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Health: NICE

Volume 720: debated on Wednesday 14 July 2010


Asked By

To ask Her Majesty’s Government whether they plan to review the management and procedures of the National Institute for Health and Clinical Excellence to ensure that patients suffering from the most prevalent conditions of cancer and Alzheimer’s disease are properly treated.

My Lords, our White Paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010, sets out our commitment to renew the National Institute for Health and Clinical Excellence and, through primary legislation, to re-establish it as an executive non-departmental public body. Legislation on NICE will be included in a health Bill in the autumn.

The Minister’s Answer is extraordinarily welcome. So far as concerns those suffering from cancer and similar problems, is he aware that according to a report called Exceptional Progress?, published in March this year, fewer than four out of nine of the drugs put forward were refused by NICE, which left 16,000 patients with nowhere to go, whereas if they had been French or German those drugs would have been available? Furthermore, is he aware that there is currently great criticism of the processing, structures and methodology used by NICE and that, against that background, his news that the organisation is to be totally reformed is enormously welcome?

My Lords, I am grateful to my noble friend. It is important for me to state that the Government respect the independent expertise provided by NICE and we think that it should be allowed to continue to issue guidance free from political interference. That is a point of principle. However, we also think that there are failings within the wider system regarding drug pricing and drug access. We are determined to address that but we are clear that NICE plays a vital advisory role.

My Lords, how will the Government ensure that the research, which NICE requires to provide the data on which it can make informed decisions, will be supported in the newly reorganised NHS? The NICE document published today, with its review of Alzheimer’s drugs, has as a major recommendation: co-ordination of research to provide good, long-term, end-of-life care studies of the effects of these new drugs in patients.

My Lords, the noble Baroness will have seen in the White Paper the emphasis placed on research. A number of paragraphs in it will be of interest to her, as they emphasise the key role that research and research funding play in the long-term agenda of the NHS and as regards the interests of patients.

My Lords, does the Minister agree that, if early treatment benefits and enhances the lifestyle of those suffering from dementia, and if the cost of granting such treatment is very low, not only would that enhance the life of the individual, it would give added value to carers, as their caring role and their role in employment and in the exercise of their skills would continue to benefit society and all of us for much longer?

My Lords, the noble Baroness makes a very important point about dementia. She will be aware that when the Alzheimer’s drugs were appraised by NICE some years ago, there was disquiet that the role played by carers had not received adequate attention in the appraisal process. It is an issue of great importance to many people, but it is very complex. Given the finite, overall health budget, if we give greater weight to one factor, such as carers or getting people back to work, we automatically, by default, give less weight to others, such as people at the end of their lives. We need to look at this, but it is complex. We shall not let it go, but I cannot give the noble Baroness a definitive answer today.

My Lords, I wonder whether the Minister can do better than the Prime Minister did in Prime Minister’s Questions earlier today, when he declined to give a guarantee that the 14-day period, within which cancer patients should receive hospital treatment, would be upheld. Can he confirm that the Government will stick to the 14-day period?

My Lords, that target of a 14-day referral period has a definite clinical underpinning. There are certainly no plans to abolish it.

My Lords, the treatment of such disorders—particularly cancer, but it is also true of Alzheimer’s disease—requires not just biological but psychological and social interventions. Although the biological research is often funded by pharmaceutical companies, NICE has great difficulty in finding the funding for research for psychological and social treatments. Can my noble friend indicate whether there is any way in which NICE can be assisted to be more broad-ranging in its understanding of a bio-psychosocial approach to treatment of these disorders by facilitating more funding for research in the psychological and social areas?

My Lords, I am sure that my noble friend will accept, as I hope I made it clear the other day, that the Government are wholly committed to improving the quality of care for people with dementia and their carers. We are standing fully behind the dementia strategy, instituted by the previous Government. That strategy contains a specific objective of improving the quality of dementia care in hospitals. I take on board what my noble friend says about the absence of adequate research in the psychosocial domain. I shall discuss that point with NICE over the next few weeks as I am aware that it is one of its concerns.

My Lords, I welcome the statement that the Minister has made about keeping NICE as an independent voice. That is vital. Will the Government still support NICE in its work not just in medical research, but as regards the broader aspects of disease, social conditions, social care and so on, as mentioned by the noble Lord, Lord Alderdice? NICE has broadened its brief and has taken a much more holistic view about the conditions on which it issues guidance. Will the Government still support it in doing that?

My Lords, as the noble Baroness will know, in 2005, the then Government charged NICE with producing public health guidance as part of its work. As we establish a more integrated and effective public health service, we will look actively at how NICE can contribute to that agenda, and, in particular, how it can contribute to integrated care provided by health and social care combined.