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House of Lords

Tuesday, 16th June 1998.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Southwell.

Viscount Scarsdale--Took the Oath.

The Lord Chancellor: Leave of Absence

The Lord Chancellor (Lord Irvine of Lairg): My Lords, before business begins, I take the opportunity to inform the House that I will be visiting the Combined Court at Winchester and meeting local magistrates on Friday, 19th June. Accordingly, I trust the House will grant me leave of absence.

Multiple Sclerosis and Beta-interferon

Lord Walton of Detchant asked Her Majesty's Government:

    What is their policy with respect to the prescribing of beta-interferon for patients with multiple sclerosis.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, the noble Lord will of course be aware from his own distinguished career in medicine that Her Majesty's Government do not have policies about individual prescribing decisions, which are naturally best left to members of the clinical professions. However, in November 1995 the NHS Executive issued a circular to health authorities and trusts about the introduction of a newly licensed beta-interferon product for multiple sclerosis. Copies of it are available in the Library. The circular suggested that the product should be prescribed by hospital neurologists where clinically appropriate. It asked health authorities to implement local arrangements to manage the entry of such drugs into the NHS. The guidance in that circular is still in force.

Lord Walton of Detchant: My Lords, I thank the Minister for that reply. I appreciate to the full the dilemma for many health authorities faced with the prospect of paying for a drug which costs £10,000 per patient per year. However, does the noble Baroness accept that the evidence indicating the benefit of the drug in the relaxing and remitting form of multiple sclerosis has been known for some time, but that a recent multi-centre European trial has shown that the drug also produces substantial benefit in the chronic progressive form of the disease? Is it therefore acceptable that many health authorities and trusts are refusing to allow prescription of the drug and others are offering only token support? One per cent. of patients

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with multiple sclerosis in the UK receive it, compared with 7 per cent. in France, Germany and Italy and 15 per cent. in Australia and Greece.

Baroness Jay of Paddington: My Lords, I naturally hesitate to have any discussion based on my own understanding of the references that the noble Lord made to individual trials of the beta-interferon product. As I understand it--and I bow to the noble Lord's greater clinical knowledge--there are some conditions within multiple sclerosis which are affected by some of the drugs which are at present on the market and some which are not. One trial in particular, which I understand the recent health technology assessment of the NHS conducted, concluded that it was poor value for money in certain circumstances.

However, that certainly does not prevent the Government from feeling that the, as it is called, "post-code" prescribing decisions by individual health authorities affect the understanding of the national care that we want to see offered under the health service. That is why we are introducing new ways of organising the introduction of drugs. For example, the National Institute of Clinical Excellence--and details will be published shortly--will issue guidelines to health authorities about their prescribing practices. They will perhaps be slightly more forceful than the previous ones.

Baroness Gardner of Parkes: My Lords, when the Minister talks about value for money, is not the whole issue in the case of this drug its cost? The cost is now half what it was when it was introduced. As the noble Lord, Lord Walton, said, recent research has shown that it is effective in treating not only the form that the Minister mentioned but also all forms of multiple sclerosis. Yet, as I understand it--and I ask the Minister to confirm this--from the time when patients are told that they would benefit from it and should definitely have it, there is a procedural delay of over six months before the drug is received. It is a deliberate cost-saving tactic.

Baroness Jay of Paddington: My Lords, I can only re-emphasise what I said in reply to the supplementary question by the noble Lord, Lord Walton, that we are aware that there are examples of what is called colloquially "post-code" prescribing. Through it, some people are prevented from having the drug but others are not. It is unfortunate and something which we are determined to improve through the national guidelines, the national performance framework and the national clinical service frameworks. Those will come into force once we can achieve the legislative process through Parliament.

As to the specifics about individual patients being asked to wait six months, I suspect that that has to do with the individual decisions of health authorities. Unfortunately, they vary across the country.

Baroness Masham of Ilton: My Lords, because interferon is being used now for the treatment of

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hepatitis C and other conditions as well as multiple sclerosis, what are the chances of the pharmaceutical industry bringing down prices?

Baroness Jay of Paddington: My Lords, that is a complicated industrial question. It is something about which patient groups feel strongly, and probably rightly so. It would be helpful if pressures could be brought to bear on the pharmaceutical industry for the introduction of effective and cost-effective drugs at lower prices.

To return to the point made by the noble Baroness, Lady Gardner, which I believe to be the same as that being made by the noble Baroness, Lady Masham, the decisions in relation to these drugs should be made not simply on cost terms, but on cost-effectiveness terms. It is not simply a question of the marketing price, but of the relative marketing price in terms of other methods of treatment.

Lord Ashley of Stoke: My Lords, does my noble friend agree that this is a tricky question? Clinical judgment is of little value if, when it is exercised, the health authority will not fund the necessary provision. I know of some health authorities which do not keep up to date with modern developments--I can provide my noble friend with evidence of that statement if necessary. Would it be worth while for the Government to monitor whether health authorities keep up to date with modern developments so that they know whether or not to take action?

Baroness Jay of Paddington: My Lords, I agree with my noble friend that it is a tricky question. It is a question of balance between the individual clinical freedom of practitioners in the medical profession and the understanding of local health authorities. I re-emphasise to my noble friend that we hope that, with the introduction of so-called clinical governance, variations from the expected good practice which will be recommended by the National Institute for Clinical Excellence will be increasingly challenged. We expect that guidance to be implemented consistently across the NHS. How well that happens in practice will determine whether and how NICE's powers may or may not be strengthened in the future.

Lord Mackie of Benshie: My Lords, following the question of the noble Baroness, Lady Gardner, is there anything to prevent the Government from acting as a bulk buyer to bring down the price of drugs?

Baroness Jay of Paddington: My Lords, that is precisely what the NHS is; that is, a bulk buyer of drugs. That is why, overall, patients who obtain drugs on prescription through the NHS do so at competitive prices, particularly if we draw comparisons with our neighbours in Europe.

Lord Thurlow: My Lords, is the noble Baroness aware that the promising evidence that MS sufferers can be restored to normal health and activity by controlled

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diet and lifestyle change is mainly anecdotal at present? Will she encourage research to endeavour to establish the facts?

Baroness Jay of Paddington: My Lords, the noble Lord was kind enough to tell me that he might raise this issue. I asked people what the situation was on research into the matter, which is broadly in the area of complementary medicine for MS. At the moment the people involved in funding clinical trials, which would be the basis on which the NHS would make a decision about treatment, are not intending to conduct such trials.

Earl Howe: My Lords, the NHS White Paper commits the Government to ensuring consistent access to beneficial care across the NHS. Yet the unfortunate fact is that the strong guidance issued in 1995 by the NHS Executive has been ignored by many health authorities. Perhaps I can draw the Minister a little more on what she said about the National Institute for Clinical Excellence. What prospect is there that any guidance which may be issued by the institute will carry any more force than the guidance already promulgated? If it does not, then these inequalities in treatment will persist.

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