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NHS: NICE-appraised Medicines

Volume 752: debated on Thursday 27 February 2014


Asked by

To ask Her Majesty’s Government what is their response to the report of the NHS Information Centre for Health and Social Care, Use of NICE appraised medicines in the NHS in England-2012, experimental statistics, which showed extensive variation in patients’ access to new innovative medicines.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I refer noble Lords to my health interests.

My Lords, patients have a right to drugs and treatments that have been approved by the National Institute for Health and Care Excellence that their doctor decides are appropriate for them. There can be many reasons for variation in use but we are determined to tackle unjustified variation where it exists.

My Lords, I am grateful to the noble Earl for that response. Does he agree that one of the conclusions of the report is that there can be a tenfold variation in the take-up of innovative new medicines that have been approved under the NICE technology appraisal programme? Given that it is a legal requirement for clinical commissioning groups to fund those treatments, as I understand it, what sanctions can be taken against commissioning groups which do not fund those treatments? What can patients do in each area if they are refused such treatments? Is there a process of appeal that they can take their concerns to?

My Lords, there is a process of appeal. Patients can go to their clinical commissioning group or, indeed, to NHS England and ask for the matter to be specially looked at. However, it is important to understand what these figures are and what they are not. They are not intended to be, and do not claim to be, a statement of whether certain drugs are being underprescribed or overprescribed in a particular area. One has to drill down into the reasons. In fact, when one does that, for most of the groups of medicines where it was possible to compare observed and predicted use, the report shows that use has increased over time, and we are introducing additional tools to allow the NHS to get to the heart of the reasons for variations in local areas.

My Lords, can the Minister say what consideration the Government are giving to the availability of the highly expensive so-called orphan and ultra-orphan drugs that are now coming on stream, which are effectively treating many rare diseases?

My Lords, this important class of drugs will be subject to a special evaluation process by the National Institute for Health and Care Excellence. That methodology has been worked through and over the coming months we will see NICE evaluating orphan medicines and medicines for highly specialised conditions to inform clinicians in the NHS and, where appropriate, provide a funding direction for those drugs.

My Lords, perhaps I may follow on from the Minister’s answer to the noble Lord, Lord Hunt, on clinical commissioning groups. The previous year’s report on appraised medicines provided a very helpful algorithm of biologics for rheumatoid arthritis. Will NICE and other organisations involved in these specialist medicines follow a similar algorithm to make it even clearer to CCGs where they should not step out of line but must follow clinicians’ advice?

It is important to distinguish between a technology appraisal, where, if favourable, there is a clear funding direction for the NHS—in other words, it must fund the drug if the doctor thinks that it is appropriate for the patient—and a clinical guideline, where NICE issues best practice advice for the NHS. There is no funding direction attached to that. However, clinicians are expected to take account of NICE guidelines in everything that they do.

My Lords, I declare my interest as chairman-elect of University College London Partners, one of the designated academic health science partnerships. Is the noble Earl content that the funding arrangements to be put in place by NHS England for the 15 designated academic health science networks are appropriate and will ensure that they can discharge their substantial obligations under their licence agreement, including the adoption of NICE guidance among the populations for which they are responsible?

The noble Lord asks a very important question. It is slightly wide of the Question on the Order Paper, which relates to a particular set of statistics. However, I can tell him that I am broadly satisfied with the level of funding for AHSNs, and NHS England has given its commitment to maintain its support for them going forward.

If the appeal is to NHS England or the commissioning groups, does that mean that they have the right to overrule the decision that has been taken by NICE?

My Lords, patients have a right under the NHS constitution to access clinically appropriate drugs and treatments recommended by NICE technology appraisals. That is a legal right. If a prescriber has failed to adhere to that, a clinical commissioning group is bound to find in the patient’s favour. However, there are clearly individual circumstances for each case that need to be looked at. The key is that the patient is entitled to expect a transparent and fair process where the reasons for a decision are published.

Given that the noble Earl has just referred to the Question of the noble Lord, Lord Hunt, about access to new, innovative medicines, will he undertake to look at material which I have sent to him today from the Toronto-based mesothelioma research institute, which has developed new, innovative treatments for mesothelioma victims and may hold hope for some of the 2,200 who die of that horrific disease in this country every year?

Mesothelioma is a devastating disease, and I certainly undertake to look at the material that the noble Lord has sent me.

My Lords, is the noble Earl aware that a new treatment has recently been licensed for advanced pancreatic cancer, offering the greatest improvement in survival of any such treatment in 17 years? Does he share my concern that it needs to be made available to sufferers from the disease as urgently as possible via the Cancer Drugs Fund while awaiting NICE approval?

My Lords, drugs which have not yet been assessed or approved by NICE are eligible for use under the Cancer Drugs Fund. I am pleased to say that the Government have made a total of £1 billion available under that fund and 44,000 patients have been treated under it. I appreciate the noble Lord bringing that particular drug to my attention and I undertake to look at it.

My Lords, does the Minister realise the frustration that some clinicians have when there is a drug that gives a better quality of life to patients but they cannot give it to them?

My Lords, if a drug is licensed in this country, it is open to a clinician to prescribe it as long as their clinical commissioning group will fund it. There are local funding policies for drugs. I understand the noble Baroness’s point, but when a drug is assessed by NICE, it can be assessed for quality-of-life properties—that element will have been included in the assessment. Indeed, that is the reason why we have the process that NICE goes through.