Off-patent Drugs Bill

Kit Malthouse Excerpts

Friday 6th November 2015 Commons Chamber

[Marcus Fysh]

That is a good point and one I will come to in a moment.

One of my Yeovil constituents, Heather Moore, wrote to me this July, asking me to vote in favour of the Bill. She wishes it to become law not only because it would give patients wider access to the benefits of new treatment options, but because it would give financial advantage to the NHS by providing some very low-cost treatments. At this time of pressure on health services from demography and budget pressure, the improvements in cost-effectiveness that could stem from the Bill are essential.

A similar private Member’s Bill, sponsored by the previous Member for Cardiff North in the last Parliament, made it to Second Reading but was regrettably stopped short of becoming law. I believe that today’s Bill outlines an even more compelling case for approval, since it specifies the need for the Government to seek licences for off-patent drugs in new indications.

[Kit Malthouse (North West Hampshire) (Con)]

Like my hon. Friend, I am extremely supportive of the Bill—it is a very sensible measure—but there is a difference between what is being proposed and what is already available. I am patron of the Andover and Rural District branch of the Multiple Sclerosis Society. As I understand it, these cheaper generic drugs are already available for prescription off label. I think the Bill is trying to make the point that that is not being advertised enough to the clinical community and that the addition of a licence for particular treatments would promulgate their effectiveness much more widely. If I have missed the point of the Bill, please forgive me, but it seems to be as much about information as the ability to prescribe. The two are not mutually exclusive. We can provide more information to clinicians and provide licences at the same time.

[Marcus Fysh]

My hon. Friend makes a good point. The General Medical Council says that, traditionally, doctors have been reluctant to do that, partly because they may be wary of prescribing drugs for new uses owing to the increased level of personal liability that they may encounter.

Providing a way to overcome this reluctance, where efficacy has been demonstrated through licensing, deals with the argument made by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), in the debate on the previous Bill that the current law best meets the individual clinical needs of patients. The flexibility clinicians currently have to prescribe medicines, which my hon. Friend described, is fine, and it is each doctor’s solemn prerogative, but it should not be used as a structural excuse not to pursue new treatments where they have been shown to be effective for non-clinical reasons. In practice, that can encourage a lack of consistency and assurance for the patient because of the lack of NICE approval in the form of a technology appraisal. NICE is, in fact, in a very good position to conduct studies that test efficacy on particular subsets of patients, with their consent.

A partnership in my constituency between Yeovil District Hospital NHS Foundation Trust, Somerset clinical commissioning group, South Somerset GP federation and Somerset County Council was selected this March by a rigorous NHS England process to be one of 29 partnerships spearheading new ways of working—a vanguard project in finding new models of care. This partnership, called Symphony, is looking in particular at the integration of health and social care, bringing together GPs, hospitals, community hospitals, mental health and social services, and is focused on joint commissioning based on outcomes for patients. The intention is for the lessons learned in implementing this new model to be taken on board in replicating the integration process across Somerset and beyond. We need to learn the lessons and move forward together—fast.

I believe that this vanguard, which is led by very committed and talented people in each partner organisation—I congratulate and encourage them today—could act as a leader not only in developing this new care model, but in working with NICE in its role under the Bill to conduct technology appraisals for new uses of off-patent drugs.

This has particular application to one of the most difficult issues of our time—the fact that our population is ageing rapidly. There are areas of Somerset, as elsewhere in the country, where a majority of people are of retirement age—and that is likely to increase dramatically over coming years. The management of conditions that are becoming more prevalent as our population ages must be taken forward with every tool available to us.

A report written by the governors at Yeovil district hospital in October last year shows that there has been an increase in the number of local patients with suspected cancer. Indeed, Somerset has one of the highest proportions of cancer prevalence in England. This may come as no surprise, as it is a very attractive place to live and work, and it has attracted many people moving from other parts of Britain, with many choosing to retire in the area.

I strongly support the new cancer drug fund that this Government have implemented, which has given more cutting edge treatment options to those with cancer, but we can go further by increasing access to new treatments through off-patent drugs, which can be much cheaper.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I was interested to hear the hon. Member for Torfaen (Nick Thomas-Symonds) mention the research into zoledronic acid. I took part in the AZURE study, which indeed means that this bisphosphonate, which strengthens bone, will help bone to avoid getting invaded in the first place. We already use it in breast cancer for patients who have bone metastasis, but it provides a perfect example of where a second use can be found.

