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Health: Velcade

Volume 688: debated on Thursday 18 January 2007

asked Her Majesty’s Government:

What are the consequences to National Health Service patients of the National Institute for Health and Clinical Excellence’s decision not to approve the drug Velcade.

My Lords, the National Institute for Health and Clinical Excellence has not yet issued its final guidance on the use of Velcade. Appeals have been lodged against NICE’s final appraisal determination and are due to be heard on 8 February.

My Lords, has my noble friend seen the press reports in relation to Mr George King, who suffers from myeloma but has been told that the next stage of his treatment will require the drug Velcade? In view of that, he has announced his intention to go to Scotland because the drug is not available in England due to the NICE decision. Does my noble friend agree that that is unacceptable and ludicrous? As Mr King has put his move on hold until his appeal has been heard, does he also join me in hoping that NICE will reverse the decision so that Mr King can stay in his home and with his family and friends?

My Lords, while of course I have every sympathy with any member of the public who suffers from this condition, it is not appropriate for me to comment on the NICE decision because it is still going through the appeal process. Up to the moment when NICE makes a final decision and it is issued to the health service, it is up to individual primary care trusts locally to make a decision. So at this stage it is very much a matter for a local decision in the NHS.

My Lords, does the Minister agree that NICE is faced with an incredibly difficult and daunting task in trying to assess the clinical effectiveness of new drugs and new interventions in the NHS? Did he notice the long interview given by the chairman of NICE in a weekend newspaper? One implication of his remarks is that as more and more highly effective and very expensive drugs come on stream the time may ultimately come when the NHS will not be able to afford them. What steps are the Government taking to deal with that eventuality?

My Lords, I certainly read with a great deal of interest Sir Michael’s interview with the Times on Saturday. I think that he was joining in the usual NHS process of encouraging generous settlements on behalf of the NHS. In general I would say two things. First, the impact of NICE has speeded up the introduction of new medicines and treatments. We reckon that the cost of the technology appraisal judgments to the NHS since NICE was introduced is more than £1 billion. Secondly, the funding that we have put into the NHS indicates that the NHS is in the best position that it has been in to take advantage of these new techniques.

My Lords, the Minister has just said that it is up to local primary care trusts to decide whether to allow Velcade to be prescribed. Does he not think that the Secretary of State should perhaps give the same clarification to PCTs about Velcade that she gave with Herceptin—that they should not necessarily use the NICE process as an excuse not to prescribe a drug and therefore end up with people going to Scotland, or whatever?

My Lords, we have made it absolutely clear to primary care trusts that in advance of any NICE judgment a PCT cannot simply say that it will not fund a treatment because it is waiting for a NICE decision. In the period before a NICE decision, the local PCT has to take a number of factors into account and reach its own judgment.

My Lords, is not the position very difficult when PCTs have large debts? Can the Government not do something about the drugs being given nationally instead of by the PCTs? Otherwise, it is going to be postcode prescribing all the way.

No, my Lords, I do not agree with that. NICE was introduced to deal with postcode prescribing. We now have much more consistency and a much more rigorous approach to introducing new treatments and drugs which have proven to be clinically and cost effective. Yes, a number of PCTs, but only a minority, are facing financial challenges to come out of deficit in the current financial year. But overall we are in the middle of the biggest expansion in finance that the health service has ever seen, which is why we can treat more patients more quickly and take advantage of many new treatments and drugs.

My Lords, while not wishing to undermine or overrule NICE, perhaps I may ask what steps the Government have taken to negotiate with the makers of Velcade, Johnson & Johnson, to explore all other possible means of making this promising drug more widely available for the benefit of NHS patients; for example, through a risk-sharing scheme. The Minister must understand the seriousness of the issue—the great frustration which NICE’s decision has caused for many cancer patients and the perceived injustice of the drug being available in Scotland.

My Lords, I do not underestimate the concern and anxiety that is caused to patients, but we have to ensure that the way the resources available to the NHS are used is clinically and cost effective. That is why we have established NICE as an independent body. That is why it would not be right for Ministers to intervene in that process.

My Lords, is the Minister concerned that the All Wales Medicines Strategy Group looked at the same data as NICE but came to a different conclusion? For the past 18 months, Velcade has been available in Wales, and patients have moved there. Does this not undermine public confidence in the way health economics data are presented and analysed?

My Lords, it is inevitable that, if health services are the responsibility of different Administrations in the UK, different approaches will be taken. The NICE methodology has been tested considerably. Many countries look to NICE for guidance and advice based on the thorough approach that it takes. The Government are not complacent. NICE is about to undertake a further review of its approach and methodology. We will want it to take account of all factors. If there are lessons to be learnt from other countries, we should take them on board. In the years of NICE’s existence, it has shown itself to be wholly independent and rigorous.