Health: Multiple Sclerosis

Earl Howe Excerpts

Monday 30th June 2014 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what plans they have to introduce new treatment for relapsing-remitting multiple sclerosis.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, it is important that people are able to access the innovative and effective new treatments they need. Many thousands of people in England with multiple sclerosis have benefited from the medicines recommended by the National Institute for Health and Care Excellence or covered by the MS risk-sharing scheme.

[Baroness Gardner of Parkes (Con)]

My Lords, I thank the Minister for that reply. People with multiple sclerosis consider that specialist MS nurses are the key health professionals for providing responsive, person-centred, co-ordinated and integrated care. The latest MS Trust report assesses the provision of MS nurses across the UK and considers that there is a shortage of around 200, and that more specialist nurses are required to ensure that everyone has access to a specialist nurse. The new draft NICE guidelines offer only limited support for this specialist role. Given the scarcity of neurologists in the UK, is it not important that this chain of nurses is in place to ensure that emergencies do not develop, which of course costs the National Health Service very much more? Can my noble friend assure me that he will take action to ensure the continuance of MS nurses?

[Earl Howe]

My Lords, I am pleased to say that the number of specialist nurses for multiple sclerosis in the UK has risen from 80 in 2002 to 245 currently. I hope that my noble friend will agree with our view that local healthcare organisations, given their knowledge of the healthcare needs of their local populations, are the people best placed to determine the workforce needed to deliver safe and effective patient care within the available resources. However, it is of interest that NHS England’s service specification for specialised neurology does specify that nurse specialists should be involved in the care of people with multiple sclerosis.

[Lord Turnberg (Lab)]

My Lords, 11 drugs are now available for remitting and relapsing multiple sclerosis, three or four of which have been approved only in the past two or three months, which is great news. Is there any chance that these new drugs will be included in the risk-sharing initiative with industry?

[Earl Howe]

My Lords, I think that the answer is almost certainly no because the risk-sharing scheme initiated under the previous Government is quite complex to administer and we would need to be persuaded that the administrative burdens associated with it were worth while. Now that we have the NICE process, it is probably best that NICE should look at these drugs in the context of its new clinical guideline, which is what the stakeholder groups thought was preferable.

[Lord Blencathra (Con)]

My Lords, I declare a personal, though not a financial, interest in this Question. My noble friend may be aware that there is a drug called benztropine which has been approved for the past 10 years for use in Parkinson’s patients. We know that it is not carcinogenic, mutagenic, teratogenic or any other genic—it is safe. US researchers have just discovered that it seems to completely restore the myelin sheath on the spinal cord, at least in laboratory animals. This is of enormous interest to MS patients. Will my noble friend add benztropine to the list of medicines for urgent consideration by his early access to medicines scheme?

[Earl Howe]

My Lords, we are keen to see candidates being proposed for the early access to medicines scheme. If a body of evidence suggests that benztropine could qualify for designation as a promising innovative medicine—a PIM—the Medicines and Healthcare products Regulatory Agency stands ready to consider such evidence. However, it is for the manufacturer of the drug, not the Government, to decide whether it wishes to propose the drug as a candidate for the scheme.

[Baroness Barker (LD)]

My Lords, three drugs are currently awaiting approval by NICE, some of which have been turned down by the European Medicines Agency because of their side effects. To what extent does NICE take that factor into account in its own decision-making process?

[Earl Howe]

My noble friend will know that NICE looks at the clinical effectiveness of a drug alongside its cost effectiveness. The cost-effectiveness equation will naturally include consideration of unpleasant side-effects. The advice that it issues will reflect the evidence that it has from clinicians on that matter. It will then be for clinicians to decide whether the risk-benefit ratio is appropriate for particular patients.

[Baroness Wheeler (Lab)]

My Lords, when considering the Care Act we were very concerned to ensure that care and support plans for social care users included contingency planning for people who have fluctuating conditions such as MS and rheumatoid arthritis, where support needs can vary from week to week and day to day. What mechanisms are being put in place to ensure the provision of the flexible and comprehensive care plans that are needed?

--- Later in debate ---

[Earl Howe]

The noble Baroness is right that care plans have to be tailored to each individual patient. For those with serious neurological conditions, that is as important as for anyone. I do not have up-to-date information about what work NHS England is doing at the moment on this, but I am happy to write to her on the subject.

[Lord Roberts of Llandudno (LD)]

My Lords, how widely shared are these new medications? For instance, I know that some cancer medications are available to patients in England but not to patients in Wales. How widely is this information shared so that everyone can benefit, even if we are under the devolved Administrations?

[Earl Howe]

My noble friend will know that I cannot speak for the devolved Administrations, who have complete autonomy in their healthcare policies. I can say that a number of drugs have been recommended for use on the NHS for MS patients, including Tysabri, Gilenya, Aubagio and Lemtrada. However, it is ultimately for the devolved Administrations to decide whether they wish to have the same set of rules in place as we do in England.