The hon. Member for Newton Abbot (Anne Marie Morris) expressed concern about prices going back up, but that simply does not apply. These drugs have been through the whole process, so we know about their safety and their side-effects; they are now cheap and generic. They are made by lots of different companies, and the reason they do not get licences is that it is simply not worth while because the companies cannot put the price back up. If a formulation is changed—if it was a tablet and is now an injection, or if it was an injection and is now a tablet—it is possible to apply for a new patent. If it is exactly the same drug, even with a new use, the company cannot get a new patent. It is not willing to spend the money on sponsoring it.

I have heard people say, “It is in the guidelines”—and believe me, many of these drugs are in NICE guidelines. NICE guidelines say exactly what was said at the beginning of the debate, which is that tamoxifen should be made available to patients who are at high risk of breast cancer. However, it is not licensed for them.

I am a breast cancer surgeon, and in my practice we carry out an operation called sentinel node biopsy. Instead of taking all the lymph nodes out of a woman’s axilla and giving her lymphedema—which some Members will have seen, either in their families or in their constituents—we try to remove only one or two, and we use dyes to target them. One is a blue dye called patent blue dye. It is so old that it is not even made in this country any more, and it literally costs pennies, but it is unlicensed. One of its possible side-effects is anaphylactic shock. That is very rare, thank goodness, but there it is. According to all the UK guidelines, that is the approach that must be taken to breast cancer patients.

I used to have to sign a form before every case that I handled, stating that I accepted personal financial liability if the patient suffered. Eventually I said, “Wait a minute: I am not putting my house on a piece of paper for every case when I would be in trouble if I did not handle that case.” Thankfully, my health board was eventually willing to underwrite it.

The idea that guidelines give us protection is unfortunately not true. When guidelines were introduced, the medical profession was reassured that they did not handcuff a clinician, and if a patient was treated off-guidelines, because patients do not fit in cubbyholes, there would not be an issue. Similarly, following guidelines slavishly does not give any protection. Doctors carry legal responsibility for any drug that they prescribe. So the specialists will prescribe off-patent drugs, and we will be using them.

[Kit Malthouse]

I am slightly confused. Doctors are absolutely responsible for what they prescribe, but only if they do so negligently. The hon. Lady would not expose herself to litigation if she had, for instance, used the dye on a patient who then suffered from anaphylactic shock if that had been an appropriate and responsible thing to do given the patient’s condition at the time.

[Joanna Cherry (Edinburgh South West) (SNP)]

There is a risk.

Mental Health (Armed Forces Veterans)

Kit Malthouse Excerpts

Wednesday 14th October 2015 Commons Chamber

[Dr Cameron]

I thank my hon. Friend for a very well-made point. I certainly urge the Minister to commit himself to research on that issue.

In the context of referral and assessment, it has been suggested that there are still problems caused by a lack of understanding and awareness among many mainstream health care professionals of how to deal with the issues that veterans present. There is a tendency to rely on prescribing medication, and, according to Combat Stress, there is a problem of low rates of referral to its service by GPs and community mental health teams. The British Medical Association has drawn attention to the chronic undermanning of Defence Medical Services, which is reported to have had a detrimental effect on morale, motivation, and the retention of doctors. The association says that adequate resources are a key factor in ensuring the best quality and consistency of mental health care in the long term. It believes that the issue should be addressed as a matter of urgency, given the need for appropriate and sustained long-term funding.

The Royal College of Psychiatrists has highlighted the need for better trauma-related treatment from the NHS. It reports that many veterans rely on small charitable providers that sometimes do not have the resources to be trained in evidence-based therapies, which should be consistent with the current evidence-based practice. The Royal College has also raised the need to evaluate the effectiveness of current follow-up service. The Murrison report recommended a telephone or face-to-face check on how someone was doing a year after they had left service. Currently, however, all that happens is that a letter is sent to the last known address of the service leaver, telling them that they can phone or see their GP if they have an issue. It is suggested that there may be a need for investigation into the uptake of this service and whether this correspondence is in fact being received.

The Government therefore need to address issues of help-seeking, stigma, referral processes, assessments and availability of appropriate treatments. There are also issues of co-morbidity and the requirement for integrated approaches across services including health, criminal justice, forces and social care. There is, in addition, a reported lack of service provision for partners and children of service personnel, who may also suffer mental health issues owing to the nature of their family member’s job. I am pleased that the Scottish Government have put in place a veterans commissioner for Scotland to begin to address some of these issues, but I would like to see similar credence given across the rest of the UK.

