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NHS: Cancer Drugs


3.24 pm

Asked By Lord Naseby

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Baroness Thornton: My Lords, the National Institute for Health and Clinical Excellence appraisals of Tyverb for advanced breast cancer and Sutent for both renal cell carcinoma and gastro-intestinal stromal tumours are ongoing. It would not be appropriate for the Government to pre-empt NICE's final guidance to the NHS. Until NICE issues its guidance, decisions on the funding of these drugs must be taken locally.

Lord Naseby: My Lords, I am most grateful to the Minister, but there was a total review of cancer drugs by Professor Richards. It is amazing that NICE continues to review these two drugs at such inordinate length, which means that the 1,500 people with advanced stage bowel cancer and the 2,000 with advanced breast cancer—both of which are terminal—are still suffering. Taking that into consideration, does it make sense for the Government, in the past five years, to have funded an increase in clerical staff in the PCTs from 54 million to 115 million? The House will accept that these drugs are expensive, but, after all, do these National Health Service patients not deserve the best? Surely, they can be funded from a reduction in clerical staff in the PCTs.

Baroness Thornton: My Lords, the Government are very concerned to make sure that as many drugs as possible are available to patients with these conditions. The noble Lord will appreciate that Tyverb comes under the heading of a very difficult area. If Tyverb were to be considered by NICE under the flexible approach it is now taking to end-of-life drugs, it is still unlikely that it would be recommended under the quality-adjusted life years measurement used by NICE.

NICE is issuing guidance that Sutent should be available on the NHS to those who have renal cell carcinoma. In the past week, Macmillan Cancer Support has said that this will make an enormous difference to those patients. Every year, 7,000 people are diagnosed with kidney cancer in Britain, and 3,600 of those patients will be eligible to receive Sutent.

Lord Walton of Detchant: My Lords, while we must sympathise deeply with the patients suffering from these serious and incurable forms of cancer and who see these drugs as giving them a prospect of many more months of useful life, would the noble Baroness nevertheless agree that the National Institute for Health and Clinical Excellence is faced, at times, with an almost insuperable dilemma, in having to determine not only the efficacy of drugs but also their cost-effectiveness? Despite that, is it not the case that, if an oncologist can persuade a local health authority or a primary care trust to prescribe one of these drugs for a patient, he or she can do so? Will the Government also confirm that, in the light of their recent decision, in an extreme position any patient wishing to purchase these drugs will not be denied continuing NHS care as a result of doing so?

Baroness Thornton: My Lords, the noble Lord is exactly right about both those issues. The timetable outlined by the Secretary of State on 4 November 2008 means not only that we will deal with issuing guidance faster on these drugs, but also that the flexibility referred to by the noble Lord is built into the system.

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Baroness Hollis of Heigham: My Lords—

Baroness Tonge: My Lords—

The Minister of State, Department of Energy and Climate Change & Department for Environment, Food and Rural Affairs (Lord Hunt of Kings Heath): My Lords, if my noble friend goes first, then we can hear from the noble Baroness, Lady Tonge.

Baroness Hollis of Heigham: My Lords, I will be quick. What is my noble friend able to do to speed up NICE assessments?

Baroness Thornton: My Lords, we have already taken action to improve the speed with which NICE guidance is issued. As I said, my honourable friend the Secretary of State outlined a new appraisals timetable which will mean that, by 2010, the average time taken by NICE to produce draft or final guidance on new cancer drugs will fall well below six months after licensing.

We are determined that the fast-track, single-technology appraisal process will shorten the time taken to bring on new cancer drugs. Building on these improvements, we also intend to extend that provision to achieve timely delivery of guidance, as a matter of course, on all new drugs.

