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Multiple Sclerosis

Volume 730: debated on Thursday 13 October 2011

Question

Asked By

To ask Her Majesty’s Government what action they are taking to improve the United Kingdom’s international standing in relation to patient access to new treatments for multiple sclerosis.

My Lords, a number of treatments for multiple sclerosis are available to UK patients, supported by the multiple sclerosis risk sharing scheme, National Institute for Health and Clinical Excellence guidance and Scottish Medicines Consortium advice. Our priority is to ensure that patients have access to new and effective treatments. NICE’s forthcoming review of its clinical guideline on MS will bring together up-to-date advice on the best treatments for patients, as part of the overall package of care.

My Lords, I thank the noble Earl the Minister for that reply. It is true that the prognosis for many patients with multiple sclerosis has been transformed by the use of these immunosuppressive agents since interferons were introduced. Is he aware that recently a new and effective remedy called fingolimod, which is available by oral administration instead of injection, has been introduced? It has been licensed but has been rejected by NICE for the moment purely on cost grounds. At the moment, evidence suggests that about 60 per cent of patients with this condition in the United States, 30 per cent in most of Europe and only 17 per cent in the UK are receiving this type of medication. Is it therefore not likely that this is the result of restraints on prescribing largely on financial grounds?

The noble Lord is quite right about fingolimod. Since the publication of NICE’s draft guidance, the manufacturer has proposed a patient access scheme for the drug, and the department has agreed that this can be considered as part of NICE’s appraisal. The noble Lord raises a very interesting point about cost. Professor Mike Richards’s report, which came out last year and looked at the extent and causes of international variations in drug usage, outlined a number of potential explanations for the relatively low uptake of some treatments. In the case of MS, one of the reasons identified was caution among some neurologists about the benefits of particular treatments, but also tighter clinical guidelines on the use of MS treatments in the UK compared with some other countries. It is important to stress that in treating MS, medicines form only part of an overall package of care, which of course can consist of access to neurology services and specialist MS nurses.

My Lords, referring to what the noble Earl just said about the Richards report, that report ranked the UK 23rd out of 25 EU countries, with only Slovenia and Lithuania more restrictive on access to new treatments than the UK. The NICE guidelines will not be revised until 2014, having last been done in 2003. For sufferers of MS, a horrible disease, that seems a very long time to wait. I hope that in the reviews that are taking place, the Government will do everything possible to accelerate this work and ensure that NICE gets on with it, and that the Government give priority to MS research in future.

My Lords, I take the noble Lord’s point. NICE is reviewing its clinical guideline. That is not due to be published until 2014. Although we strive to ensure that there is national guidance on the most commonly used medicines and treatments, there will always be instances where decisions have to be made locally. Under the NHS constitution, patients have the right to expect local decisions about the funding of medicines and treatments to be made rationally, following proper consideration of the evidence. We are emphasising to PCTs that they should do just that.

My Lords, I declare an interest in that I have a daughter who has had MS for 30 years. Recent research announced in Russia indicated that they believe they are developing an answer to rebuilding the myelin sheath, which would be great progress in multiple sclerosis treatment. Can the Minister assure us that when that research is available we will follow it here and introduce it at the earliest possible time?

My Lords, new and innovative treatments for MS are being developed in a number of countries. It is quite clear that any new treatment of this kind should be subject to the rigours of the regulatory system before it is made available to NHS patients. Many of them will not have been fully tested to ensure efficacy and safety, but we will of course examine every novel and innovative treatment that has the potential to benefit patients.

The Minister will be aware that the move from the large-scale commissioning of health services to smaller-scale commissioning carries a danger for those who will be deemed on the smaller scale not to have sufficient critical mass numbers to command attention. What do the Government intend to do to ensure that conditions such as MS and other chronic conditions are not endangered by that move to small-scale commissioning?

The noble Lord makes a very good point. Commissioning by clinical commissioning groups does not mean that individual groups will have to commission every service. They can commission collaboratively across larger populations if that makes sense for them. Additionally, some services for less common conditions, including some neurological conditions, fall within the scope of specialised commissions and will be commissioned subject to the passage of the Health and Social Care Bill by the NHS Commissioning Board.

I understand that in Europe the neurological commissioning support, which was developed with the support of a number of neurological charities, including the MS Society, has been well received by commissioners and is doing very good work.