[Kit Malthouse (North West Hampshire) (Con)]

I congratulate the hon. Lady on securing this debate on such an important subject. I have Army headquarters in my constituency and strong services links in Hampshire. So desperate were a group of veterans in my constituency that they started their own organisation, Veterans in Action, who have just this month launched PTSD awareness month. I am wearing their little badge, which looks not dissimilar to an SNP badge, I have been told. The hon. Lady put her finger on the problem earlier in her speech when she said that there is not enough awareness out there about these issues, particularly among medical staff. I hope, therefore, that she might support an initiative such as awareness month in the future.

Dementia Care Services

Kit Malthouse Excerpts

Wednesday 9th September 2015 Westminster Hall

[Kit Malthouse (North West Hampshire) (Con)]

As a Dementia-Friendly Hampshire ambassador—I am not quite a champion, but an ambassador—I welcome the debate and remind my hon. Friend of the Government’s commitment just before the election to creating a dementia research institute somewhere in the UK within the next five years. Does he agree that it would be helpful if the Minister updated us on the funding envelope for that, and the implementation plan for it over the next four and a half years, given that time is running out for its creation? I have to declare a slight interest, as the idea was fermented at City Hall. I may have had a hand in it, and therefore have a stronger motive to see it come to fruition.

[Edward Argar]

I am grateful to my hon. Friend, and I am beginning to think that I must be careful about what I think, because yet again a Member has touched on a paragraph I was about to begin. He is absolutely right. The Government’s dementia research funding now stands at £66 million. That is double what it was in 2010, but we need to be clear that we must not stop there. I was pleased that earlier this year the Government reaffirmed their commitment to doubling the dementia research spend by 2025. That is vital, and I know that Members on both sides of the House, in the spirit of constructive support, will help to hold the Government to that. Will the Minister commit to collating information on that spend centrally, and to publishing it annually, so that we can track progress? Coming to my hon. Friend’s point, I would be grateful if the Minister updated the House on the plans for a dementia research institute to drive forward research in a truly world-leading way. I pay tribute to my hon. Friend for the work he did in City Hall, and as a Deputy Mayor, in pushing that agenda forward.

Finally and most importantly—I declare an interest as a member of the Alzheimer’s Society—I pay tribute to such organisations as the Alzheimer’s Society, Alzheimer’s Research UK, Age UK and myriad others for the work they and their members do to ensure that we in this House and society never forget this cause, and that we continue to support the tens of thousands of people with dementia—and the voluntary carers, who are the real heroes and heroines. We have a duty to recognise what they do, and to do everything we can as a country to support them. I look forward to the Minister’s comments on what we can do to support carers.

I will close by quoting from a moving and powerful article by Alice Thomson about her father’s dementia. It was published in The Times this summer. She said:

“Old age shouldn’t be seen as a humiliation but more as the other bookend to your childhood; a time when you can rely on the help and patience of others to reach the end but can also still be a central part of family and community life”.

I echo those words and ask the Minister, the Government, all of us and society as a whole to continue to rise to the challenge and to make that a reality for all those who have dementia in this country.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I commend the hon. Member for Charnwood (Edward Argar) for securing this debate on what is probably one of the biggest challenges we will face over the coming decades. There is no easy answer, north or south of the border or on either side of the House. I think we all fear it. Previous generations have feared other illnesses and avoided them. They talked about consumption instead of TB, or about “the big C” instead of cancer. Most of our generation are less afraid of cancer than of Alzheimer’s. We are afraid of disappearing, or of being married to someone who simply is not who they used to be. That is a fear we all live with.

The Scottish National party welcomed the then Government’s introduction of a national dementia strategy in 2009. The Scottish strategy came in 2010. We set out clinical standards the following year and updated our strategy in 2013. We reached the 64% diagnosis target in 2013, when England was diagnosing 48% of those with dementia. I commend the fact that that has now risen to 59%, although there is obviously more work to do. Northern Ireland was diagnosing 63% of sufferers. What happens to someone when they are diagnosed? Think of the fear that we all have, and then imagine the bombshell that diagnosis is.

There is no easy answer, but we have done a few things in Scotland that we feel have worked. All our health boards now have a linked member of staff, like the cancer nurse specialists we have for breast cancer, which was my specialty. Since 2012, we have had the older persons’ acute care plan, which looks at secondary care and modern hospitals. I welcome the talk about dementia-friendly towns and villages—I will go home and throw down that challenge to my area, because that is not something I have come across.

In the past 18 months, our hospital has been completely redesigned, with colour zones and images of what everything is, instead of just words. Toilets, beds, kitchens—how to find one’s way around is all visual. We also have champions in every single ward. All that has really changed things. We have reduced length of stay from 22 days to eight days; we have reduced falls by half, and we have reduced returns to A&E from 26% to 8%. These relatively cheap, simple changes actually save a lot of money.

