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Jim Shannon (Strangford) (DUP)
I beg to move,
That this House has considered the availability of cancer drugs.
As the turnout this morning indicates, the subject of the debate is of concern to us all. There are more Members from Northern Ireland present than usual, but that may be an illustration of the concerns of our constituents across Northern Ireland on this matter.
I did some background research before I came down to the Chamber, and I discovered that in September 2013, the British Medical Journal asked:
“Which way now for the Cancer Drugs Fund?”
In July 2015, the Health Service Journal said:
“Cancer commissioning overhaul could save 30,000 lives”
and The Daily Telegraph on 4 September led with the headline:
“Thousands of cancer patients to be denied treatment”.
On 5 September, The Independent reported:
“NHS cuts to drugs fund mean thousands of cancer patients in England will be denied life-extending treatments”.
Finally, The Guardian stated on 23 September:
“UK NHS cancer patients denied drugs due to inflated prices”.
All those headlines highlight a clear problem when it comes to cancer drugs, which is of the utmost importance and which is, unfortunately, too close to home for many of us. There are many organisations that help those affected, but I would like to mention Macmillan Cancer Support, which is very much in my mind. The charity stated that 2.5 million people in the UK are living with cancer in 2015. The fact that that is slightly less than 5% of our total adult population indicates that this problem is enormous. It is hard to find anyone whose life has not been touched by this horrendous disease in some way.
My father, who passed away this year, had cancer on three occasions. He survived all three of them and lived to the ripe old age of 85, having first been diagnosed some 36 years ago. I have always said that the skill of the surgeons, the care of the nurses and the prayer of God’s people saved him on those three occasions. For many of us, cancer is not simply something that others talk about; it is something that affects each and every one of us.
My father is only one example. In my office every week, people come to me who are suffering from cancer. Some are also in the throes of benefits problems; very often, in addition to the trauma of health issues caused by their cancer, people have to deal with benefits difficulties. We have to work out how to get them into the benefits process and take the financial pressure off them at such a crucial time.
Lady Hermon (North Down) (Ind)
I congratulate the hon. Gentleman on securing the debate, which concerns the availability of cancer drugs throughout the UK, not simply in Northern Ireland; I am surprised that more Members are not present. Greater availability of off-patent drugs would help in the fight against cancer and reduce cost to the NHS. Will the hon. Gentleman support that call and the private Member’s Bill on the topic?
Jim Shannon
I thank the hon. Lady—my hon. Friend—for her contribution, and I am happy to add my support. Indeed, I attended a meeting of the all-party group on off-patent drugs last Thursday, and it is important that we support its campaign.
Nick Thomas-Symonds (Torfaen) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Strangford (Jim Shannon) on securing a debate on an important issue that affects many families—perhaps all families—across the UK. I intervene at this point because the hon. Member for North Down (Lady Hermon) has mentioned the private Member’s Bill that I am sponsoring—the Off-patent Drugs Bill. Would the hon. Gentleman agree that there are problems affecting the prescription of off-label drugs? It happens inconsistently across the country, and there are problems of information and a conservatism about prescribing off-label. Does he agree that those problems are best dealt with by legislation?
Jim Shannon
We have hit on an issue that resonates across the whole House. Let us put on the record the fact that there is a goodly representation of other parties today, and those hon. Members are here because they have an interest in the matter. I am pleased to see the Minister in his place. He tells me that I never miss one of his debates, and I do not know whether this is his debate or mine, but we are both here for the same purpose. I am pleased to see the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), in his place as well.
Survival rates are improving, and that development is great for everyone.
Ms Margaret Ritchie (South Down) (SDLP)
I congratulate the hon. Gentleman on securing this debate about cancer, which impacts on almost every family throughout Northern Ireland and Britain. Before we proceed to talk about cancer drugs, does he agree that it is most important that we have proper diagnosis and proper testing? As well as widening access to cancer drugs, does he agree that access to testing such as Oncotype testing for breast cancer, and BRCA1 and BRCA2 testing for ovarian cancer, is important, because they will suggest the right type of cancer drugs to prescribe—and, indeed, indicate whether cancer drugs are required at all? We need the diagnosis and testing, and then we need the right type of drugs.
Jim Shannon
I absolutely agree. The hon. Lady mentioned ovarian cancer. Most of us from Northern Ireland will know of Una McCrudden, who passed away earlier this year. She was an energetic person who spoke out on behalf of those with ovarian cancer. She survived six years after she was first diagnosed, and all her latter years were put into that campaign. I know that the hon. Lady knew her as well as the rest of us did.
Great work has been done on ovarian cancer. Only last week, I heard of one of my constituents who had been diagnosed with ovarian cancer and undergone surgery. The operation was successful, and we thank God for that, but many others do not survive. Survival rates are improving, and given that one in two people diagnosed with cancer in the UK survives, we are on the right track. The fact remains, however, that we could and must do so much better.
With innovation in cancer treatments making great strides, it is imperative that we, as representatives of the people the length and breadth of this nation of the United Kingdom of Great Britain and Northern Ireland, campaign to increase the availability of cancer drugs to our constituents. The Minister and I have discussed this many times. Queen’s University in Belfast is one of the leading advocates for innovation in the search for new cancer drugs, and it leads the way in cancer treatment, as it does in many other spheres of life. Today the Chinese President is visiting Parliament, and we have all sorts of other contacts with China, so it is particularly appropriate to highlight the fact that Queen’s University works in partnership with organisations and universities in China to move that work forward.
Cancer knows no creed, colour, race, religion or class. It is an enemy that we have all come together to fight. With that in mind, I hope that we can all come together to give our constituents up and down this nation access to the very best treatment for that common enemy. We are united in our desire to see greater availability of cancer drugs in every postcode area across the United Kingdom.
Mr Andrew Smith (Oxford East) (Lab)
I join other hon. Members in congratulating the hon. Gentleman on securing the debate, and I support what he is saying about access to cancer drugs. Is it not also important to underline the fact that the overwhelming majority of successful treatment of cancer is by surgery or radiotherapy, often supported by drugs?
Jim Shannon
Absolutely. My father survived cancer three times because of the surgeon, the chemotherapy, the radiotherapy and all the other treatment that he received, and the drugs helped. So, by the way, does a good diet; there are lots of things that we need to do to tackle the disease. I draw the House’s attention to the recent developments in Northern Ireland. Hon. Members will know that health is a devolved matter. My party colleague, Simon Hamilton MLA, the Minister for Health, Social Service and Public Safety, has taken the initiative to release £1.5 million to fund specialist cancer drugs. That will allow for NICE-approved cancer drugs and treatment to go ahead this year.
Gavin Robinson (Belfast East) (DUP)
I congratulate my hon. Friend on securing this debate. He mentions the figure that has been secured by our Health Minister in Northern Ireland. Has any thought been given to the amount of money or resources made available to reduce the time individual patients will have to wait before securing the drugs they need?
Jim Shannon
I am unable to answer that question effectively and honestly. I know that question will be brought to the attention of the Minister back home and the Minister here will have a response to it. Today’s debate highlights the issue and raises awareness. We have concerns about the long waiting list. As the hon. Member for South Down (Ms Ritchie) said, we need diagnoses early—the earlier the better. I find it frustrating when I hear from some of my constituents who might wait 12 weeks for a diagnosis and perhaps longer for treatment. We need to address that.
