(3 weeks, 6 days ago)
Commons ChamberRead Hansard Text Watch Debate Read Debate Ministerial Extracts
Dr Rupa Huq (Ealing Central and Acton) (Lab)
Joe Biden’s recent diagnosis has to some extent put prostate cancer in the spotlight of late, but it is not just him—there is Stephen Fry, Jools Holland and Robert De Niro. More than 50,000 men in the UK and 1.4 million men worldwide are diagnosed with prostate cancer yearly, which is projected to double by 2040. With one in eight men diagnosed during their life, it is the most common male cancer. More than half of those men are pre-retirement age, such as the cyclist Sir Chris Hoy, who was diagnosed at 48, but 70-plus is the most common age.
My late dad was 69 when he was diagnosed. He left this earth just shy of his 79th birthday in August 2014, so he had 10 years. It is often said that men die with prostate cancer, not of it. With my dad, it spread to bone cancer, but pneumonia was actually the cause of death on the certificate. I miss him every day.
Treatment for prostate cancer has improved dramatically since then. One crucial breakthrough is the development of the drug abiraterone, a Great British success story discovered and initially developed in London at the Institute of Cancer Research. It is a shining example of British science leading the world and revolutionising advanced prostate cancer care.
Clive Jones (Wokingham) (LD)
Will the hon. Member reiterate a question that I have for the Minister? Specifically, given that abiraterone is already approved for use in Scotland and Wales, what action is the Minister taking to ensure that men in England are not disadvantaged in accessing lifesaving cancer treatments?
Dr Huq
The hon. Member reads my mind about the postcode lottery, which I will come to in my list of questions. I know that my hon. Friend the Minister is very sympathetic and on the right side.
Abiraterone is now a global drug. Half a million men around the world have had transformed outcomes, improved quality of life and extra years spent with loved ones.
Jim Shannon
I thank the hon. Lady for bringing forward this debate; she is absolutely right to do so, and I congratulate her on that. She may not be aware that abiraterone is not routinely available in Northern Ireland for men with high-risk hormone-sensitive metastatic prostate cancer, unlike in Scotland and Wales. It is primarily approved for men with advanced prostate cancer that has already spread. While it can be accessed through an individual funding request process, it is not a standard first-line treatment option. Does she agree that men in Northern Ireland and right here in England should be able to access treatment that is available in Scotland and Wales?
Tom Gordon (Harrogate and Knaresborough) (LD)
I thank the hon. Lady for securing this important Adjournment debate. We have heard from a number of Members who have constituents who are affected or have frustrations with the current system. I met a gentleman called David in the run-up to the general election who has metastatic prostate cancer and is not eligible for abiraterone. He asked me if we would push and do what we could in Parliament to ensure that people such as him could get the drug. He is fortunate and can afford to pay for it privately, but not everyone is in that situation. This is about ensuring that we have equality of access for everyone, regardless of their financial circumstances. Does the hon. Lady agree that we need to have another look at this issue?
Dr Huq
I completely agree with the hon. Gentleman that access should be based not on how deep somebody’s pockets are, but on need.
Abiraterone halves the risk of relapse. Each relapse literally costs the NHS millions—the definition of lose-lose. As many Members have pointed out, it is already successfully available on the NHS and routinely funded for use in metastatic cases in England, but sadly there is a catch: abiraterone is not available on the NHS for men with non-metastatic prostate cancer living in England.
Danny Beales (Uxbridge and South Ruislip) (Lab)
I thank my hon. Friend for bringing forward this very important debate for her constituents, my constituents and people in the UK. Does she agree that since this issue was last assessed by the National Institute for Health and Care Excellence, there have been significant developments, as has been mentioned by other colleagues, both in the provision of the drug in other nations and the fact that it is now available off-patent, so it is much cheaper to access? That will fundamentally change the cost-benefit analysis that NICE did previously. Does she agree that her constituents and my constituents need this drug just as much as patients in Scotland and Wales who are benefiting from it?
