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We have never, under Governments of either party, measured the delays in diagnostic tests, the time between additional out-patient appointments, the referrals between one specialist and another, or the referrals, often for patients with complex cancers, between one hospital and anotherbetween the secondary and the tertiary centres, for instance. All those can add to delays, uncertainties, anxiety or even mistakes. We are changing all that, and it is a pity that the hon. Member for Billericay does not recognise the scale of our ambition, or indeed our achievement.
David Tredinnick: I hope that the Secretary of State will also address the various support services in the complementary sector, which are not commonly mentioned by Ministers, such as traditional Chinese medicine and acupuncture, particularly as the Government have been pressing for a statutory register, which should be coming on-stream soon. I would be grateful for an explanation of that. What is she doing to examine the contribution of advisory services on diet and lifestyle, because, as I mentioned earlier, according to reports from America 80 per cent. of cancers are caused by lifestyle issues?
We are making remarkably good progress towards achieving the targets that we have set for prompt first treatment. Between July and September last year, nearly 95 per cent. of patients had commenced their first treatment within 31 days of being diagnosed, and more than 80 per cent. of patients were treated within 62 days of being referred urgently by their GP. There is still much more to do on that, but we have made remarkable progress already.
I want to deal with the issue of cancer drugs, and particularly herceptin, which has rightly been a focus of much of the debate already. I pay tribute to the superb campaigning of Barbara Clarkewho is taking an interest in this debateand other women. When we heard the results of the initial clinical trials last year, which suggest that herceptin can make a very significant difference to perhaps one in four women who are HER2 positive and have been diagnosed with breast cancer, we immediately considered the implications for the national health service. In particular, I took steps, with the support of Professor Richards, to ensure that HER2 testing will be available across England to all women diagnosed with early-stage breast cancer, so that they and their clinicians will know whether they might be able to benefit from the drug.
The hon. Member for Billericay is right, however, to point to the difficulties that arise with drugs, not only herceptin, that are neither licensed nor evaluated by NICE for use. We have made it clear as general guidance for many years that no primary care trust should refuse
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any treatment on the blanket grounds that it has neither been licensed nor evaluated, because it is entirely possible for a clinician to prescribe treatment that is neither licensed nor evaluatedor that might have been licensed but not evaluatedand for a primary care trust to fund that treatment. In the light of the risk that herceptin might be ruled out because it was not licensed, not evaluated, or solely on grounds of funding, I added to the guidance already issued by making it clear that primary care trusts should not refuse herceptin purely on grounds of cost.
Mr. Liddell-Grainger : The Secretary of State is right. Herceptin is licensed for late-stage breast cancer, however, and has been for some time. Barbara Clarke's campaign was to get it licensed for early-stage breast cancer. Does the Secretary of State agree that if that could be rolled out across the whole United Kingdomit is already in Scotland and Waleswe would resolve the problems that my hon. Friend the Member for Billericay (Mr. Baron) was talking about?
Ms Hewitt: I was about to explain why we cannot do what the hon. Gentleman suggests at this point. In fact, I am not sure what he was suggesting; I think he was quite confused about it. He asked for national standards. That was our aim in setting up NICE: we wanted to end the lottery of postcode prescribing. NICE, however, cannot evaluate a drug before a licence has been applied for. It simply does not have the information that will enable it to evaluate the drug if the manufacturers who have that information from the clinical trials have not yet submitted it to the licensing authority.
Although, as the hon. Gentleman says, herceptin has been licensed for some time to treat late-stage breast cancer, it has not been licensed for early-stage treatment. When a fast-track licence was requested from the licensing authorities, the clinicians involved in the decision took the view that it would be wrong to put herceptin through a fast-track process for early-stage treatment because of serious concern about side-effects relating to heart disease. That is not a worry if a woman is in the late stages of breast cancer, but it can be of significant concern if the woman is in the early stages.
Mr. Wills : I am grateful to my right hon. Friend for giving way, especially as my intervention relates to a constituent. I am sure that she was well aware of the case even before the premature intervention of my neighbour, the hon. Member for North Wiltshire (Mr. Gray). I shall leave the House to judge whether it was inappropriate.
As my right hon. Friend knows, I have written to her several times on behalf of my constituent. I think that everyone who considers that case, and indeed the whole issue, realises just how difficult and delicate such matters are at this stage in the development of drugs. I welcome
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my right hon. Friend's rapid and sensitive intervention last year in an attempt to deal effectively with a very difficult issue. May I ask her, however
Mr. Deputy Speaker: Order. The hon. Gentleman has gone on for far too long. I have already appealed for brevity, and indeed for fewer interventions, if we are to have any debate at all involving Back Benchers.
Ms Hewitt: I will be guided by you, Mr. Deputy Speaker. However, my hon. Friend has raised an extremely important and difficult case, to which I referred in a written statement earlier today. As an appeal is pending, I do not think it would be appropriate for me to comment on the individual case, which is of course particularly difficult and painful for the individual concerned and her family. I think we all recognise that.
As I have said, NICE cannot begin to evaluate a drug or a new application before a licence has been applied for. What we didI pay tribute to the Minister of State, Department of Health, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who did much of the workwas enable the NICE evaluation to be speeded up, for herceptin in particular but also for a number of other drugs, especially cancer drugs. We did that by ensuring that, rather than having to wait until the licence is granted, in cases such as this NICE can begin its evaluation as soon as the licence is applied for. I can confirm that it has begun its evaluation of herceptin, following Roche's recent and welcome application for a licence.
The first five drugs to be subjected to the new faster processthe single technology appraisal by NICEare cancer drugs. We expect the evaluation of herceptin to be completed within a few weeks of the granting of the licence, but until the evaluation has been completed and the licence granted, it would be wholly wrong for me as Secretary of State to overrule or prejudge the decisions of either the licensing authority or NICE. The hon. Member for South Cambridgeshire appeared to be saying that I should not do so. It is a pity that he has not supported me.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The question surely is this. The Secretary of State chose to intervene last October. It surely cannot be her proposition that primary care trusts are obliged not to refuse treatment on grounds of cost alone. She intervened in respect of herceptin. When NICE conducts an evaluation, it automatically feeds through into the resources that are made available to PCTs. There is no NICE evaluation. Therefore, no resources to support herceptin are allocated to PCTs in their overall allocation. The Secretary of State gave the impression that PCTs would be funded to provide herceptin if they thought that it was clinically appropriate, but she did nothing of the sort.
The hon. Gentleman is wrong. What I said at the time I made my statement was that I recognised full well the difficult financial position that some primary care trusts found themselves in, and that they would have to make difficult decisions on priorities in order to ensure that herceptin was not denied purely on grounds of cost, but I think that he labours under a
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misapprehension. As we have set out clearly, when NICE evaluates a drug and makes a positive recommendation, the NHS then has three months to ensure that its recommendation is followed. However, the NHS is expected to do that within the funding that it has already been given. There is not a separate pot of money sitting in the Department of Health waiting to be allocated as each NICE evaluation is made.
We have given primary care trusts, the local NHS, more money than ever before and devolved to them some 85 per cent. of the total health budgeta devolution of resources that I would have thought the hon. Gentleman supportedit is simply not possible to say, for each new drug that comes along, when it is positively evaluated by NICE, "Here is more money for that drug." It would not be a sensible way to allocate resources.
The resources are allocated in a single pot. They are not ring-fenced for a particular drug. They are not even ring-fenced for drugs as a whole. It is up to the local NHS, the PCT, to decide its priorities and to get the best value for money to ensure that patients receive the best possible health care and that funding is released for new drugs and therapies as they become available.
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