Andrew Stephenson (Pendle) (Con)
I join other hon. Members in congratulating the hon. Gentleman on securing the debate. I agree with the point that he is making about the availability of cancer drugs across the United Kingdom. Does he agree with me that the environment in which patients are treated is also important? Will he join me in congratulating my local hospital trust, East Lancashire Hospitals, on its commitment to build a new cancer unit at Burnley general hospital with the support of the Rosemere Cancer Foundation?
Jim Shannon
As the hon. Gentleman says, there are many good examples across the whole United Kingdom of Great Britain and Northern Ireland, where things are done well. We thank the doctors and nurses, who work energetically, and the many charities.
The national target for accessing these life-changing drugs is 19 weeks. The move in Northern Ireland will go a long way towards enabling the health service there to reach that target. My hon. Friend the Member for Belfast East (Gavin Robinson) was correct that we need to focus on that target. Each day in Northern Ireland, 23 people are diagnosed with cancer and 11 people die of it. According to Cancer Research UK, there were 331,487 new cases of cancer in 2011 and 161,823 deaths from cancer in 2012. That tells us a wee bit about the magnitude of cancer and its importance to every person in the whole United Kingdom. More should be done but I can only welcome the recent developments in the Province. I hope that other areas of the country can follow suit by freeing up the funds necessary and introducing legislation to prioritise fighting this awful disease to the best of our ability.
In England and Wales, cancer remains one of the biggest killers, causing 29% of all deaths. Progress has been made and all progress is welcome, but it is opportunities like today when we can really make a difference to the lives of individuals and families from all walks of life. Recent developments across the water—here—are deeply concerning. In September, 16 drugs were removed from the Cancer Drugs Fund list in addition to another 16 drugs that were removed from the list in January.
Nick Thomas-Symonds
I congratulate the hon. Gentleman on making that point. Does he agree with me that the removal of Abraxane from the national Cancer Drugs Fund list is particularly concerning given that pancreatic cancer patients, 80% of whom are diagnosed when the cancer has already spread, are often left with a finite and small amount of life? A drug such as Abraxane can make a significant difference to those people and that decision should—I hope it will—be reversed in future.
Jim Shannon
The hon. Gentleman must have helped me put my notes together because I have written that one down. It was one of my next points. Yes, we are concerned about that. I look forward to the Minister’s response on that point because, quite clearly, it is hard to understand why Abraxane should be removed given that it at least extends the life of many people.
Sir Oliver Heald (North East Hertfordshire) (Con)
On that point, a very small number of conditions are very fast-acting. Pancreatic cancer is one of them—six months, on average, between diagnosis and passing away. Does he agree with me that NICE needs to find some way to capture the importance of an extra two months? An extra two months to somebody who only has six is time to settle their circumstances and come to terms with the situation. It is a very important two months and somehow that needs to be captured.
Jim Shannon
I could not have said it better. That is exactly the issue for many in the House and for those outside who have to deal directly with these issues.
Moves such as the removal of the drugs prevent thousands of cancer sufferers across England and Wales from being able to access the quality treatment they deserve. Thousands of people are disadvantaged, thousands of families are losing out and thousands of normal people are in despair. Today, we need to give them hope, an advantage and life itself.
The Government have said that the manufacturers of drugs recommended for removal from the Cancer Drugs Fund will have an opportunity to reduce their costs. Negotiations are under way. I am keen to hear the Minister’s response on that. I would like confirmation that patients already receiving a drug that will be removed from the Cancer Drugs Fund will continue to be treated with that drug. Clinicians certainly indicate that they consider it appropriate to continue treatment. The patient needs to be assured that the system is such that those who are on the drugs will continue to be. I had written down the point about pancreatic cancer. The hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) is absolutely right. I thank him for his intervention.
We are living in times when we are all being asked to tighten our belts but when it comes to issues like this, we simply cannot put a price on doing what is right. Given the consequences for patients, it is imperative that we act sooner rather than later. A long-term and sustainable system for cancer drugs is essential and, while we build that, we have to keep doing what we can to improve the lives of those suffering right now. That starts today with this debate. The debate has been happening outside the Chamber and today is an opportunity to highlight to issue in the Chamber.
I am particularly looking forward to hearing the Scottish National party spokesperson today because I was talking to the hon. Member for Central Ayrshire (Dr Whitford) last night at a different debate. She was unable to attend today. The Scottish National party, Scotland and its Parliament have led the way in how cancer drugs can be allocated. There are lessons to be learned from Scotland so the SNP’s comments will be particularly pertinent.
We have an opportunity to do what is right. Today we have an opportunity to make a difference and to affect normal, everyday people’s lives in a positive way. We need to seize that opportunity. Let us use this House for what it was designed for—to help the people we represent. Cancer can strike anyone. It is indiscriminate and that is why we should be doing our best to get what is best for our constituents.
With the working group on the Cancer Drugs Fund currently suspended, it is important to remember that each minute we fail to make progress on the issue we are failing a British citizen suffering from cancer. I need not remind the Chamber of the ultimate consequences of patients being denied access to life-extending treatments. The longer we delay consultation on the new system, the more lives we are failing. Having said that, it is important that we consider the outcome and results rather than just the intention of the actions we take. The Cancer Drugs Fund did great work when it started and the intention of the fund was most honourable. However, we all know of the budgetary constraints that made the Cancer Drugs Fund sustainable, which is why we need to have an open and rational discussion about how to progress.
I should have said this at the beginning, but I will do so now: I thank the hon. Member for Scunthorpe (Nic Dakin), who attended the Backbench Business Committee on my behalf on a Monday about two months ago. I was unable to be over here on that Monday but he did it for me so I thank him publicly for that opportunity.
I welcome the fact that the Cancer Drugs Fund will become operational once again from April 2016, as I welcome any provision of care for cancer sufferers, but it is imperative that we develop a long-term solution that commits us to those who depend on cancer drugs for the extension of their life and for their families. Very often—I see this in my constituency office and I know that other Members do—we see the impact on the families. There are enormous financial, emotional and physical pressures.
Ms Ritchie
Is the hon. Gentleman aware that the UK National Screening Committee, which advises the devolved Administrations and the NHS in England on clinical trials, started a process of clinical trials last year? At the debate that I had in this Chamber on 4 November last year, I was told by another Minister in the Department of Health that that evidence base would be assessed for future treatment and diagnostic purposes. Does the hon. Gentleman agree that it would be useful if the Minister, in summing up, advised us of the results of those trials, which could then lead to better treatment and decisions on possible cancer drugs?
Jim Shannon
The Minister’s staff are taking notes, and hopefully he will be able to respond positively.
During the transition to the new system, cancer sufferers who were not registered with the Cancer Drugs Fund prior to suspension are not able to access the benefits of the CDF, which is deeply concerning. The second round of delisting will see a further 16 drugs delisted. As the CDF is suspended, patients who did manage to get registered are losing out on drugs that could potentially have been listed and may have been vital to their treatment, which is of concern to everyone in this House.
