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Anticholinesterase Drugs

Volume 447: debated on Tuesday 20 June 2006

2. What recent representations she has received on the prescribing of anticholinesterase drugs to people in the early stages of Alzheimer’s disease. (78461)

Ministers have received a number of representations on the availability of those drugs in the context of the drugs’ ongoing appraisal by the National Institute for Health and Clinical Excellence. I have also recently met representatives of the Alzheimer’s Society, the Royal College of Psychiatrists and the Royal College of Nursing to hear their views.

In those meetings, did the Minister note the strong feeling among patients, carers and clinicians that the early prescription of these drugs leads to a higher quality and longer life? All those people believe that early prescription slows long-term decline—what is the Minister’s view?

I am aware of those strong feelings. It is crucial that the appraisal process is carried out properly, and, as my hon. Friend knows, the process is still ongoing. Independent clinical experts should be the ultimate arbiters, but it is also right that the strength of feeling among patients throughout this country is voiced through their parliamentary representatives, which my hon. Friend has done today.

Is it not morally wrong that people with dementia are prevented from having the relatively inexpensive drugs that will prevent their dementia from getting worse? Preventing people from having those drugs is a false economy, because when dementia deepens, the cost of looking after the patient is much greater.

The National Institute for Health and Clinical Excellence was set up to take on the difficult questions that we face in judging the clinical effectiveness of treatments against their cost-effectiveness. The hon. Lady would perhaps be the first to complain if that judgment was being made by Ministers. It is important to make it clear that existing patients will not be affected and will continue to receive these treatments. However, we all want the process to be conducted fairly and, ultimately, an independent judgment to be made on the evidence.

Having been to local meetings of people concerned about the use of these drugs, I know that it is a huge benefit for people to able to have them in the early stages of Alzheimer’s disease. When my hon. Friend speaks to NICE, will he ask it to consider the contribution that the drugs make to a more independent, less stressed, and perhaps even happier life?

The NICE process has been undertaken with unprecedented thoroughness. My hon. Friend refers to the early stages of the disease, and the use of drugs at that time is precisely the issue that is being examined in depth and will be considered during the appeals process. I am sure that the strength of feeling that she represents will be heard, but ultimately it is right that an independent judgment is made by experts in that illness.

May I declare an interest in that I am patron of the east Cheshire branch of the Alzheimer’s Society and therefore take a huge and close interest in this subject? Does the Minister accept that society has a duty to enable those who suffer from Alzheimer’s, even those in the early stages of the disease, to have the best quality of life that is available to them, and that that means the use of the most advanced drugs? Will he ensure that the best drugs are available to give those with Alzheimer’s the best quality of life that this House would wish them to have?

Of course, there will be no division between Members in wanting to ensure that people get the best quality of life that they can. That is precisely what NICE is considering in terms of the difficult judgment that must be made. As a former Chair of the Health Committee, the hon. Gentleman will know that a balance must be struck between the available resources and the benefits that this treatment can offer. We have collectively asked NICE to investigate these difficult questions for us, and we all have a duty to support it through this difficult process and ultimately to consider fairly its recommendations.

Does it worry my hon. Friend that if the NICE guidance is implemented there will be less support in future for patients in the early stages of Alzheimer’s? Can he at least give assurances about the things that matter to those patients and their carers: early identification of Alzheimer’s cases; more support for the patient, the family and the carer; and more research into finding treatments that will be effective in the early stages of the disease?

I can certainly assure my hon. Friend on his last point. Research into those matters is hugely important. Of course, I am not a clinician, which is why it is important that the NICE appraisal process carefully considers questions about the early stages of Alzheimer’s and makes its judgment on whether there is evidence to support the arguments that he and other hon. Members are making. It is right that that process should be allowed to run its course, and it would be wrong for me to prejudice it. I am pleased that my hon. Friend and other hon. Members have expressed their points of view, and I am sure that they will be heard beyond this House.

Despite what the Minister says, he will have to accept that NICE has confirmed that these drugs are clinically effective but that people will now have to wait longer before receiving them. That is not only harsh but contradicts the Government’s own policy of early diagnosis and intervention. Given that, last year, the Government asked NICE to re-examine whether its model of cost-effectiveness took full account of the complexities of this case, particularly the impact that withdrawing those drugs would have on carer time and quality of life, is he completely satisfied that NICE has addressed those specific concerns; and if not, what further action does he propose to take?

The hon. Gentleman must accept that the appraisal process that NICE has gone through is extremely detailed and that it has examined all the available evidence. Indeed, the appraisal process continues—it is right that it should do so and that the questions that he identifies are properly considered. However, is it right for us to second-guess the independent experts? Is it right that we should set up NICE only to undermine—