We obviously need more research and development, because at the end of the day families want a treatment to make early diagnosis worth while. Otherwise, what is the point? We have to be able to intervene. We can slow things down, but we want a drug that will stop dementia and reverse it. At some point further down the line, we will face the challenge of drug companies coming to us with an expensive drug that will do that. It will be important for the National Institute for Health and Care Excellence and other agencies to weigh up the sheer scale of dementia that we face and the money that could be saved by using even quite an expensive drug.

[Kit Malthouse]

One of the interesting developments over the past couple of years, which was looked at by Dennis Gillings, the international dementia envoy appointed by the G8, has been the question of whether the financial equation around the development of a drug could be changed by negotiating an international exception for its patent life, extending it by, for instance, five or 10 years. That might propel investment into research to find a cure and also make it cheaper when it does emerge, because the time for commercially exploiting it would be extended. Would the hon. Lady support such a proposal?

[Dr Whitford]

I absolutely would. In my previous life as a breast cancer surgeon, when I was also doing breast cancer immunology research, I watched what became Herceptin go from its development on the bench-top into common use. That took 21 years. This is something we often do not recognise when we moan about big pharmaceutical companies: they are investing in something that may turn out to be a mirage. The more that we can look at supported or shared R and D, the cheaper the drug will be when it finally comes to market. I would commend something like that.

The current problem is that most patients face living with dementia, and we must think about how we help them and their families to do that. We should be challenging ourselves to make dementia-friendly our surroundings and all the agencies that sufferers may interact with, whether through visual aids, through other people recognising them or, as the hon. Member for Stockport (Ann Coffey) said, through technology. The eHealth programme in Scotland is working on that, including devices in patients’ homes that it can interact with and establish whether the person is okay. Much of the care that people receive is the 15 minutes that the hon. Lady mentioned. How can we improve that? How can we ensure that the faces are not different every day? Some patients and families report 100 carers in a year. We should look at how we organise the care and remember who the real carers are: the family.

It is predicted that one in three of us will be carers for someone with dementia. We have a vested interest in ensuring that we look after them. The carer’s allowance is currently £60 a week, which does not even match jobseeker’s allowance, for a job that could be 164 hours a week, so we need to think of how we support carers and the work that they do. In Scotland, things are slightly different as we have free personal care, so the family does not pay for the carer who comes into the home. If that person has to go into a care home or nursing home, they do not pay for the personal care. The system has been expanded and deepened and actually allows us to keep more people at home for longer.

One problem is that care jobs attract lower earners. How can we motivate people and attract high-quality candidates if they are being paid the lowest possible amount?

Health and Social Care

Kit Malthouse Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Kit Malthouse (North West Hampshire) (Con)]

I am grateful, Mr Deputy Speaker, for this opportunity to make my maiden speech, particularly during a debate of such high quality. I congratulate those Members who have made their maiden speeches today, and I am particularly pleased to follow my Hampshire colleague, my hon. Friend the Member for Eastleigh (Mims Davies), thanks to whom I made quite a lot of money at Ladbrokes.

The wonder of modern technology and the labours of our friends from Hansard mean that I have read, listened to and watched a number of speeches over the past few days, and I have been impressed by many. For instance, thoughtful speeches from my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) and my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) on the opening night illustrated the high quality of thinking in the Chamber, and I am pleased to be able to participate.

I am relieved that you, Mr Deputy Speaker, are in the Chair for my speech, because it is a tradition in a maiden speech for a Member to panegyrise their constituency, but 20 years ago the jewel—the glowing green emerald—that is North West Hampshire slipped through the otherwise deft fingers of the Speaker when he was the very young candidate for the candidacy there and was the runner-up to my predecessor. He will know from that experience that there can be few slices of England as fair as North West Hampshire. It has the world’s most important chalk stream, the River Test, rising and gurgling through it; it has “Watership Down” at its very heart and 60 largely thatched villages and hamlets dotted among its verdant hills. It is no surprise, therefore, that much of the constituency is designated an area of outstanding natural beauty.

In the north of the constituency lies the industrious town of Tadley—hard up against the fence of the Atomic Weapons Establishment in the constituency of my hon. Friend the Member for Newbury (Richard Benyon)—with its famous treacle fair, held just this last Sunday. In the south there is the ancient market town of Andover, made modern in the 1960s by a deal with the Greater London Council to become a London overspill town, greatly increasing the population—and, I am afraid to say, the number of Arsenal supporters.