This is clearly an emotive issue that goes to the heart of everyone here and our constituents across the United Kingdom of Great Britain and Northern Ireland, which is why so many people are in this Chamber today. I thank each and every Member for their interventions and contributions. I look forward to the contributions to come.
Action is urgently needed, but we also need a sensible, rational and robust exchange on how to deliver this positive initiative in a sustainable manner that allows us to have a positive, long-term impact on those who are suffering. I look forward to the contributions of the shadow Minister, the hon. Member for Denton and Reddish, and particularly the Minister, for whom I have the greatest respect. I look forward to his reply with all the positive answers that we want so much.
Several hon. Members rose—
Mr Philip Hollobone (in the Chair)
Order. The debate is due to last until 11 o’clock. I want to call the three Front Benchers no later than just before 10.30 am—they will have about 10 minutes each. We will hear from Mr Shannon again for two or three minutes at the end as he sums up the debate. I will then put the motion to the Chamber. Now, the moment we have all been waiting for: I call Nic Dakin.
Nic Dakin (Scunthorpe) (Lab)
As ever, it is a real pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Strangford (Jim Shannon), who is an assiduous campaigner on this and many other issues, on setting out the case very clearly in his opening speech.
I will focus on pancreatic cancer, which, as everyone knows, is an extremely aggressive form of cancer with the worst survival rates of any of the most common cancers. The way in which Abraxane has been dealt with by the cancer drugs fund and the National Institute for Health and Care Excellence is illustrative of the challenges in access to other cancer drugs.
When used in combination with standard chemotherapy, Abraxane can extend the life of eligible patients on average by just over two months compared with using gemcitabine alone. However, it is important to note that, in some cases, patients live for significantly longer than two extra months, with some patients on the trial living for more than two years. The hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) captured very clearly how two months can be significant in allowing patients with such an aggressive disease to settle their affairs and manage their situation as best as they can. There has also been a significant increase in the number of patients surviving for more than one year. For a disease in which there have been no drug improvements for more than 40 years, Abraxane is significant in finding a better answer.
Abraxane represents a middle road for pancreatic cancer patients. It is more effective than gemcitabine alone and, although it has considerable side effects, it is less toxic than FOLFIRINOX, which has been shown to extend life for longer but can only be used for the very fittest of patients. Although not all patients will be fit enough to use Abraxane, more patients will ultimately have access to life-extending treatment.
Abraxane was added to the cancer drugs fund in March 2014. That was a moment of great hope and expectation for the pancreatic cancer community, which for so long has had little about which to be positive. However, as new drugs were added to the cancer drugs fund and costs started to rise, a process began of removing drugs from the CDF’s list of approved drugs so that the fund could keep within budget, as the hon. Member for Strangford has outlined. A further review began in July 2015, and a decision was announced in September that Abraxane, along with several other drugs for other conditions, would be removed as of 4 November. That is happening across cancer treatment. For example, lenalidomide, which is currently being trialled on multiple myeloma patients with positive results, is also being removed from 4 November. This is a big problem out there in the real world.
It seems bizarre that a drug can be added to the cancer drugs fund in March 2014, then be removed just 18 months later. It seems wrong that a drug for which there was such strong demand—more than 550 patients accessed Abraxane via the cancer drugs fund in its first year, and the numbers were rising towards the end of the year—should be removed when few other treatments exist. It seems inequitable that the scoring system used by the CDF does not take into account the extremely poor survival rates for pancreatic cancer. We simply cannot have a one-size-fits-all system in which a drug giving substantial relative gain for a disease that has seen hardly any new treatments or improvements in survival for decades is judged by the same standards as drugs for other cancer types that have much better survival rates and many more treatment options.
Abraxane is not one of the most expensive drugs on the CDF. It costs some £8,000 per patient, not the £90,000 for some other treatments. There is considerable public outcry against the decision. One petition on Change.org created by my constituent, Maggie Watts, who lost her husband to pancreatic cancer 40 years after he lost his mother to pancreatic cancer— there has been no change in survival prospects over those 40 years—has exceeded 88,000 names already. Another petition started by the charity Pancreatic Cancer Action on the parliamentary e-petition site has passed 20,000 signatures.
There is a real problem, and a postcode lottery is emerging across the United Kingdom, with Scotland having approved Abraxane for routine use on the NHS back in January 2015 after the drug was assessed using Scotland’s new patient and clinician engagement system. Perhaps, as the hon. Member for Strangford said, we in England can learn from that. Wales used its own assessment to approve the drug for use back in September 2014. However, because NICE has said no to Abraxane in England, the drug will be reappraised in Wales, which might lead to access being removed. Northern Ireland has never had access to the drug because it generally follows NICE decisions and, as things lie, it does not look as if Northern Ireland will have access to the drug in future.
Mark Tami (Alyn and Deeside) (Lab)
My hon. Friend has outlined all the hoops that people have to leap through. If their timing is wrong, they may or more likely may not qualify for the drug. That is happening when patients are at their weakest. They are not experts, and they find themselves victims of what can appear to be a very cruel and harsh system.
Nic Dakin
My hon. Friend is right that patients and their families are at a critical point, which is why it is important that, on this difficult issue, we try our best to find a way forward that is sensitive to the need for such exceptional drugs in exceptional circumstances. In many ways, the Government should be praised for introducing the cancer drugs fund, but the CDF is clearly not fit for purpose when dealing with such exceptional situations, which is what is needed.
Other countries across the world are taking a leap forward in approving Abraxane for their health systems. Abraxane has been approved on price grounds for reimbursement in Austria, Denmark, Germany and Greece, and it has been given the go-ahead in the USA, Canada and Australia. There is a real danger that patients in the UK will be left behind unless they happen to be in Scotland. Removing access to Abraxane could mean that fewer patients can access trials. Moreover, we could be setting back research into a disease that for many years has had the worst survival rates of the most common cancers. This is an opportunity for a breakthrough in medical research that needs to be taken
I ask two things of the Minister, who goes about his work in an assiduous and effective way. First, can he take steps to examine the processes that NICE and the CDF use to consider drugs so that they take into account the exceptional circumstances surrounding drugs of this nature in areas where there has been no medical process or medical hope for many years? Secondly, will he meet me and the other officers of the all-party group on pancreatic cancer to explore the specific issues around Abraxane?
David Simpson (Upper Bann) (DUP)
I congratulate my hon. Friend the Member for Strangford (Jim Shannon) on securing this debate. On a more humorous note, I heard him mention that he has never missed a debate that the Minister has participated in; I think we could safely say that he has not missed any debates in the past five or 10 years. He is a champion in his own constituency when it comes to cancer research and pushing for cancer drugs, and I congratulate him publicly today on his work and his effort.
I welcome the opportunity to participate in this debate. In recent days, our newspapers, TV screens and social media have been flooded with reports about cuts to cancer treatments. One of the latest reports I read indicated that 5,500 patients could miss out under the Government’s plan to reduce the availability of cancer drugs.
