Mr. Paterson : Can the Secretary of State explain in simple terms to a 10-year-old constituent of mine why their parents, who have paid their taxes, are having to spend a day in Shrewsbury starting to raise £47,000, when their neighbours two miles away in Wales are getting the drug? We do not have national health, or so-called national care, but we do have national comprehensive taxation.
Ms Hewitt: The NHS in Wales, for which, of course, I am not responsiblethat is a devolved matterlooks to NICE, as indeed much of the rest of the world does, for the evaluation. I make decisions about the NHS in England. I believe, and I thought at least at one point in the speech by the hon. Member for Billericay that he agreed, that it would be wrong for a politician to override, pre-empt or prejudge the decisions that should rightly be made by the independent licensing authority and by NICE.
Mr. Baron: I believe that the Secretary of State is somewhat confused herself. Does not she realise that, by intervening as she did, that is precisely what she did? She overruled NICEshe pre-empted NICE, I should say; I apologise. She caused confusion. She has not given extra budgetary finance to those PCTs that want perhaps to bring it in. That has caused more of a postcode lottery than existed previously.
Ms Hewitt: I am sorry but the hon. Gentleman is wrong. I was very careful in everything I said on the subject last year not to pre-empt NICE. If he cares to ask Professor Mike Rawlins, the chair of NICE, he will find that Professor Rawlins and I are in complete agreement on that point.
As I said earlier, we have said for some years that PCTs should not deny or withhold treatment on a blanket basissimply on the grounds that a drug is neither licensed nor evaluated. In addition, I have specified that they should not withhold funding for
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herceptin on a blanket basis purely on the ground of cost; rather, they must consider each individual case. If a PCT decides not to fund such treatment, that decision can of course be reconsidered on appeal by the clinical exceptions committee. The more that such decisions are taken by clinicians, the better.
I shall end my remarksI am conscious that a number of colleagues wish to speakby referring to the surveys carried out by the National Audit Office between 2000 and 2004, which have confirmed the significant improvements in cancer treatment to which I have already referred. They show that fewer patients reported a deterioration in their condition while waiting for treatment. Of course, fewer patients now wait weeks or even months for treatmenta wait that was, I am afraid, a feature of cancer treatment in the past. Perhaps most crucially of all, nearly nine out of 10 cancer patients reported that they were treated with dignity and respect at all times.
We are just halfway through implementing the national cancer plan. As I believe Members in all parts of the House will accept, we have already made great progress, but as I would be the first to acknowledge, there is a great deal more that we have to do. But given our continuing investment in cancer services and the record sums going into the national health service; given our confidence that by the end of 2008after two more years of record increaseswe will have achieved the European average in health care funding; given the extra specialists, the new drugs and the continuing drive for an improved patient experience and proper support throughout the cancer journey; given the provision of better advice and more choice and control for patients; and given the provision of more care in or near the home, as reinforced by our recent White Paper, I believe that we are well on the way to making Britain's cancer services among the best in the world.
All the progress that we have already made and will make as we continue on this course in the years to come would be jeopardised by the new fiscal rule announced by the Leader of the Opposition, the right hon. Member for Witney, as confirmed in his most recent statement. That "proceeds of growth" rule would inevitably mean cuts in the NHS budgetthereby reversing the progress that we have madelonger waiting lists, fewer specialists and poorer services for cancer patients.
Steve Webb (Northavon) (LD): I know that the House is keen that Back Benchers have the chance to speak before the winding-up speeches begin, and although this is a very important topic that, to judge by the contributions that we have heard so far, deserves a lot more time than has been allocated to it this afternoon, I will curtail my remarks, not least in the hope that my hon. Friend the Member for Dunfermline and West Fife (Willie Rennie) can catch your eye, Mr. Deputy Speaker, and make his maiden speech.
I want to focus on the crucial issue of cancer drugs and access to them, but first I want to place on the record my support for the 10-year cancer plan, which, as has
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rightly been said, has made an important contribution. However, I hope that the Government will say whether and when they plan to renew and refresh that plan, because we do not want it more or less to expire, and then to be presented with a new 10-year plan. Cancer treatment provision and cancer prevention is a long-term process, so we need a long lead time into the next stage of the cancer plan. I therefore hope that the Minister can tell us this evening when we will get the shape of the next plan, rather than waiting until the current one ends. We need a longer-term horizon than that.
