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House of Commons

Tuesday 24 October 2006

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—


1. Jessica Morden (Newport, East) (Lab): What assessment she has made of the effect that recent preliminary National Institute for Health and Clinical Excellence guidance on the use of Velcade has had on the treatment of myeloma patients; and if she will make a statement. [95960]

The Minister of State, Department of Health (Andy Burnham): I have made no such assessment. The National Institute for Health and Clinical Excellence has not yet issued its final guidance on the use of Velcade. I understand that it plans to do so in November 2006, subject to any appeals against its final appraisal determination.

Jessica Morden: The recent decision on Velcade, according to press reports, is a huge blow to thousands of myeloma patients, as it is one of the only treatments for that type of bone marrow cancer. As the decision appears to have been made on the basis of cost, will the Minister urgently review the value that NICE places on treatments that extend life, and which are crucial for patients and their families—if the reports turn out to be true?

Andy Burnham: I am grateful to my hon. Friend for her question. I pay tribute to her work with the International Myeloma Foundation, and I know of her personal interest in the matter. We are asking NICE to take some extremely difficult decisions on our behalf and, although I understand her points, it is important that it is able to do its work, and to consider all the evidence on the clinical effectiveness of treatments, free from political interference. That is the right position. There is an ability to appeal against any NICE decisions, and the final appraisal determination is still subject to such appeal. At this stage, it would be inappropriate to comment further.

Dr. Julian Lewis (New Forest, East) (Con): My constituent, Brian Jago, was fortunate enough to receive a course of Velcade, as a result of which he does not have to move to Wales—as he was going to do—where he could have got it free. He now faces the prospect of at least another two years of high-quality life. Is not that the worst form of postcode lottery?

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Andy Burnham: In making public statements, it is extremely important that we do not seek to mislead and give patients false expectations of what is available in other parts of the United Kingdom— [Interruption.] If the hon. Member for New Forest, East (Dr. Lewis) will hear me out, I will explain to him that interim guidance is issued in Wales, but NICE guidance, when finalised, will also apply in Wales. That is the system, so there will not be any difference between the two countries. The hon. Gentleman will be aware from a press release issued by NICE this week that, according to the manufacturers’ evidence, Velcade has the potential to extend life by one year. It is important to consider such matters in the round and to have a balanced discussion and, if resources can be put elsewhere into cancer care, to take such decisions so that we provide the best possible treatment to patients for the money available.

Mr. Lindsay Hoyle (Chorley) (Lab): I am sure that my hon. Friend is aware that there is not a constituency in the country that does not have myeloma sufferers. Cannot more money be made available for this drug treatment, as it is the only treatment that can work and prolong life? We should have a special fund and take the decision away from NICE by making extra moneys available. Will he consider that if NICE refuses to recommend the drug?

Andy Burnham: I do not intend to take the decision away from NICE. When the Government came to power, we set up NICE specifically to introduce fairness into the system, so that decisions would be taken that balanced clinical effectiveness with cost-effectiveness. I do not dispute that myeloma is an awful condition, of which some 4,000 new cases are reported every year, and everything possible must be done to help such people. It is inappropriate to second-guess NICE’s decisions and to undermine its difficult work, which it does on behalf of all of us as taxpayers and all of us who want health resources to be used as effectively as possible. In making such extremely difficult decisions, we owe NICE our support.

Mr. Boris Johnson (Henley) (Con): Will the Minister join me in congratulating a woman who has written to me offering the use of her house in Scotland to a 39-year-old Oxfordshire patient suffering from multiple myeloma? Can he explain to her and to me what the rules are for such people who wish to travel to Scotland to use Velcade to prolong their lives? Is not it disgraceful that the millions of others who are not able to travel to Scotland must go without?

Andy Burnham: I say again that it is wrong to raise expectations about the effectiveness of a particular treatment. There is a whole series of pressures on the national health service. Of the 26 cancer drugs on which NICE has issued final appraisal determinations, it has recommended the use of 25. Those are difficult decisions. Only a couple of weeks ago, in the Opposition day debate, there was support from the hon. Gentleman’s Front Bench for NICE’s independent role in taking such difficult decisions—

Mr. Boris Johnson: What are the rules?

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Andy Burnham: If the hon. Gentleman is telling me that he knows more than NICE, and that he has more expertise and evidence, I do not believe him. For residents of England, the rules in relation to NICE apply, and the primary care trust of the individual concerned would have to make any decisions about whether to fund a particular treatment. That is the position, and it remains the position.

Steve Webb (Northavon) (LD): An expert hospital consultant has written to my hon. Friend the Member for Carshalton and Wallington (Tom Brake) saying that she does not know how she will face patients if the Velcade decision stands, because she will have to tell them that there is a treatment which in her view is effective and would help to prolong their lives, but which is not available in this country although it is available in other European countries.