Today, cancer is a word that has become all too familiar in our households. As we come together to debate the availability of drugs, some 2 million people are battling cancer. They are husbands, wives, mothers, fathers, sons or daughters. The impact of cancer is much greater and much more widespread than it might appear if we consider only those who are statistically labelled.
Recently I had the opportunity to visit the state-of-the-art facilities at the Queen’s University Centre for Cancer Research and Cell Biology in Belfast. It is making fantastic headway in understanding cancer: how it is formed; how it develops; and ultimately how we can slow down its growth, and eradicate faulty genes and molecules in tumours. The centre was recently awarded almost £4 million to continue its work in research and in developing cancer treatments.
I am proud that Almac, a pharmaceutical company that is a world leader in cancer drug discovery, has its headquarters in my constituency of Upper Bann. Its founder, the late Sir Allen McClay, was so dedicated to improving patient care that he donated much of his wealth to the Centre for Cancer Research and Cell Biology. However, while all this work is going on and new drugs and treatments are being identified, we consistently hear reports that there are plans to remove life-prolonging drugs for various cancers, including breast cancer, prostate cancer and bowel cancer, to name just a few.
Lady Hermon
One of the greatest concerns is about the cost of these drugs. The hon. Gentleman said that one of the famous manufacturers of cancer drugs is based in his constituency. How often does he have the opportunity to meet people from that company? Would it be helpful for a cross-party delegation to meet the senior management of that company, to persuade them to reduce the cost of their drugs? I am sure that they could; where there is a will, a way will be found.
David Simpson
I welcome that intervention—the hon. Lady makes a very good point. If Sir Allen were alive today and witnessing the cuts in the availability of these life-prolonging drugs, which were once in the headlines as good news stories, he would come out with his old statement: “Bang your heads together and get a resolution to this.” It is a good idea to have such a delegation. I meet Almac staff on a regular basis. Almac is a pioneer in this sector; it is working with Government very closely; and I understand that the pricing of its drugs is not ridiculous.
However, I will make a parallel point. Well over a year and two months ago—perhaps more—it was announced at the Budget that the Health Minister would introduce funding so that a vaccine for meningitis B could be given to children. It took a year and two months—perhaps even more time—for that policy to be implemented, because the pharmaceutical companies were holding out for more money than the Government could afford to pay. They were asking ridiculous prices, because they had the sole remedy for a complaint, so could exploit that situation.
The message needs to go out to some of the pharmaceutical companies that we are dealing with life here. And as one hon. Member said earlier, even if there are only two or three months of life left, people want to hold on to that life as long as they possibly can, because where there is life there is hope, and hope is what people want to hold on to.
A number of weeks ago in this House, I attended an awareness day for secondary breast cancer, and I was shocked to learn that the Government do not keep data on people who are living with this incurable disease, which is remarkable. In the other House, Baroness Morgan of Drefelin has highlighted the issue: because the Government, the NHS and the pharmaceutical industry have again failed to agree realistic prices for new drugs, some women will die sooner than they should.
Bowel cancer is the fourth most common cancer in the United Kingdom. Experts say that around two thirds of those who seek NHS treatment for advanced bowel cancer treatment are likely to face an earlier death under the plans to scale back spending. That is wrong. Like many Members, I regularly meet—possibly on a weekly basis—constituents who are battling cancer or who have just been diagnosed with cancer. I recently met a family who told me of their agonising fate as their father had been diagnosed with lung cancer. Like many families, they have carried out their own extensive research and confirmed with their oncologist that there are drugs out there that could prolong his life. Millions of pounds have been spent on developing these drugs, which could perhaps either save people’s lives or prolong them. However, that family were told, “Sorry, but we can’t give it to him, because it’s just too expensive.”
Where do we draw the line when it comes to someone’s life and life expectancy, and the family who are left behind? I realise that the Government have very hard decisions to make. I appreciate that, but anyone in Westminster Hall today who has either suffered from cancer or known a family member or a loved one suffer from cancer would go to the ends of the earth to try to help them and to resolve this issue, because life is precious. As I say, the Government have hard decisions to make, but I do not think that anyone here today would or should put a price tag on a loved one’s life.
More needs to be done. Families living with cancer need all the help they can get, through the Government, through counselling, through drugs or through whatever help they can find. I trust that the Government will consider that when it comes to the funding of these drugs.
Mark Durkan (Foyle) (SDLP)
As other hon. Members have said, it is truly a pleasure to serve under your chairmanship, Mr Hollobone. I want to begin by commending the hon. Member for Strangford (Jim Shannon) on securing this debate and giving us an opportunity to discuss an issue that is important to many people and families in every constituency that is represented in this House. The issue is important not just because of the scale of cancer’s impact, but because people are confused about some of the policies: the policy language and all the different funding mechanisms that seem to afflict delivery of treatments and options for new drugs.
I endorse much of what the hon. Member for Scunthorpe (Nic Dakin), who chairs the all-party group on pancreatic cancer, said about Abraxane. I, too, am an officer of that group. Abraxane is a perfect but terrible example of exactly the confusion and concern that people feel. Here is a drug that was supported by NHS England, but will be withdrawn on 4 November. People do not understand why, in this day and age, with evidence-based policy and all the intelligence that we are supposed to have at the disposal of the public policy system, we have a snakes-and-ladders system that means that drugs are available in some places but not others, or are available for certain periods but then are not.
As the Minister will probably tell us, part of the problem goes back to pressure on the Cancer Drugs Fund. The fund was a positive innovation, but it was meant to be a transitional step—something to make good the problems with the National Institute for Health and Care Excellence and its approval system, which was leading to poor rates of approval for many cancer drugs. Most of us, across all political parties, thought that there was a problem with drugs breaking through the NICE approval thresholds. The Cancer Drugs Fund was a deliberate innovation aimed at ensuring that in the short term more drugs would be available and used under that specialist mechanism, with the intention that underlying problems and issues with the NICE regime would be resolved.
Now, the Cancer Drugs Fund has ended up with its own budget pressures. Thankfully, the Government have topped up the fund over various periods, but that applies to NHS England. In Northern Ireland, where my constituency is, we did not have a bespoke cancer drugs fund and we were caught in the twilight zone of drugs seeming to be available and being discussed in debates such as this as though they were available when they were not available in Northern Ireland. The terrible irony is that some of the drugs that were available under the Cancer Drugs Fund were the subject of clinical trials.
The hon. Members for Strangford and for the hon. Member for Upper Bann (David Simpson) referred to the centre at Queen’s. What I am probably most proud of in my political contribution is that as Deputy First Minister I insisted on securing funding for the regional cancer centre in Belfast. We designed it as part of the reinvestment and reform initiative. When we negotiated with Tony Blair and Gordon Brown, I made it clear that we wanted a down-payment for the new borrowing power. The first thing we wanted to do was invest in the cancer centre at Queen’s, without messing around with public- private partnerships or anything else. We wanted a straight-up investment.
That cancer centre, like so many others, is working miracles every day, but alongside the miracles performed by those who carry out surgery or lead the radiotherapy units that the right hon. Member for Oxford East (Mr Smith) discussed, there seem to be debacles with funding policy and schemes.