Dr Huq
I totally agree. West London needs the same as the west of Scotland, the west of Wales, and all the other bits of those other nations. Men can access abiraterone on the NHS in Scotland and Wales, but not in England, even with an identical diagnosis. It seems at best anomalous that their postcode, not their prognosis, is determining their treatment, and we all know that the NHS is meant to be free at the point of need.
I would give anything to have had longer with my dad. I was reminded of him when, like the hon. Member for Harrogate and Knaresborough (Tom Gordon), I had someone come to see me: Peter Treadgold, who came to my advice surgery and pointed out that he is falling between the cracks. He had a long-standing diagnosis, with remission, and he diligently followed all the advice. He was under NHS monitoring for 20 years because he had heightened prostate-specific antigen levels, although he was never actually offered an MRI or ultrasound scan. Last year, his cancer came back, and he was told that he would need hormone and radiation therapy; abiraterone was not offered. Peter is one of the one in three people who get the devastating news that their cancer has come back, and has been denied access to a treatment that could save or extend his life.
The first time I heard of abiraterone was when I met Peter, because as my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) said, in my dad’s day, it would not have been cost-efficient. However, it is now a generic drug—it has gone off patent—but it is licensed only for metastatic cases. As my hon. Friend the Minister knows well, there is a complicated, convoluted process involved in getting it approved for non-metastatic cases. There is no question about the effectiveness of abiraterone. It has had one of the biggest trials known to mankind, a genuinely world-beating trial. When NHS England’s own clinical priorities advisory group plotted the clinical benefit against the net cost, abiraterone scored highest in that tabulation. It is calculated that two years of abiraterone treatment would halve the death rate for men with locally advanced prostate cancer, but we hear about budgetary challenges. I have written to the Minister and tabled questions, and have been told that NHS England has not identified the recurrent budget to support provision of the drug.
We should look long-term, at the remissions, and at the cost of chemotherapy, hospital appointments and other associated things. Those costs add up. University College London found that abiraterone would pay for itself if it were £11 a day. Do Members know what the NHS is actually paying? Does anyone want to hazard a guess? Oh, we are not doing call and response. Abiraterone costs £2.75 a day, now that it is off patent and has come down in price. That is less than three measly quid to avoid costly relapses, scans, chemo, hospital appointments and everything else—less than three little round ones to improve lives and reduce deaths. As we have heard, only people who can fork out up front for private treatment or private medical insurance currently have that option, and again, our NHS was not meant to be for private profiteering or big pharma drug pushers. People are seeing their pensions and life savings evaporate, and we are in a cost of living crisis. This drug should be universally available.
It took less than one year for abiraterone to be approved for men with non-metastatic prostate cancer in Scotland and Wales. In England, it is now three years and counting, and we still have not had a concrete resolution. Right now, abiraterone is the cheapest and most cost-effective it has ever been, and as the excellent Prostate Cancer UK put it, the postcode lottery must end. Lord Darzi’s independent investigations into the NHS found that the UK had higher cancer mortality rates than other comparable countries, and sadly, progress in diagnosing cancer at stages 1 and 2 is flatlining. Just over half of prostate cancers are caught at an early stage. That falls well short of the NHS target of 75%. I appreciate that Labour has just come into power after 14 years of the Conservative party, so it will take time to fix our health system, but we need it to be more responsive—to act early and rapidly, to use all the tools it can, and to offer preventive rather than after-the-fact care in every case. Abiraterone exemplifies all those things.
I welcome the Chancellor’s 3% real-terms increase in NHS spending to deliver the exciting plan to build an NHS fit for the future. With the 10-year plan coming soon and the national cancer strategy due this autumn, we have a real chance to deliver significant improvements for people living with cancer, so as is customary, I have a list of questions for the Minister. I will incorporate those of my hon. Friends—I think we are all friends here, even if we sit on opposite sides of the Chamber.