I accept what the Minister says about the independence of NICE, but NICE is answering the question that the Government have asked it. What is different about the process here? Why are other European countries coming up with the answer that Velcade is both clinically effective and cost-effective? Why, when we asked NICE the question, did it decide that that was not the case? Has the Minister considered how this is handled in other countries, and whether we can learn from them?

Andy Burnham: I believe that it would be irresponsible for someone in my position to build expectations in people that they can safely have access to every drug that comes along. The responsible course is to arrange an independent appraisal process—as we did with NICE—that balances clinical effectiveness with cost-effectiveness.

I see reports week after week about every new wonder drug that comes on to the market; no doubt the hon. Gentleman does as well. It is simply not right to jump on the bandwagon for political purposes whenever a new drug comes along. A broader, more balanced view must be taken of whether treatments are effective or not. We must give a clear line to the public and not raise false expectations. That is what NICE has been seeking to do and Opposition parties have supported it before. I believe that it is when decisions are difficult that we owe NICE the most support, and all parties in the House should provide that support at this time.

David Taylor (North-West Leicestershire) (Lab/Co-op): My father-in-law died of myeloma some years ago. It is a dreadful disease from which at least 20,000 people in the United Kingdom currently suffer—30 or so in each parliamentary constituency. Should we not back treatments such as Velcade? If no one had backed insulin two generations ago, people would still be dying of diabetes in great numbers rather than leading longer and more fulfilling lives. We really must do more to turn incurable, dreadful diseases such as myeloma into chronic illnesses. I agree that we should not jump on bandwagons, but we should show faith, provide support and produce the necessary resources to give hope to thousands of families in the United Kingdom.

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Andy Burnham: It is important to keep such matters under review, but, as my hon. Friend will know, the Government have made huge progress in the treatment of patients suffering from cancer across the board, in terms of both access to treatment and the treatments available. As I have said, we do fund those treatments. Of the 26 cancer drugs referred to NICE, 25 have been approved. That clearly shows that NICE is helping people in need to obtain treatments.

I heard what my hon. Friend said about his personal experience of a family member with this condition. It is an awful condition—I do not deny that—but I should point out that every new treatment that comes along is not necessarily the best option. We must see the position in the round and ensure that funds go into improving services across the board, rather than simply paying for every new treatment that comes on the market.

Mr. Andrew Lansley (South Cambridgeshire) (Con): On 27 September, Janice, Jacky and Marie—the “Velcade Three”—handed this letter to the Secretary of State. They have not received a reply. Why not?

Andy Burnham: I can tell the hon. Gentleman that they have received a reply. The Secretary of State wrote to the individuals concerned last week, explaining precisely the process that NICE has been through. That reply has been sent and was dated 23 October. [Interruption.] It is important—without, as I have said, raising the temperature for political purposes—to offer NICE some support at the time of this difficult decision.

Mr. Lansley: The Minister will recall that I raised the issue with the primary care trust in spring this year on behalf of one of my constituents, as other Members have on behalf of their constituents.

May I suggest a way forward? Leaving it to the manufacturer and others simply to appeal to NICE is only one solution; a better one would be to recognise that what NICE said last week was that it had insufficient evidence to demonstrate cost-effectiveness. If the Department is willing to talk to Johnson & Johnson, the manufacturer, it ought to be possible to find a way forward that allows patients to receive the drug for a future period, so that definitive evidence of its cost-effectiveness can be determined. Will the Minister and the Department get together with Johnson & Johnson to do precisely that? NICE does not have the power to question the price given to it by the manufacturer.

Andy Burnham: I hear what the hon. Gentleman says, but we need to be extremely careful about the points that we make on these matters. A couple of weeks ago, he was asked by one of his colleagues about Alzheimer’s drugs and he said:

I would view that as an endorsement of the NICE process, where people who are expert in the conditions take the decisions. The hon. Gentleman does not— [Interruption.]

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Mr. Speaker: Order. The Minister must be allowed to reply without interruption.

Andy Burnham: The hon. Gentleman does not have a medical background and I do not have one. Yet when asked on television on Sunday whether he would allow the drug to be prescribed and paid for if he were Health Secretary, he said that he would—a direct contradiction of what he said in the House just a couple of weeks ago. There is a need for some consistency in this argument. Patients need consistency and they do not want mixed messages or double standards simply because it is politically convenient to get off the front pages of the newspapers, as the hon. Gentleman—

Mr. Speaker: Order.

Charging and Prescriptions

2. Ann Winterton (Congleton) (Con): When she next plans to review the regulations on NHS charging and prescription exemptions. [95961]

The Minister of State, Department of Health (Andy Burnham): The Government published on 17 October their response to the recent review of NHS charges by the Health Committee, which set out our plans for a review of prescription charges and exemptions. We will report the outcome of the review to Parliament before the 2007 summer recess.