There is a question about what will happen. We are supposed to be looking at a merger of NICE and the Cancer Drugs Fund. The fund is meant to move on from next year, but people who are directly involved and who deliver cancer services and campaign on cancer policy have no clear feeling about what is happening. People’s hopes are at stake, and they are confounded by what has happened with Abraxane and many other drugs that will no longer be available from 4 November.
We are blessed in this debate because the Minister not only speaks a lot about innovation, but in many ways has become a bit of a byword for innovation—and not just in life sciences. I hope that he and his colleagues can be truly innovative in the policy instruments and funding mechanisms that they hope to introduce. A key issue, which other Members have touched on, concerns not just provision of funding but control of prices and their negotiation. We must make sure not only that we have funding mechanisms that we understand, but that there is real leverage in price negotiation if we are to make those drugs truly available.
In these islands, we have a number of different Administrations and perhaps we need to do more to achieve combined purchasing power strength. One of the most neglected and underused creations of the Good Friday agreement is the British-Irish Council, which brings together all eight Administrations across these islands. That is a very good example of where those eight Administrations need to collaborate much more effectively, combining their leverage to make sure that there is a more consistent and compatible policy on available drugs, services and treatments, and to provide strength in combined purchasing when negotiating.
Devolution gives us the benefit of being able to innovate and take things forward in slightly different ways. I look forward to hearing the word from Scotland—from the hon. Member for Motherwell and Wishaw (Marion Fellows)—because, as we have heard in previous debates, Scotland moved to a new drugs fund that combined elements of the Cancer Drugs Fund with responses dealing with rare diseases. That, too, is subject to its own pressures and there are difficulties about what gets through and what passes the requirements test for funding and availability.
Obviously we do not have clinical expertise or a full understanding, but we are meant to be able to assist with policy constructs and governance, and we can do more. We should encourage the Minister to work with colleagues, not just in the devolved Administrations, but also with the Irish Government—all eight Administrations across these islands—to do more with the drugs companies and to achieve better understanding.
That would be a great help to the many people who provide key services, innovating, researching, and conducting clinical trials, not just in the cancer centre at Queen’s, but in other locations throughout these islands. It makes it much easier for them if they know that they are working against a better policy-meshed backdrop at the level of government; that the challenge funds are there for their research work; and that the collaboration that they are trying to achieve with commercial companies is matched by real price leverage and positive price control effort, as well as conscious usage planning on the part of Governments.
As the right hon. Member for Oxford East said, the issue is not just cancer drugs. Surgery is a key issue and none of us wants to understate its importance, nor that of radiotherapy. In my constituency, thankfully, a radiotherapy unit will open in 50 weeks’ time. It will be a cross-border unit, again using some of the models and ideas in the Good Friday agreement. The new radiotherapy unit, which will be part of the new cancer centre at Altnagelvin hospital, is funded by the Irish Government as well as the Northern Ireland Administration. It will make a huge difference to many people, assisting them on their cancer journey and making sure that they have less arduous physical journeys.
I look forward to the Minister’s response and the ongoing work that I know he wants to do. I hope that he takes that work forward with colleagues throughout all the Administrations in these islands and not just with his Whitehall colleagues.
Mr Philip Hollobone (in the Chair)
We now come to the first of the speeches by the Front-Bench Members. They have about 10 minutes each.
Marion Fellows (Motherwell and Wishaw) (SNP)
Thank you, Mr Hollobone; after the build-up I have had, I hope not to disappoint. However, my hon. Friend the Member for Central Ayrshire (Dr Whitford) I am not, so you will forgive me if I disappoint somewhat. I apologise in advance that I will not be able to stay for the summing-up, as I have urgent constituency business connected to Tata Steel.
Cancer is an enemy we all have to fight. The hon. Member for Strangford (Jim Shannon) said that earlier. He is absolutely right, and I thank him for securing the debate. Many right hon. and hon. Members have already mentioned that cost is often a factor in decisions regarding specialist cancer drugs, and it is a factor that cannot be overlooked.
Scotland does things slightly differently. Its £80 million new medicines fund is proportionately much larger than the UK’s cancer drugs fund of £340 million. The Scottish Medicines Consortium—the SMC—which was reformed last year, gives advice to NHS boards in Scotland and is in charge of the fund. The SMC takes patient and clinician evidence as part of its assessment for drugs, which has led to many more of them being passed for use. The SMC also covers orphan drugs, for one-off conditions. In January of this year, the first case of Translarna for use in muscular dystrophy was agreed in Scotland, because of the SMC’s work.
Returning to cost, the UK’s pharmaceutical price regulation scheme limits the amount of money paid by the NHS to pharmaceutical companies and thereafter a rebate comes back to the service. In Scotland, the rebates are put back into the fund, but I understand that in the rest of the UK the money goes to the Treasury. In that way, Scotland sometimes gets the fund to grow even more. The cancer drugs fund can lead to health inequality, simply because better educated, middle-class patients and their families are better able to argue their case. That is not right, and something should be done on it.
A number of right hon. and hon. Members, including the hon. Member for Foyle (Mark Durkan)—I apologise in advance for not referring to all Members by their constituency—have said that funding is important. The price challenge from cancer drugs is acute, and we all need to find a better way of funding drugs, to help everyone. For example, Herceptin took 20 years to get to patients, and a lot of drugs frequently do not make it through. It is understandable that the cost of drugs reflects that of research and development, which can take a long time and cost large sums, but surely it cannot be impossible to bring about a costing system that benefits everyone. A combined purchasing council, as mentioned by the hon. Member for Foyle, is something that the Government should look into.
I am extremely sorry that I cannot bring any more new information to the debate, but the fact that the Scottish Government place so much emphasis on the matter, and spend such a large proportion of their health budget on it, is indicative of how much we need and want to help cancer sufferers and those with unusual conditions. I hope that my small input has helped to stimulate the debate. Mr Hollobone, I am afraid that I now have to leave the Chamber because I have had an urgent call to go elsewhere. I apologise.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to see you in the Chair, Mr Hollobone, and to follow the hon. Member for Motherwell and Wishaw (Marion Fellows).
I commend the hon. Member for Strangford (Jim Shannon) on securing the debate through the Backbench Business Committee and on the way in which he opened it. He has set the correct tone for how we seek the improvements we would like to see in access to cancer drugs for all our constituents. He was absolutely right to say that cancer touches every family. I lost my mother to ovarian cancer 21 years ago, and it is as painful to talk about today as it was then, when I was teenager. Only last week, my aunty passed away from cancer. It was a quick movement from the diagnosis to her passing, and I would like to place on the official record my thanks and tribute to all the staff at Willow Wood hospice in Ashton-under-Lyne, who looked after her so beautifully in her last days and hours. I also express my condolences to Evan, Shana, Sonya, Lal and Connor, who she has left behind.
The hon. Member for Strangford was absolutely right to say that we have made advances, but we still lag behind many comparable countries in cancer treatment. Access really does matter. I represent a cross-borough constituency, so I have to deal with two of everything, from police divisions right through to NHS trusts. Early on in my time as the Member of Parliament for Denton and Reddish, a constituent who had been diagnosed with breast cancer came to my advice surgery. She explained that her specialist had recommended Herceptin for its treatment, but that it was not available in her primary care trust area. If she had lived across the road, across the invisible administrative line—but still in the same constituency, with the same Member of Parliament—she would have had access to the drug. That was one of those moments when it was perfectly acceptable for the Member of Parliament to throw all the toys out of the pram. I did so, and thankfully I managed to get the primary care trust to change its mind.