First, will the Minister commit to exploring ways of ensuring that additional NHS funding is used to make abiraterone available to all men who need it in England—and in Northern Ireland, as the hon. Member for Strangford (Jim Shannon) has pointed out? Secondly, will the Minister support the introduction of a national programme of screening for prostate cancer, like those that we have for comparable cancers in the United Kingdom? Thirdly, given the complexity of NHS England’s decision-making processes in relation to the availability of abiraterone—which sound like a right old bureaucratic nightmare—as the functions of NHS England are transferred back to the Department of Health and Social Care, will the Minister take steps to ensure that all decisions about access to medicine, including abiraterone, are timely and transparent? I know that she has had a long career in the NHS, and as I have said, she is on the side of the angels.
Fourthly, will the Minister commit to publishing an equality impact assessment, given the disturbingly disproportionate effect that prostate cancer is having on black men, who are more likely to develop it and to receive a late diagnosis, and less likely to receive the right treatment? I am doing this partly for Dad, who is watching from somewhere up above, but also for the black and minority ethnic men who are implicated here and now. This is the second time that you have been in the Chair, Madam Deputy Speaker, when I have been talking about health inequalities since Friday, when we discussed assisted dying. You have chaired both debates excellently.
Fifthly, in the light of the lengthy approval process, will the Minister assess the adequacy of the funding formula model—we have NICE and we have the Medicines and Healthcare products Regulatory Agency, and it all seems a bit knotty—and consider whether novel pharmaceutical treatments could be produced cost-effectively, especially, as my hon. Friend the Member for Uxbridge and South Ruislip said, when they come off-patent. I am arguing for simplification in cases in which drugs are already prescribed for limited use and there is a credible case for expanding their application to a generic treatment. We are halfway there; we just need to go that little bit further.
Prostate Cancer UK estimates that 672 men die prematurely each year because we have no access to abiraterone. Each week that this continues, 13 men in England will die from a cancer that could have been treated cheaply had they lived in Scotland or Wales. Labour is the party of the NHS, and a Labour Government introduced the UK’s first dedicated cancer strategy; so let us go for this win-win for all, end the iniquitous, unjust postcode lottery, celebrate the best of British science, and widen access to abiraterone for all those who need it, not just those who can afford it.
The Minister for Secondary Care (Karin Smyth)
I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for securing the debate, and I thank the other Members who have spoken.
As my hon. Friend has said, more than 50,000 men are diagnosed with prostate cancer every year, and one in eight will be diagnosed with it during their lifetime. I commend her for raising an issue that I know is very personal to her, as she has articulated so well. I am sure that her late father is watching her carefully. She was also right to support her constituent Peter by raising this issue, which affects so many men, and to highlight the number of black and minority ethnic men presenting with the disease. That is something on which we have all campaigned very strongly.
Timely and equitable diagnosis and access to innovative medicines for the treatment of prostate cancer are of the utmost importance. To support faster diagnosis, NHS England has redesigned pathways to maximise capacity. We are also aware of very early-stage trials of the use of artificial intelligence in prostate cancer detection, and we look forward to a formal report on those trials, so that the evidence can be considered carefully.
Carla Lockhart (Upper Bann) (DUP)
The effects of prostate cancer have been well noted tonight, as has the number of men who are affected. About 12,000 die from it each year, more than 300 of them in Northern Ireland. Does the Minister agree that Northern Ireland should be included in the commissioning, and will she undertake to speak to the Health Minister in Northern Ireland about the issue? Does she also agree that this needs to sit alongside a UK-wide prostate cancer screening programme, targeting in particular people with a family history of the disease?
Karin Smyth
We talk regularly with our colleagues in Northern Ireland, and I am always happy to do so. As the hon. Lady knows, this matter is devolved, so it is a matter for Northern Ireland, and we respect the devolution settlement.
Our elective reform plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding community diagnostic centres, and better use of technology. With nearly 170 community diagnostic centres up and running, they can take on more of the growing diagnostic demand in elective and cancer care. We will also deliver additional capacity in 2025-26 by expanding some existing centres and building up to five new ones. We will address the challenges in diagnostic waiting times, providing the CT, MRI and other tests that are needed to reduce the elective and cancer waits.
