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Mr. Andrew Turner (Isle of Wight) (Con): Does my hon. Friend accept that an important component of radiotherapy is being able to access the service? It is recognised by authorities that stress and concern about travel arrangements affects people's ability to benefit from radiotherapy. Will he congratulate the Isle of Wight council on announcing that it is making £50,000 available from its budget this year to fill the shortfall caused by the NHS withdrawing funding for radiotherapy patients to cross the Solent for treatment in Southampton?

Mr. Baron: I do not know the details but it sounds as though the local authority has done a good job and I duly congratulate it.

David Tredinnick (Bosworth) (Con): My hon. Friend mentioned that survival rates are low. Is not one of the weaknesses of the Government's strategy that not enough has been done to support cancer sufferers? Not enough attention has been paid to the work of the Bristol Cancer Help Centre or the cancer lifeline kits that are available, which offer a range of supporting therapies and address things such as diet, detoxification, relationships at home and even spiritual issues. The Government have missed those soft targets.

Mr. Baron: My hon. Friend will remember that I attended one of his meetings on this issue, and I agree that we need to consider providing much wider support—

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but when he turns away to address his hon. Friend, he should bear in mind that he should be addressing the Chair and that it is also important that he should address the microphones, otherwise, it creates a problem for Hansard.

Mr. Baron: I appreciate that guidance, Mr. Deputy Speaker.

The short answer is that I agree, but I shall make some progress.

Let me turn to access to drugs—another area where cancer services should be doing much better. We have the best cancer research record in Europe but among the poorest uptake of new drugs, as recently confirmed by the Karolinska report, which identified that the UK was consistently below average in adopting new drugs for the treatment of breast cancer, colorectal cancer and lung cancer. The reasons for that are varied. First, the NICE process has been too slow. Delays have meant that English patients have been forced to wait for approval, even though patients in Scotland and the rest of Europe have sometimes received their drugs more quickly.

Last year, CancerBACUP identified 23 cancer drugs that were subject to delays after NICE's budget was cut and the number of appraisal committees was reduced from three to two. Since then, some reform has taken place, and we support it. However, the success of the
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new single technology appraisal should not be won at the cost of other drugs going through the standard procedure more slowly. Ultimately, if NICE is to meet the growing demand for new drugs, it should be provided with the resources that it needs to support three appraisal committees.

Another problem is that, although NICE was set up to tackle the postcode lottery in drugs throughout the country, its guidelines are subject to postcode lotteries—a fact recognised by the cancer tsar, Mike Richards, in his report two years ago. More recently, the Public Accounts Committee report confirmed that, one year after NICE approval, the use of herceptin for breast cancer ranged across cancer networks from 90 per cent. to under 10 per cent. of eligible women.

For one bowel cancer medicine—eloxatin—independent research found that more than one in four consultant oncologists were not able to implement new NICE guidance in the 90-day implementation period. Those clinicians cited the lack of funding as the main reason, despite the Government's extra investment in the NHS. Such regional variations must end.

The Opposition believe that we have a system that is essentially unfair. There is an inherent inequity in the system in gaining access to drugs. The postcode lottery for the availability of drugs can only be eradicated if NICE is asked to carry out full resource implementation assessments alongside its appraisals for cost and clinical effectiveness. That will help to ensure that aspirations contained in the guidance become a practical reality. The guidance will be realistic because the decisions have been costed.

Nowhere has the controversy over access to drugs been fiercer than over the funding of herceptin for early-stage breast cancers. The intervention by the Secretary of State for Health last October, when she suggested that PCTs should not withhold the drug for reasons of cost alone, has added to confusion about patient entitlement to unlicensed drugs. Inadvertently, the right hon. Lady raised the hopes and expectations of women with HER2 positive breast cancer that they would have access to that drug, but those hopes were crushed by the High Court ruling last month. If her original remarks at the Breakthrough Breast Cancer fly-in did not sufficiently create the impression that eligible women should expect primary care trusts to fund herceptin where a clinician was prepared to prescribe it, her subsequent decision to challenge North Stoke PCT certainly did. Now, there is still a postcode lottery in the prescribing of herceptin for early-stage breast cancer, as PCTs come to different decisions about the drug. That was the danger in the Secretary of State pre-empting NICE.

Mr. Ian Liddell-Grainger (Bridgwater) (Con): My hon. Friend is well aware that the condition of the lady who fought for the drug—Barbara Clark, who is one of my constituents—has now got worse, because its use has been okayed for late-stage cancer but no one can decide when a patient's stage changes from early to late. The postcode lottery is all right if someone is late-stage, but there is still a battle. Wales has just announced that it
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will stop the lottery, so has Scotland. Only England has the problem. Does my hon. Friend agree that that is a farcical position for us to find ourselves in?

Mr. Baron: I completely agree. It is simply farcical that we have got ourselves into this position and it is does not look as though the situation will get better. Unless we make the recommendations to NICE that we have suggested, there will continue to be a postcode lottery and many patients will suffer as a result.

Dr. Stoate : It is impossible for NICE to make a decision on early-stage breast cancer because, as the hon. Gentleman knows, Roche only applied for a licence for herceptin in the past few days. Is he as dismayed as I am that Roche has been so slow in pushing for a licence for a drug that American studies have shown to be so useful?

Mr. Baron: The key question is: on what basis should herceptin be available now? The Secretary of State has caused confusion by intervening and overruling NICE. Primary care trusts are in a very difficult position. Some, like Swindon, will have the option of not funding herceptin if they can demonstrate doubts about its safety or clinical effectiveness. However, the PCTs that have decided to fund herceptin for early-stage breast cancer on the back of the right hon. Lady's intervention find themselves in a difficult situation. Although many trusts are struggling with deficits, the Secretary of State has not made special funding available. Local health managers face the unwelcome task of diverting funding away from other services, including those for other cancer patients, to action a political instruction from Government half way through the financial year.

It is no surprise that Pamela Goldberg, the chief executive of Breast Cancer Campaign, has said—I hope the House will forgive me for citing her comments, but they provide a powerful illustration of the situation—that the intervention

If the point of the Secretary of State's intervention was to end the postcode lottery for herceptin, where is the evidence that that has been achieved? If it was not designed to do that, will she explain to the House what the point of her intervention was?

Steve Webb (Northavon) (LD): The hon. Gentleman is making a measured contribution, but is he saying that, if he were the Secretary of State for Health, he would ask NICE to appraise unlicensed drugs, or that he would require PCTs to pay for herceptin and would provide central funding for that?

Mr. Baron: There are a number of issues, one of which is transitional funding. As soon as drugs become licensed, they should be appraised. The fast-track process should apply in this case. If we continue with the current system, the postcode lottery will inevitably follow. We must sort the situation out and the only way
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in which we can do that is by making sure that there is an appraisal process as soon as a drug is licensed and that full resource implementation takes place in tandem.

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