Several years later the lady came to my surgery again, about something completely different, and it was one of those proud moments when one realises one has made a difference. She said, “Mr Gwynne, you don’t recognise me, do you?” and I replied, “I’m sorry, I don’t. I have met lots of people in my time as an MP. Should I recognise you?” She said, “I’m that lady you got Herceptin for, and I’m still here.” I do not know whether the Herceptin made a difference, but she believed that it did, and she would not have had access to it if I had not thrown all the toys out of the pram. That is why I start by commending the Government on the introduction of the Cancer Drugs Fund. The fund has been of significant benefit to patients, and that is to be welcomed—it would be churlish not to recognise the difference it has made. I am a little concerned, however, that the Government—as we have already heard—are now presiding over a series of reductions, which threaten the progress made.
We have already seen 18 treatments cut, and now NHS England has announced that a further 25 are due to be removed from next month. The Rarer Cancers Foundation has estimated that if all the cuts go ahead, more than 5,500 patients a year could be denied access in the future. My hon. Friend the Member for Scunthorpe (Nic Dakin) and others during the course of the debate have made that point powerfully.
Is the Minister content to stand by as the cuts are made? What will he do to help the patients who will miss out on these treatments if they are removed? At Prime Minister’s Question Time last week, the Prime Minister lauded NHS England’s negotiation process as a means of securing better value for the taxpayer, yet I fear the truth is rather different. I hear reports from charities and drug companies that suggest that NHS England has refused even to discuss discounts on some of the treatments threatened with cuts. Far from wanting to strike a deal that works for the taxpayer and helps patients, NHS England seems intent on leaving deals on the table. It is sad that efforts to save money on a range of drugs have been spurned. The chief executive of NHS England once said that he wanted his organisation to:
“Think like a patient, act like a taxpayer.”
The current position, however, seems to be against the interests of taxpayers and patients. Will the Minister intervene in NHS England to ensure that it considers every single offer that is put to it and that it redoubles efforts to maintain access to these drugs while securing the savings we all want to see?
The Minister cannot wash his hands of the issue when the process is evidently failing patients and delivering poor value for public money. Other countries seem to be able to make the drugs available without spending more money on their health services, which implies that they are better at striking deals, or at least are more flexible in doing so. Why are we not following the same process? Why should our constituents be denied these drugs when patients in other countries have access to them?
In brief response to my hon. Friend the Member for Torfaen (Nick Thomas-Symonds), I place on record that we on the Labour Front Bench support his private Member’s Bill on off-patent drugs, which has the support of the Association of Medical Research Charities and will help to improve access to off-patent drugs. We also need to look at ways of encouraging clinicians to use off-patent drugs.
I will touch briefly on points that my right hon. Friend the Member for Oxford East (Mr Smith) and the hon. Member for Foyle (Mark Durkan) made on radiotherapy and surgery and the benefits that extending access to those treatments can provide. Going into the general election, the Labour party’s position was that we would extend the Cancer Drugs Fund to become a cancer treatment fund that would include radiotherapy and surgery. What consideration have the Government given to ensuring that all the innovations will be available as part of the fund?
On the pharmaceutical price regulation scheme, I fear that there is more bad news to come for cancer patients. In August, the Department of Health snuck out some changes to the PPRS on a Friday afternoon, and I fear that the implications of that news could be bad indeed. The change agreed with the Association of the British Pharmaceutical Industry effectively limits the level of PPRS rebates that drug companies have to make on expenditure through the Cancer Drugs Fund. That creates a financial black hole over the lifetime of the PPRS that the Rarer Cancers Foundation tells me could amount to £567 million. The Government need to find more than half a billion pounds to cover the gap between projected Cancer Drugs Fund spend and PPRS rebates. Will the Minister tell the House how this gap will be filled? Can he reassure patients that the budget for the CDF will not be cut and that patients will not miss out as a result of that secret deal between the Government and the drugs companies?
Finally, I want to cover the consultation on the future. The cuts announced to the Cancer Drugs Fund in September were an inevitable consequence of an abject failure to fix the system. The Government’s record on the reform of drugs pricing and assessment is a sorry tale of promises not kept. First we had value-based pricing, which was meant to be the solution, but went nowhere. Then we had value-based assessment, which was derided by all sides and shelved by NICE, the very organisation that proposed it. The hon. Member for Foyle made some powerful points and interesting suggestions not just on the combined purchasing power of the various NHS systems across the devolved Administrations, but on the wider purchasing power of all the Administrations of the islands on which we reside. I would like the Minister to consider that.
We have the promise of Cancer Drugs Fund reform, but the process is already riddled with confusion and delay. The NHS England working group on reform was shut down as quickly as it was set up. A consultation was promised for July and then September—now it is October and we still have no consultation. In drawing the debate to a conclusion, will the Minister provide an update on when the consultation will finally be published? If he cannot do so, will he intervene with NHS England to ensure that Members are updated so that they can reassure the many of thousands of cancer patients whose treatment depends on satisfactory reform?
The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)
It is a pleasure to serve under your chairmanship, Mr Hollobone, at this early hour of the morning. I know that many Members would have liked to have been here for this debate. I suspect that if the debate had been scheduled for the main Chamber, we would probably have half-filled it, given the level of interest. I am delighted to have the chance to respond.
First, I congratulate and pay tribute to my friend, the hon. Member for Strangford (Jim Shannon). He is, as a number of colleagues have observed, a tenacious campaigner on this subject, and I am glad that we have kept up our record of 100% support for each other. He is a parliamentary champion of this cause, and it is a pleasure to work with him on it. He spoke powerfully about his own family’s experience of cancer, as did the hon. Member for Denton and Reddish (Andrew Gwynne). I am sure many Members from all parts of the House have experience of cancer. My father died of throat cancer when I was 19. It is a disease that still, despite all the progress, robs families and stalks the land. I will say something in a minute about the progress that has been made, because it is stunning.
I suspect when many of us were children, that word—cancer—normally spelled a quick and tragic death. Now, more than 2 million people living in Britain have had a cancer diagnosis. Cancer Research UK and all those involved in cancer research have achieved extraordinary things, but it is still a diagnosis and treatment that people dread. Cancer is a serious cause of early death, and it was powerful to have heard such cross-party support for cancer research.
As the hon. Member for Strangford and others observed, cancer does not respect any boundaries, whether they are of geography, income or party politics, although I make the point that it heavily correlates with health inequalities. Many colleagues in the House with constituencies with particularly high incidences of cancers also have constituencies with particularly a high incidence of poverty generally. There is a strong link between life chances and poverty and health and health inequalities. I observe that the Petitions Committee has received a petition on Abraxane, which is a symptom of how widely the concern on this issue goes across the House.