Baroness Tonge: My Lords, I appreciate that this is an extraordinarily difficult area, but I understand that the National Institute for Clinical Excellence says that Tyverb will give only a few extra weeks of life, if that. In many cases, patients may be quite content to have just a few extra weeks or months of life for some family event they are looking forward to. The drug company that manufactures the drug has offered 12 weeks of treatment free to those patients whom the clinicians think may benefit from it if the Government will take up funding thereafter. If the national institute is right, those patients will be dead in a very short time anyway, so why do the Government not take up the offer of the drug company?

Baroness Thornton: My Lords, the noble Baroness is quite right: Tyverb is a very difficult issue and a high-profile drug. Even if the Government were to take up the offer of the drug company, NICE—this is on the website and in the published draft guidance—estimates that the cost of Tyverb per quality-adjusted life year is around £70,000, compared with the normal NICE threshold of around £30,000. The renal drug Sutent, which NICE has recently recommended, costs around £50,000. The noble Baroness will appreciate that we are talking about very difficult and expensive drugs. The matter is still under consultation. The final decision has not been taken. I am sure that this short debate will be fed into the process. Those are the economics of the drugs.

Consolidated Fund (Appropriation) Bill

First Reading

3.31 pm

The Bill was brought from the Commons, endorsed as a money Bill,and ordered to be printed.

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Arrangement of Business


3.32 pm

Lord Bassam of Brighton: My Lords, it may be helpful to the House if I say a few words about the expected timing of proceedings in the Northern Ireland Bill and the Marine and Coastal Access Bill. There are some 20 amendments on the Marshalled List for the Committee stage of the Northern Ireland Bill, which we estimate will take around two hours to consider. Once Committee stage of the Northern Ireland Bill is completed, the Committee stage of the Marine and Coastal Access Bill will be resumed. The Report and remaining stages of the Northern Ireland Bill will be taken after further proceedings on the Marine and Coastal Access Bill.

It might also be helpful if I set out the arrangements for Members wishing to table any amendments for Report stage of the Northern Ireland Bill. The Public Bill Office will accept any amendments for Report stage for one hour after the end of Committee stage. If amendments are tabled, the Public Bill Office will produce a Marshalled List, which will be made available in the Printed Paper Office as soon as can be arranged. The expected time for the Report stage on the Northern Ireland Bill will then be displayed on annunciators around the House.

Northern Ireland Bill

Bill Main Page
Copy of the Bill
Amendment Paper
6th Constitution Committee


3.33 pm

Moved by Baroness Royall of Blaisdon

Baroness Royall of Blaisdon: My Lords, before I ask the House to resolve itself into a Committee on the Bill, I am sure that the whole House will join me in sending heartfelt condolences to the family of Constable Stephen Carroll, the brave PSNI officer who was shot dead on Monday morning. Constable Carroll died in the line of duty, doing his job protecting the community where he worked. He was murdered by cowards—desperate and isolated individuals who are determined to destroy a political process that is working for and wanted by the people of Northern Ireland. They must not be allowed to destroy or undermine that peace process. I beg to move.

Motion agreed.

Clauses 1 and 2 agreed.

Clause 3: Miscellaneous amendments

Amendment 1

Moved by Lord Kingsland

1: Clause 3, page 2, line 17, at end insert—

“( ) For section 22(2) of the Justice (Northern Ireland) Act 2002 (c. 26) substitute—

“(2) The Attorney General for Northern Ireland shall be appointed by the Lord Chief Justice and the provisions of section 5 (as amended) shall have effect for the procedure governing such appointment.”

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( ) In the Justice (Northern Ireland) Act 2002 (c. 26) omit section 41.”

Lord Kingsland: I, and all Members who sit on this side of the Committee, echo everything that the Lord President said about the ruthless and cowardly killing that took place between Second Reading and today. It is tragic that on the first two occasions when the House has addressed this Bill, we have had to begin proceedings by expressing our condolences in that way. Let us hope that it will not happen again.

I had an opportunity at Second Reading to outline the substance of my amendment. I merely intend to underwrite those remarks by providing your Lordships with a little more detail. In this group of amendments we have Amendment 1 and Amendment 12. It might be helpful to the Committee if I began not at the beginning but at the end, by reading out the text of Amendment 12.

