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Volume 450: debated on Tuesday 24 October 2006

1. 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)

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.

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?

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.

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?

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.

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?

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.

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?

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—

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.

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?

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.

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.

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.

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?

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.

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.

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:

“Frankly, it is my opinion that in an independent national health service such decisions must be made independently”.—[Official Report, 11 October 2006, Vol. 450, c. 307.]

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.]

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—