I will try to deal with some of the issues that have been raised. The truth is that the field of cancer research has pioneered the model of 21st-century drug discovery and life science research that is transforming how the sector works. That is driven principally by breakthroughs in genomics, genetic science and informatics—the ability to develop treatments and diagnostics based on being able to predict which patients will respond to which drugs and which patients are likely to be predisposed to a particular disease. Such breakthroughs and the use of big data, big informatics and genomic insights into the use of genomic biomarkers are allowing us to redesign the way in which drugs are discovered and developed. Cancer has led in that field partly because cancer is itself a genetic disease and because of the extraordinary work of Cancer Research UK and various other charities. I pay tribute to their work and leadership not only in deep science, but in the policy-making framework on treatment, diagnosis and care. I will talk about the cancer strategy that CRUK has helped us to put together in a moment.
The role of charities is growing in this space. I recently opened a combined laboratory in Cambridge shared by Cancer Research UK and MedImmune, a subsidiary of AstraZeneca. We have seen partnerships and collaborations between charities and companies before, but this was a joint laboratory, jointly funded with a joint research committee. It is a sign of where this landscape is going. We will see charities become the gatekeepers of patient power, patient tissues and patient genomic information, and gatekeepers of the patient asset in this new landscape of patient-centred research. It is a very exciting time for medical research charities.
Pioneering cancer research has made many cancers diagnosable and treatable diseases. As I have said, more than 2 million people now live with cancer. Diagnosis is still poor in pancreatic and colon cancer, and in many cases there is no proper cure, but about 98% of breast cancers are treatable and curable. That is a stunning breakthrough and I am sure that over the next 20 or 30 years we will see all cancers quickly reach that point. We need to recognise the extraordinary improvements in this field. The role of genetics and informatics is welcomed by the Government. We are doing everything we can through our life sciences strategy, set out by the Prime Minister in 2011, to drive this new landscape.
We have made groundbreaking commitments with the Genomics England programme. We are the first nation to commit to sequence the genomes from 100,000 NHS patients and combine that with clinical data. We have made groundbreaking commitments to open up our data sets to drive this model of 21st-century research. It is important that all of us who understand the power of that work also support it, because our constituents worry about the use of data. We need to make sure we safeguard individual patient data, and we need to make sure we unlock the assets of the NHS throughout the United Kingdom so that we are a genuine powerhouse in the 21st-century model of patient-centred research.
I want to pay tribute to the work of Northern Ireland scientists, academics and companies. The hon. Member for Strangford mentioned the Experimental Cancer Medicine Centre at Queen’s University. He is absolutely right that it is a world-class centre. I visited earlier in the year to commend, congratulate and support the team there. Sometimes the sector appears to be more interested in Oxford, Cambridge and London than in the extraordinary world-class centres out on the corners of the United Kingdom. I went specifically for that reason. The work there is not only world class in terms of the deep science on the cell mechanisms of cancer, but, in embracing the unified life sciences strategy research and treatment, the centre has helped to pioneer leadership in stratified medicine, pulling in inward investment and, interestingly, taking the patient catchment for the lower quartile of cancer outcomes to the upper quartile. That is a sign of how research medicine drives up clinical standards.
Jim Shannon
I visited Queen’s University in Belfast in the summer. They told me that they wished to see more partnerships and relationships with other universities, including on the mainland. The funding strand needs to be encouraged and we need to be a part of that. Will the Minister take that on board? I am sure he knows all about it, but I simply remind him.
George Freeman
The hon. Gentleman makes an important point. I will be discussing the matter with the Minister for Universities and Science and the Medical Research Council. We need to make sure that we move to a more networked and collaborative model of science funding. Traditionally, we have tended to fund established centres of excellence, which is important, but we also need to make sure we build networks. Cancer networks in research and treatment have been incredibly powerful in driving the advances that we have discussed. He makes a very good point. I was delighted to see the leadership of the Queen’s centre recently recognised by Cancer Research UK with a £3.6 million grant.
I want to talk about the wider landscape of cancer treatment and then turn to the drugs question.
Lady Hermon
I am grateful to the Minister for allowing me to intervene on him before he moves on to a different point. I am pleased that Her Majesty’s Opposition have made it clear in the debate this morning that they are going to support the Off-patent Drugs Bill, a private Member’s Bill. It would be helpful to many MPs who have had emails from constituents, as I certainly have, to find out what the Government’s attitude is to the Off-patent Drugs Bill. I encourage the Minister to say, “Yes, the Government will support it,” although I do not want to put the exact words into his mouth.
George Freeman
I will come to that important point as I deal with some of the questions that have been raised.
On the wider issue of cancer treatment, I want to highlight the announcement that the Secretary of State recently made on setting out our cancer strategy and the work of the cancer taskforce. We have set out important measures on a wider treatment regime for cancer. By 2020, NHS patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will be underpinned by an extra £300 million a year by 2020. We are launching a new national training programme that will equip another 200 staff to develop the skills and expertise to carry out endoscopies by 2018. We have a commitment from NHS England to implement the independent cancer taskforce’s recommendations on molecular diagnostics. This will mean that around 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments.
I have been absolutely insistent since day one when we launched the genomics programme that this deep science project should be embedded in NHS England. Patient recruitment for the project comes through the 11 genomic medicine centres in NHS England, and NHS England is now developing an infrastructure for doing genomic and molecular diagnostics in the mainstream NHS. We want the NHS to be the first health service in the world to launch genomic medicine for all as part of our universal 21st-century offering. A lot of work is going on at the moment on how we build the infrastructure for molecular diagnostics.
Our aim is that, by 2020, everyone diagnosed with cancer will benefit from a tailored recovery package, individually designed to help each patient. We are also committed to empowering patients and giving them much more information, so that those who choose to do so will be able to access personal health information, such as their test results, diagnosis, treatment history and their cancer recovery package, online. By 2017, there will be a new national quality of life measure to help to monitor how well people live after their treatment has ended, enabling priorities for improvements to be identified. We will continue to work with NHS England, charities and patient groups to deliver those commitments. It is important to remember that as people live with cancer—hopefully, more people will live with it—we will need to invest in the support network for how they live with it, and how we continue to monitor and support them and deliver post-treatment care.
I want to emphasise the importance of the role of NICE. Nothing I am about to say in any way undermines our commitment to its independent role and expertise in guiding and supporting decision making on drug access with the latest evidence and health economic leadership. In no way do we want to undermine its position. NICE has led the world. That is a great tribute to it and to the UK’s system. We are clear that if a drug is recommended by NICE, the NHS is legally required to fund it. Over the years, many thousands of people in England have benefited from the cancer drugs that NICE has recommended. These include Herceptin, Yervoy, and Zytiga for prostate cancer.
Most recently, hon. Members will have seen that NICE published final guidance on 7 October that recommends Keytruda, or pembrolizumab, for the treatment of advanced melanoma, after disease progression with Yervoy. I urge NICE to embrace the new technologies. I will talk about that in a moment. I am particularly pleased to be able to announce that in the early access to medicine scheme, which we launched last year as the beginning of the new landscape and which I have asked my accelerated access review to look at beefing up and developing, the first drugs have come through. They have been fast-tracked.