This amendment seeks to amend Section 42(1) of the Justice (Northern Ireland) Act 2002, which refers to the independence of the Director of Public Prosecutions for Northern Ireland. As many of your Lordships are already aware, the subsection reads:

“The functions of the Director shall be exercised by him independently of any other person”.

Amendment 12 seeks to amend Section 42(1) as follows:

“The Director must exercise his functions under the superintendence of the Attorney General for Northern Ireland in relation to devolved matters and the Advocate General for Northern Ireland in relation to retained matters and is subject to any directions given by either of them thereunder, but a failure to comply with this subsection does not affect the validity of anything done by or on behalf of the Director”.

Your Lordships will be familiar with the relationship between the Attorney-General and the Director of Public Prosecutions in England and Wales and, indeed, at present, in Northern Ireland. This amendment simply mirrors our own constitutional practice. We believe that Section 42(1) needs this amendment because if it were not so, the Director of Public Prosecutions for Northern Ireland is likely to be exposed to an unacceptable degree of political pressure over at least some of the prosecutorial decisions that he will have to make. In particular, I fear that he is likely to be accused of bias. Under the 2002 Act, the director has no access to the Northern Ireland Assembly to explain and justify his prosecutorial decisions.

That brings me to the other amendment in this group, Amendment 1, which is in substitution of Section 22(2) of the Justice (Northern Ireland) Act 2002. It may be helpful if I read out that subsection before I come to the amendment. It states:

“The First Minister and deputy First Minister, acting jointly, must appoint a person to be Attorney General for Northern Ireland”.

So the Attorney-General is appointed, in effect, by a political deal between the two leading politicians in Northern Ireland. That deal does not even have to be sustained or justified by any reference to the Assembly, because there is no requirement in the 2002 Act to refer the deal to the Assembly.

We submit that that subsection should be replaced by the following:

“The Attorney General for Northern Ireland shall be appointed by the Lord Chief Justice and the provisions of section 5 (as amended) shall have effect for the procedure governing such appointment”.

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Section 5 provides that listed judges, and that includes High Court judges, shall be selected in the following manner. After interviews, they will be nominated by the Judicial Appointments Commission in Northern Ireland. That appointment will then be endorsed by the Lord Chief Justice. That is the selection procedure for High Court judges and below. We propose that that procedure should now be used also to appoint the Attorney-General for Northern Ireland.

I think that it is plain to your Lordships why we have done this. Superintendence works in this country because, although the Attorney-General is a member of the Government by constitutional convention, in our jurisdiction he is nevertheless under a quasi-judicial duty to exercise his superintendence over the Director of Public Prosecutions entirely independently of political pressure. That constitutional convention does not exist in the Northern Ireland jurisdiction, or will not exist once devolution occurs. Therefore, this amendment is intended to inject our convention into the devolved system of justice in Northern Ireland.

Once Amendments 1 and 12 are read into the 2002 Act as a result of amending the Bill today, we will have injected into devolution precisely the same arrangements as we have here. That means that, in an often highly charged situation, the Director of Public Prosecutions in Northern Ireland will have the proper protection in relation to his decisions that our own Director of Public Prosecutions receives here.

The Government have taken issue with this and set out their reasons for doing so in the debate on Second Reading. The basis of the Government’s view is that the 2002 Act is the consequence of an investigation which took place right at the end of the previous century and crystallised itself in to what is termed the Northern Ireland Criminal Justice Review. The review was completed in 2000 although it was not published until 2002. The 2002 Act is, in effect, a carbon copy of the Criminal Justice Review. The Government contend that it would be a monumental mistake to seek in this Bill to change the conclusions of that review, as the Lord President said unequivocally to your Lordships’ House on Monday.

Our response is twofold. The first, which was extremely eloquently expressed by my noble and learned friend Lord Mayhew, is that the review was completed nine years ago and a great deal has happened since then; and it would be a mistake to lash ourselves to the tiller of the review without giving ourselves any room for manoeuvre to respond to the many events that have happened since.