Ann Winterton: Although I welcome the forthcoming review—the present system of prescription charges is quite arbitrary and the list of exemptions for asthma, for example, was compiled in 1968 and despite vast improvements in medical science has not changed since—will the Minister give an undertaking that the review of prescription charges will be transparent and that its findings will be published for all to see?

Andy Burnham: I can give the hon. Lady that commitment. She makes a reasonable point and I accept that the costs for people who need repeat prescriptions can be extremely high. In response to the Health Committee, chaired by my right hon. Friend the Member for Rother Valley (Mr. Barron), we said last week that we would introduce a monthly direct debit system for patients who have a pre-payment certificate, costing £7.95 a month. That is £2 a week and is an improvement, but I recognise that we have further to go. The hon. Lady is right to say that it is hard to see the logic on which the list of exemptions is based and any review should look into it further. Any changes should be cost-neutral to the NHS overall, but I acknowledge her point.

Mr. Kevin Barron (Rother Valley) (Lab): It is not just a matter of being cost-neutral; can the Minister assure us that the proposals will be evidence-based?

Andy Burnham: My right hon. Friend knows that the Department of Health specialises in precisely that sort of rigour and I am sure that it will be followed in this particular instance.

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Suffolk PCT

3. Chris Mole (Ipswich) (Lab): What steps she is taking to ensure that more health services are delivered in the community in the Suffolk Primary Care Trust area. [95962]

The Secretary of State for Health (Ms Patricia Hewitt): Last week, we announced a new project to shift ear, nose and throat services in Ipswich closer to people’s homes. A senior audiologist will run a clinic three times a month from a town centre GP practice with good public transport access and parking. That will mean that far more ENT patients will not need to go to hospital for their treatment, which I believe will be welcomed as part of a much broader programme to shift services closer to people’s homes.

Chris Mole: Does my right hon. Friend agree that care closer to home projects such as the primary care audiology clinic established in a GP centre in my constituency offer patients better health care, make better use of resources and should allay people’s concerns about whether changes in acute hospital set-ups are matched by the introduction of community-based health services?

Ms Hewitt: My hon. Friend is absolutely right. Partly thanks to advances in medical practice and modern medical technology, it is now possible to give patients care in a local GP surgery, health centre or, indeed, in their own homes, which could until recently be provided only within an acute hospital. What we found in the huge public engagement that led up to the “Our health, our care, our say” White Paper in January was that where it is safe and right, people prefer treatment to be given to them in their GP surgeries or, if possible, in their own homes.

Mr. James Gray (North Wiltshire) (Con): Does the Secretary of State think that there is a greater likelihood of an increase in spending and better health service provision in an area such as Ipswich, represented by a Labour MP, than in an area such as North Wiltshire?

Ms Hewitt: The hon. Gentleman is absolutely wrong. There is more money going into the NHS in every part of the country than ever before—funding that was of course made possible by an increase in national insurance contributions, which the hon. Gentleman and his party opposed. In deciding how much money should be allocated to each local primary care trust, we take into account the age of the population, especially the proportion aged 65 or older, and the burden of disease, including the fact that in some communities life expectancy is far lower and the death rate from, for instance, cancer and heart disease is far higher. We believe in fair funding; it is a pity that the hon. Gentleman does not seem to do so.

Mr. Stephen O'Brien (Eddisbury) (Con): It is clear that in Suffolk, as elsewhere, community services are being run down. The number of district nurses has fallen by 15 per cent. since 1997 and we need at least a third more podiatrists, instead of the present savage cuts. At the same time, acute services are being cut in
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Ipswich and, across the country, 81 community hospitals are under threat, including Walnut Tree, Hartismere and Aldeburgh in Suffolk. However, the Royal College of Nursing said that 71 per cent. of newly qualified nurses cannot find jobs—nurses who were recruited and trained at vast expense to the taxpayer on the basis of Labour’s cack-handed work force planning. How does the Secretary of State expect to build up the delivery of health services in the community when she is overseeing cuts in district nurses, specialist nurses such as those caring for people with Parkinson’s disease, community hospitals—

Mr. Speaker: Order. I expect that the Secretary of State will manage to reply.

Ms Hewitt: The hon. Gentleman referred to services in Suffolk. I find it extraordinary that he did not refer to the fact that the NHS is investing nearly £1.5 million in Felixstowe to turn an old general hospital into a modern community hospital, with a day-treatment centre, 16 in-patient beds and a range of clinics and services that will provide better care for people in that part of Suffolk. I am surprised that he did not mention the investment of £600,000 in the Mount Farm surgery in Bury St. Edmunds. I am surprised that he did not mention Bluebird Lodge and Ravenswood, which opened in April this year, or the fact that Suffolk PCT, which is reviewing community services, has £3 million of revenue and more than £2 million of capital to invest in other community services and buildings. It would be absurd to say that a pattern of community and cottage hospitals that were built—

Mr. Speaker: Order. I think that the Secretary of State has made her point.

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