I am delighted to confirm to the House that NHS England has now undertaken routinely to fund the use of NICE-recommended early-access-to-medicine products within 30 days of NICE guidance being published. Colleagues will know that the scheme was established so that an innovative drug may be designated a promising, innovative medicine, and if there is no alternative mainstream therapy, the treatment can be fast-tracked into patients, with their consent, and rapid assessment carried out. The link to NHS England commissioning had not been established, but it is now in place. I am delighted that the first drug has gone through that system, and we hope that more will follow.
Mark Durkan
I welcome the Minister’s words on the progress of early access, but does he recognise that since 2011 NICE has turned down every new breast cancer medicine, while the cancer drugs fund has approved six new breast cancer treatments in NHS England? Between April 2013 and March 2015, that represented more than 2,000 extra life-years for patients coming from the CDF—life-years that NICE did not deliver.
George Freeman
The hon. Gentleman tees me up perfectly for the next section of my speech, because I want to deal with access to drugs and the Cancer Drugs Fund. We all recognise, not least the Prime Minister, that access to drugs is essential in this landscape, which is why he personally led the launch of the Cancer Drugs Fund—I thank the shadow Minister for paying tribute to that leadership. We have now committed just over £1 billion to the Cancer Drugs Fund—a substantial investment—and just under 80,000 patients have benefited from treatments that otherwise would not have been approved. They are largely treatments that NICE has turned down and the Cancer Drugs Fund has then stepped in to fund.
Because of the cancer field’s leadership in this new model of drug discovery, the rate of new drugs coming through is increasing and going to a targeted patient base. The smaller patient catchment for which industry must recover costs has driven it to raise prices and costs. In many ways, it has challenged NICE’s traditional £30,000 per quality-adjusted life-year model. It is driving huge pressure on our traditional model of health-economic reimbursement.
As Members have said, and as the National Audit Office report recently highlighted, the CDF was originally established as an interim measure to ensure that cancer patients were not denied drugs while we fixed the landscape. Although I have been in post only 15 months, I hope colleagues can see that the reviews of accelerated access and the CDF are not accidentally aligned. We are currently looking at how we make sure we support access to innovative medicines. Where cancer has led, other therapeutic areas will follow.
The genomic and informatics revolution will require NICE to change how it works. The explosion of progress in this field is what has put so much pressure on the CDF. Ever more treatments are coming online, but NICE is turning down ever more treatments on very well respected health-economic grounds. Those are difficult judgments about what represents health-economic value for the system and for patients. The CDF does not have a built-in discounting mechanism: it effectively takes the price on the basis of which NICE has rejected the drug and agrees to pay it. We want to look at whether we might use our extraordinary purchasing power to use the fund in a more productive way to get earlier access and, in return, discounts. That is what the accelerated access review is all about.
It is important to confirm that if NHS England decides to de-list a drug, any patients who have received a drug through the cancer drugs fund will continue to receive it. Where patients, particularly those with rarer cancers, are unhappy with a recommendation to de-list and their clinicians advise it, they can initiate individual cancer funding requests, an important avenue that many patients are successfully using.
I want to discuss the accelerated access review and respond to some of the questions that have been asked. I launched the review this time last year, asking and challenging the system to answer three big questions. Given the NHS’s extraordinary position as a universal, single-payer health system with leadership in genomics and informatics, the review is about asking what we can do to accelerate how we get innovation to patients. I have asked three specific questions. First, what can we do to shorten the time, cost and risk of getting innovation to that all-important moment of first use in patients? How can we make things quicker both for the patients who need it and for researchers, so that they can get those all-important human clinical data?
Secondly, what can we do to help NICE to embrace new flexibilities and pathways and to use genomics and informatics to update its systems, in order to deal with the issues raised by a number of colleagues relating to the end of the one-size-fits-all blockbuster model so that, in the 21st century, NICE has more tools at its disposal and more adaptive pathways—to use the jargon—to open up those flexibilities?
Thirdly, I have asked the accelerated access review to look at what barriers we can knock over and what incentives we can put in place to speed up the roll-out of innovative drugs and device diagnostics across the system. Unfortunately, there is great variation in the pace at which innovation is rolled out. In many ways, the CDF has pioneered on the very problems with which the system is now confronted. I am convinced that the CDF will be part of the solution. I cannot prejudice NHS England’s consultation, but I can reassure Members that, through the accelerated access review and the comprehensive spending review, we are looking at what we might be able to do to ensure that our commitment to funding innovative cancer medicines through the CDF also supports the broader landscape for innovative medicines. We will have to wait to hear the detail in the comprehensive spending review and subsequent announcements at the end of the consultation.
I want to deal quickly with one or two of the points made in the debate. The hon. Member for Upper Bann (David Simpson) made an important point about the different parts of the United Kingdom co-operating. As the UK Minister for Life Sciences, I am very conscious of leadership in Scotland, Wales and Northern Ireland, and would be interested to follow up on his point about using the broader network.
The hon. Member for Scunthorpe (Nic Dakin) asked me about NICE looking at exceptional circumstances. The accelerated access review is looking at whether we can give NICE more freedoms and flexibilities. The hon. Member for Motherwell and Wishaw (Marion Fellows) made an important point about the Scottish model—the innovative medicines fund there, the Scottish Medicines Consortium and the importance of patient voice, of which I am very conscious. She also discussed health inequalities, which are important.
Various colleagues asked about Abraxane. NICE is in the process of developing guidance on Abraxane for pancreatic cancer, which it expects to publish very shortly. The hon. Member for Strangford made an important point about data. We recognise that we need to be much better at gathering and using the data from the CDF. A data-sharing agreement between NHS England and Public Health England was signed in July.
In closing, I thank the shadow Minister for his support for the cancer drugs fund. We are intent on it remaining focused on access to drugs; we are tackling the wider treatment regime through the cancer strategy I have set out.
Mr Philip Hollobone (in the Chair)
Order. I am sorry, but we are running out of time so I am going to call Jim Shannon to wind up.
Jim Shannon
Thank you for chairing the debate, Mr Hollobone. I thank all right hon. and hon. Members who participated. A vast array of excellent knowledge was on display today from those who gave speeches and made interventions. Some great ideas were put forward, particularly that of the hon. Member for Foyle (Mark Durkan) about combined purchasing power. The Minister and shadow Minister were both on to that; it is something we can use better to develop the existing innovative drugs policies across the whole United Kingdom. I draw particular attention to the advances being made at Queen’s University Belfast, which we should combine with progress in the rest of the United Kingdom.
The contributions from each and every Member were valuable, detailed, informative and compassionate. It is important that we put on the record our thanks to the charities and other contributors. We are all moved by the e-petitions, which show that there is clearly a deep interest in the best way to fund cancer drugs. We have tried to ensure that patients at their weakest are the focus of the debate. I thank the Minister for his comprehensive reply. We look forward to helping our constituents across the whole United Kingdom of Great Britain and Northern Ireland.
Mr Philip Hollobone (in the Chair)
Order. I encourage Lady Hermon to grab the Minister and the hon. Member for Strangford (Jim Shannon) on the way out.
Question put and agreed to.
Resolved,
That this House has considered the availability of cancer drugs.