Members know that the National Institute for Health and Care Excellence—we have heard a little about it this evening—is an independent body responsible for assessing whether new licensed medicines can be recommended for routine use in England, based on a thorough assessment of their clinical and cost effectiveness. The NHS is legally required to fund NICE recommended medicines, ensuring consistency of access for NHS patients wherever they live in England.
NICE is able to recommend promising new cancer medicines for use through the cancer drugs funds, which supports patient access while real-world evidence is generated to address clinical uncertainties. Through the cancer drugs fund, NHS patients also benefit from access to cancer medicines from the point of positive draft NICE guidance, accelerating access to clinically and cost effective medicines by up to five months. Through this process, many thousands of patients, including patients with prostate cancer, have been able to benefit from effective new treatments at prices that represent value to the NHS.
The drug that is the subject of this debate, abiraterone, is licensed, as my hon. Friend the Member for Ealing Central and Acton said. It is recommended by NICE for use in the treatment of certain types of metastatic prostate cancer, and it is now routinely available to NHS patients in England in line with the NICE recommendation. NHS England has recently put in place an interim commissioning policy that makes abiraterone available for men with high-risk, hormone-sensitive metastatic prostate cancer, pending the outcome of NICE’s update of its negative guidance. I am pleased that this approach was agreed between NICE and NHS England late last year to ensure uninterrupted access to abiraterone for men leaving the STAMPEDE trial.
My hon. Friend raised particular concerns about access to this drug for men with non-metastatic prostate cancer. First, it is important to note that abiraterone is not licensed by the MHRA for use in this indication, and it is therefore off-label. NICE does not evaluate the off-label uses of medicines, and the drug is also now off-patent and available generically, which means there is no single manufacturer that could sponsor an MHRA licence application or NICE evaluation. It is therefore for NHS organisations to take decisions on funding based on the available evidence.
NHS England considered abiraterone for the treatment of non-metastatic prostate cancer through its clinical prioritisation process last year. Through this process, NHS England concluded that evidence supported the routine commissioning of the drug in this indication. Approximately 7,000 men per year could be eligible for this drug, and it is estimated that it would cost an additional £20 million per year to fund that.
While, as my hon. Friend said, there may be some cost savings in the pathway from preventing the disease’s progression, these are unlikely to materialise for about five years and would not impact the up-front costs of the £20 million per year for the additional out-patient monitoring and drug cost. I had not heard the figures she outlined, but I will get back to her on some of the questions she asked, and it would be helpful to know where those figures are from.
Unfortunately, it has not been possible to identify the necessary current funding to support the commissioning of abiraterone for this purpose or any other treatments in this prioritisation round. I know that is disappointing for those affected, and I want to acknowledge that this is a really difficult and unusual situation. However, I want to assure my hon. Friend and other hon. Members that the funding position for this treatment does not mean that there are no treatment options. The NICE guideline on prostate cancer recommends the treatment of non-metastatic prostate cancer with surgery and radiotherapy.
I want to assure hon. Members that NHS England is keeping this position under review, and would reconsider funding for abiraterone for non-metastatic prostate cancer if the funding position changes. Earlier this month, NHS England met Prostate Cancer UK, which shared its financial model of the expected cost impacts. NHS England is reviewing this in more detail, and I encourage it to continue those discussions.
In closing, I recognise how hard it is when patients want access to effective treatments. I also recognise the distress and worry it causes not only for patients, but for their families and friends. The Government are committed to ensuring that we provide access to the most innovative and effective medicines, but it has to be in a way that is sustainable and affordable for the NHS. It is right that NHS England continues to engage with Prostate Cancer UK, and I know that my hon. Friend and other Members will keep an eye on this and similar issues with drugs coming forward. The national cancer plan will seek to improve every aspect of cancer care, to better the experience and outcomes of people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. I am grateful for the opportunity to respond to the debate this evening.
Question put and agreed to.