Of the £3.5 billion that we will spend this year in Northern Ireland, some £400 million will be spent on prescribed medicines. The majority, £340 million, will relate to GP prescriptions, while the balance, some £60 million, will be spent in the hospital sector. Those costs represent only a proportion of the total cost of treating a patient with a particular drug. For specialist drugs, many of which the hon. Lady has mentioned this afternoon, there are also additional costs associated with the infrastructure required for the administration of the drugs.
Today, people are living longer. With our ageing population, we should expect more age-related chronic diseases and higher levels of drug prescription. At the
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same time, patient expectations are increasing, and rightly so. Patients and their families are rightly much more aware of the treatments available and—again, quite rightly—they expect to receive the latest and best drug treatments for their particular condition.
Hon. Members will be aware of the recent report by Professor Appleby. One of the issues that it considers is the potential for greater use of generic medicines in Northern Ireland. He estimates that there would be savings of some £55 million a year, if Northern Ireland's use of generic medicines were as good as the practice in England. That £55 million is effectively being wasted in Northern Ireland because of prescribing habits, which must change. I am determined that my Department will pursue these changes in order to put that money into front-line health services.
New and revolutionary specialist drug treatments are emerging all the time. In some cases, new drug products have been developed; in others, new ways have been found to use existing drugs more effectively and for new conditions. All that is good news for patients, since better treatments are now available to cure or control the symptoms of a range of severe conditions. Improvements in drug treatments may also reduce the number of hospital admissions that patients require.
It is essential when new drugs are introduced that we continue to monitor all the available evidence in relation to their safety and effectiveness. Sometimes that will account for why we delay the introduction of some drugs. Although most drugs will prove to be effective, some medicines, despite their initial promise, may be shown to be not so effective or, indeed, they may subsequently be found to be unsafe. In those circumstances, difficult decisions will need to be taken, and the drugs may need to be withdrawn.
One very recent example of a drug with huge potential is, as the hon. Lady has mentioned, Herceptin, which has been licensed and is available to patients in Northern Ireland for use in advanced breast cancer. Early results from clinical trials indicated potential benefits for suitable patients with early-stage breast cancer, which understandably led to calls from patients and their elected representatives, including the hon. Lady, for Herceptin to be made more widely available for this new indication.
I took the view then—I still hold it now—that the decision to use Herceptin or any other drug in a new way should always be a clinical decision and that it should not be driven by political campaigns or the media, although I recognise the role that the media may play in drawing further attention to the positive effects of certain drugs. In that specific context and in what must be regarded as exceptional circumstances, I announced on 11 November that doctors should be free to make clinical decisions about the prescription of Herceptin for patients in the earlier stages of breast cancer. It was also important, as I made clear on 11 November, that despite what was undoubtedly an excellent campaign in the media, and an excellent campaign fought by a number of politicians for the prescription of Herceptin for early-stage breast cancer, few people in that campaign discussed the negative effects of Herceptin, and the extremely serious side effects reported in The Lancet, which may occur in some patients and which may include heart failure.
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