Skip to main content


Volume 460: debated on Tuesday 22 May 2007

3. If she will make a statement on the progress of the National Institute for Health and Clinical Excellence. (138338)

Since its establishment in 1999, NICE has consolidated its position as the leading source of evidence-based guidance on specific health interventions and on broader care pathways. It has deservedly earned international recognition for its work.

I am grateful to the Minister for his response. I have always supported NICE and I still do. It is perfectly obvious that we need a central assessment point for new medications and treatments. Is he satisfied, however, that there is a sufficient flow of information and discussion between NICE and the companies and patient groups involved in the assessment process? Does he think that that process could be made more transparent?

My hon. Friend is absolutely right to suggest that, in the context of modern science and health care, if NICE did not exist, we would have to create it. We are currently conducting an overall review of the way in which NICE reaches its conclusions; it began in April, and is due to report to the NICE board in November. In 2005, we introduced what is known as a single technology appraisal process, which enables NICE to speed up some of its decision-making processes. In addition, best practice guidance was issued to the NHS in December 2006, stating that if a clinical decision is made that a patient requires a particular form of medication, there is no requirement for the primary care trust to wait for the conclusion of the NICE appraisal to ensure that the patient has access to that treatment. Overall, NICE has been a tremendous success, but we are also in the process of reviewing its function, as is appropriate at this stage.

Is the Minister aware of the use of miniature telescopic eye implants as a cure for age-related macular degeneration? This operation is available in many parts of Europe and in the United States, and one operation has been successfully completed by Brendan Moriarty, an eye surgeon in my constituency. Will the Minister urge NICE to look into this new operation as urgently as possible, as it will help people to retain their sight?

I have a good deal of sympathy with the hon. Gentleman’s point. Macular degeneration is a real issue for an increasing number of our constituents. I was not aware of that specific intervention, but I think it right for us to reflect on what the hon. Gentleman has said, and then to decide whether the evidence that we have is sufficient for us to refer it to NICE as one of its priority considerations. Now that the hon. Gentleman has raised the issue, we will certainly have a look at it.

Why is it that although the chief medical officer’s recommendations on the prevention of hospital-acquired thrombosis were almost universally welcomed, shortly afterwards the NICE guidelines on the same topic seemed to contradict the original, leaving many health professionals aghast? Will my hon. Friend undertake to look into the matter, and ensure that no confused messages are being received by hospitals about a policy that could prevent 25,000 deaths?

I will certainly look into the matter. It is important that, where possible, there is no ambiguity in the message that we send clinicians and primary care trusts on the front line. I cannot comment at this stage on whether there was a difference of opinion between the chief medical officer and NICE, but I will commit myself to investigating that, and to ensuring that whatever message is appropriate is clearly conveyed.

I agree with the Minister that NICE is one of the successes of the Government’s health policy over the past 10 years, but is it not time, as part of the review to which he referred, to look again at the principles according to which Ministers retain control of the agenda of issues that NICE examines? Should not NICE have an opportunity to set aspects of its own agenda?

I think that if we are to conduct a fundamental review now that NICE has existed for some time, one of the issues that ought to be reviewed is the relationship between Ministers and the organisation, as well as the relationship with Department of Health officials. We need to ensure that we get the responsibilities of the respective decision-makers absolutely right. It is important for clinicians and primary care trusts to be clear about the position, but transparency is also important, so that patients know what to expect at a time of technological advances and increasingly complex conditions often associated with people living longer.

May I refer my hon. Friend to the NICE review of the drug Alimpta, which is used to treat mesothelioma? Specialists fear that the original decision to refuse NICE approval was based on a failure to understand the clinical evidence, and in particular the fact that the drug is efficacious in prolonging both life and quality of life. Those are important considerations for people who will certainly die of mesothelioma.

NICE is actively considering the issue. I understand that, according to the guidance, those who are already receiving the treatment are entitled to continue to receive it, but no final decision has been made. I suggest that my hon. Friend and others make representations to ensure that NICE reaches an appropriate conclusion.

NICE does a good job for the Government in rationing health care in a rational way, but is not one of the key requirements of rationing that it should be explicit and transparent? As everyone else now recognises that a treatment that costs more than £30,000 per quality-adjusted life year will not be approved by NICE, will the Minister confirm that that is also his understanding? Such transparency would help politicians to accept that that is what is happening.

No, I will not confirm that. It seems to me that the appropriate context for such a judgment and such a debate is the review, which seeks to be clear about NICE’s function. It also seems to me that we either believe in the need for an organisation such as NICE, in the context of a modern NHS and massive advances in technology and science, or we do not. The use of words like “rationing” by the Liberal Democrats does not accord well with this debate.

NICE was established to deal with the problem of postcode lotteries, but a key problem is that many new drugs awaiting appraisal are subject to terrible regional variations and lack of funding. A recent freedom of information survey by the Conservatives showed that people in England are going blind because cash-strapped primary care trusts are not funding Macugen, which has been approved in Scotland. Some PCTs have been turning down all requests for Macugen although they come from clinicians, with the average PCT funding only two patients, despite an estimate by AMD Alliance that 100 patients a year in every PCT could benefit. Will the Minister now investigate, as a matter of urgency, why his own guidance to PCTs that funding should not be withheld simply because NICE has not issued guidance is being so readily flouted, before new drugs such as Lucentus suffer the same fate?

We have moved to respond to the concerns that have been expressed as NICE’s function has been developed. For example, we introduced the new single technology appraisal process in an attempt to speed up the process. We have also issued best practice guidance to primary care trusts, which makes it clear that where a clinician believes that a licensed drug is an appropriate way of treating a condition, there is no requirement to wait until NICE has concluded its appraisal process. The right way forward is a combination of speeding up the process and being absolutely clear about what we expect from primary care trusts. Members cannot have it both ways. We either devolve responsibility, power and decision making to the local level or we command and control from offices in Westminster and Whitehall. We cannot have a contradictory approach.