North West Hampshire is a hard-working place with very high employment levels underpinned by a thriving small business community, but it is not without its problems. I have pledged to put my shoulder to the wheel to try and help, starting with schools, where performance is not universally brilliant. A successful future for the town will be built on the foundation of great schools, so our work must begin there. I look forward to working with the Secretary of State for Education, my right hon. Friend the Member for Loughborough (Nicky Morgan), in her vital campaign to drive up standards and ambition.

Like much of Hampshire, my constituency has strong links with the armed forces. The Secretary of State for Communities and Local Government, my right hon. Friend the Member for Tunbridge Wells (Greg Clark), whom I congratulate on his appointment to the Cabinet —we were councillors together at Westminster city council—may boast that his constituency is the ancient home of the lieutenant colonel, but I believe that I might have a stronger claim. With army headquarters sited just outside Andover and the plethora of bases and garrison towns in the area, many serving and retired services personnel have settled there, giving a military flavour to much of life in the constituency. I thank them for their service to our country.

The House has not heard a maiden speech from a Member for North West Hampshire for more than 50 years. The last one, in 1964, was given by the late Sir David Mitchell, father of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who sadly died last year after a distinguished life of public service. He was succeeded in 1997 by my predecessor, Sir George Young, the “Bicycling Baronet”, who was an MP already but whose Ealing Acton constituency had been abolished. Like me, Sir George had been a local councillor in London, with a young John Major, and then a member of the GLC, before entering Parliament and embarking on a glittering 42-year-long career on these Benches. I am told that he is the only Member to be hired, fired and rehired by three Prime Ministers.

Sir George’s time here was garlanded with many laurels, but it was at the constituency level that his true character shone through. His work over the past two decades has impacted on thousands of constituents. At every door I knocked on during the campaign, his industry and care were remarked upon. He has set the bar very high indeed. It has sometimes felt as if North West Hampshire had the Queen Mother as its MP, such was the regard in which he was held. He did not do it alone, of course. His wife, Lady Aurelia Young, whose father, Oscar Nemon, sculpted the magnificent statue of Churchill that stands in Members’ Lobby, has been very much a part of the team. The constituency and the country owe them a great deal.

I have tried to absorb as much of this debate as possible over the last few days, and there have been many notable and interesting speeches, but one in particular has stuck in my mind. It was given by the hon. Member for Bassetlaw (John Mann) on the opening night. In it, he said that the scandal of historical child abuse will be one of the defining issues of the next five years. He said that it would haunt the Parliament, and I agree with him.

During my many years in local and regional government in London, I have become increasingly alarmed at the social and cultural architecture in which our children live. I have tried to do my bit for them—for children in the care system, in prison or in gangs, and for children trafficked, mutilated, beaten, abused and too often killed. There are many politicians who have made a greater impact than me—not least the Minister for Children and Families, my hon. Friend the Member for Crewe and Nantwich (Edward Timpson) and the Lord Chancellor and Secretary of State for Justice, my right hon. Friend the Member for Surrey Heath (Michael Gove), whose experience and work in this area over the last five years has been exemplary. I welcome the measures in the education and adoption Bill signalled in the Gracious Speech this week.

But we have done our work in the face of profound and rapid social change in the way our children live. Their exposure and the exposure of those who have care of them to sex, violence and commercialisation is changing the way children interact with each other and with adults. The Prime Minister, I sense, feels the same, and has expressed alarm on a number of occasions. His very welcome troubled families programme, now expanded to include over 500,000 families, gives a sense of the scale of the issue. I see from the Order Paper that tonight’s Adjournment debate, called by the hon. Member for Nottingham North (Mr Allen), gives expression to a similar alarm in calling for the establishment of an institute for the study of the sexual abuse of children.

There has been much talk of this Parliament being consumed by questions of foxhunting, Europe, human rights and the Union. Even in the context of those important debates, I am with the hon. Member for Bassetlaw in believing that the horrific stories of child abuse from the past will dominate our public discourse. This House must respond by putting the future of our children, and in particular the care of our most disadvantaged and defenceless children, in front and at the centre of our considerations.

The good people of North West Hampshire have sent me here as their champion, and I intend to strain every sinew in their interests for as long as they will have me. During the time I am allowed in this House, I hope to be a champion for children, too. It was Nelson Mandela who said:

“There can be no keener revelation of a society’s soul than the way in which it treats its children.”

I am sure you will agree with me, Mr Deputy Speaker, that he was right.