I turn briefly to the important issue of the "prescription for change" campaign by Breast Cancer Care, which has highlighted an anomaly. People diagnosed with breast cancer or other cancers would once have died shortly thereafter; now, they can expect to live for much longer, but as a result they suffer prescription charges, whereas people with other conditions, such as diabetes, do not. Prescription charges are causing problems for cancer patients. For example, the Minister may not be aware that a Breast Cancer Care survey found that 15 per cent. of cancer patients had not taken up the prescriptions given to them by doctors because of their cumulative cost. There is an arbitrariness in the prescription system, for example between diabetes and cancer. That was not so important in the late 1960s, when the rules were drawn up, but it is a problem now. The present system can be defended only on the grounds that it is the one that we have got and that changing it would open up a can of worms. However, that is not a good enough reason not to look at it.
I shall focus on the question of access to expensive new drugs. We will talk about herceptin today, but there will always be another new drug just around the corner. Herceptin is going through the NICE licensing process for use in early-stage breast cancer, and we hope that it will soon be approved, but our answer to the question of access must work every time, for each expensive new treatment that comes along.
My comments are informed by a meeting that I had yesterday with oncologists from Addenbrooke's hospital. They wrote to me and other hon. Members last July about the inaccessibility of herceptin, and said:
"in our response to new treatments. We usually strongly resist pressure to switch our patients to new and expensive drugs for marginal benefits. But the recent trial data demand immediate action since these are certainly the most stunning results that any of us has seen during our entire professional careers."
It is interesting to note that, since the oncologists wrote that letter, their patients can now access the unlicensed drug herceptin for early-stage breast cancer. It was their clinical judgment that that should happen, but other PCTs have concluded that that would not be the right thing to do for clinical reasons. How can such matters be dealt with systematically? That is the important question, as our constituents sense that the present requirements are unacceptable.
The hon. Member for Billericay (Mr. Baron) said the same, but did not propose a solution. I agree that it cannot be right that a woman suffering from breast cancer should have to go to court to get herceptin. The
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hon. Member for North Shropshire (Mr. Paterson) has intervened more than once to say that it cannot be right either that a woman who happens to live in Shrewsbury cannot get herceptin, while one who lives in Staffordshire or somewhere else nearby can. Neither circumstance can be right, but we have not heard how such inconsistencies are dealt with in connection with drugs that are neither licensed nor approved by NICE. I shall make my own suggestion about that in a moment.
Some key questions on herceptin remain unanswered. First, what have the Government done to try and get it more cheaply? On average, the NHS pays more for drugs than most other health servicesa fact confirmed to me in a written answer from the Department. Have we used the buying power of the NHS to beat down the providers and get a better price? That approach must be both sensible and desirable, although I understand that the producers need their research budgets and an incentive to carry out research. That means that there is a limit on how far prices can be brought down but, if other health services can do it, why cannot ours?
Secondly, the hon. Member for Billericay said that other European countries adopt new drugs much earlier than we do. Why is that? Many other European countries have better survival rates than the UK, and that is very closely linked to our failure to take up new drugs earlier. Why do the Government think that our health service is, on average, slower to adopt new treatments? What assessment has been made of that?
On unlicensed drugs, I stress that I am speaking for myself, and that I do not ascribe my views to the consultants to whom I spoke yesterday. However, they pointed out that unlicensed drugs are used all over the place and said, "Paediatricians do it all the time." Licensing is for the benefit of patients, and is about patient safety. If patients are told that the trials and tests of a drug remain incomplete and that there is a risk attached to its use, they might still conclude that they are not willing to accept the risk of not using the drug. In those circumstances, why should the patients be told that they cannot take an unlicensed drug, simply because it is unlicensed? That cannot be right.
The fact that a drug is unlicensed should not be a barrier, but we do not have a system for the systematic appraisal of unlicensed drugs by clinicians who want to give them to their patients. Such a system would mean that the use of new drugs would not vary by postcode, or require people who want them to go to court. That is the sort of system that we need, and I shall make a suggestion to that effect in a moment.
I share the concern that has been expressed about the Secretary of State's intervention last October. She made a statement on 5 October that reiterated the undertaking that herceptin would be fast-tracked when it was brought forward for licensing. Obviously, we welcomed that. However, that statement, subsequent clarification by the Department of Health on the same day and the Secretary of State's speech to Breakthrough Breast Cancer have, according to a PCT guidance note on access to herceptin:
Whether the Secretary of State likes it or not, she clearly raised expectations. She must accept that, because there is plenty of evidence that people heard that on the news and concluded that she was telling trusts not to refuse to prescribe it. I know that she said that they were not to refuse to prescribe it on cost grounds, but does she seriously think that if herceptin cost £1 a dose any PCT in Britain would refuse its use to clinicians who asked for it? That is patently not so. If clinicians had judged that herceptin, although unlicensed, was in the best interests of their patientsand the patients knew the risks and were willing to take themno PCT would say no in those circumstances.