3.45 pm

My second response is that, in any case, in one significant manner, this Bill alters the recommendations of the Criminal Justice Review 2000 and the content of the Justice (Northern Ireland) Act 2002. It changes the way in which High Court judges are selected, and much for the better. If your Lordships glance at Schedule 3 to the Bill, you will see that, once judicial matters are devolved in Northern Ireland, judges will be selected by a procedure that differs significantly from the 2002 Act. In the 2002 Act, High Court judges are selected first by the Judicial Appointments Commission, and then

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endorsed or otherwise by the First Minister and Deputy First Minister. We deplored that at the time and have continued to deplore it in a variety of amending Acts.

I congratulated the Government on what they have done in Schedule 3. The Northern Ireland Bill has removed the First Minister and Deputy First Minister from the selection procedure and replaced them with the Lord Chief Justice of Northern Ireland. This is a very significant change. Here is a major example of the Government being prepared to think again about the 2002 Act. If they can think again about a matter as significant as that, why can they not think again about the relationship between the Attorney-General for Northern Ireland and the Director of Public Prosecutions?

We are of course in some difficulty in dealing with this Bill today, as many noble Lords said at Second Reading. It is emergency legislation and takes place against a backcloth of recent events which give rise to great concern—although not, I hope, about the future of devolution. I remain confident that we will achieve that objective. Certainly, it is not a time to start tearing apart arrangements that have been carefully crafted over a long time, even if some of us disagree with some of those arrangements. After all, the implementation is not yet to take place and we may have other opportunities to change the character of the 2002 Act.

That consideration—together with the fact that under Section 22(2) of the Justice (Northern Ireland) Act 2002, the First Minister and Deputy First Minister have already chosen the person who is to become the first Attorney-General for Northern Ireland under these arrangements—has led the Opposition, despite our strong support for this amendment, to take the view that it would be wrong, at this juncture, to press this amendment to a vote. However, I hope that we will get another opportunity to look at this in calmer legislative circumstances. I beg to move.

Baroness Harris of Richmond: I associate these Benches with the expression of revulsion and horror at the murder of PC Stephen Carroll. I have been advised today by the Police Federation of Northern Ireland that it is looking after the family of Stephen Carroll. I have expressed all our heartfelt sympathy to them.

I have a brief comment on Amendment 1. We agree that there could be difficulties if the Lord Chief Justice appointed the Attorney-General. One of the roles of the Attorney-General is of course to give legal advice to the Executive, and it could be very uncomfortable for the Lord Chief Justice to appoint the person who is to give legal advice to the Executive.

On Amendment 12, the Minister in the Commons reassured the House that the DPP is independent and that his independence is written across the criminal justice system. Members from Northern Ireland also said that the independence of the DPP has been accepted across Northern Ireland. We are in some difficulty about whether any specific instances have led the Conservatives to worry that the DPP is not independent, other than that stated by the noble Lord, Lord Kingsland, that there could be an unacceptable degree of political pressure and that the DPP could be accused of bias. In both cases the word “could” made us a little concerned. I should be grateful to hear whether any specific instances have led to their concerns.

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Baroness Royall of Blaisdon: Amendment 1 proposes that the devolved Attorney-General should be appointed by the Lord Chief Justice, instead of by the First Minister and Deputy First Minister, as provided for in the Justice (Northern Ireland) Act 2002.

Amendment 12 proposes that the Director of Public Prosecutions should be under the direction and superintendence of the Attorney-General for Northern Ireland and the Advocate-General for Northern Ireland.

These amendments would also mean that a number of functions would no longer transfer from the Attorney-General for Northern Ireland to the DPP on devolution of policing and justice. These functions include consenting to the institution or conduct of criminal proceedings, entering a nolle prosequi, and referring unduly lenient sentences to the Court of Appeal.

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