Cancer Drugs

Andrew Gwynne Excerpts

Tuesday 19th January 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing this important debate and on the depth of knowledge she has demonstrated. We might not share the same political allegiances, but we share a commitment to improving the lives of people affected by cancer, as do all Members—those who have contributed to the debate and all those in the House of Commons. The nature of the cross-party debate we have had today stands as a testament to that. I thank my hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Members for Strangford (Jim Shannon), for Solihull (Julian Knight), for Bury St Edmunds (Jo Churchill), for South Down (Ms Ritchie), for South Antrim (Danny Kinahan) and for Motherwell and Wishaw (Marion Fellows) for their contributions too.

Cancer transcends party politics. Each and every one of us has had a constituent, family member or friend affected by cancer. It is a disease that sadly touches us all, and it deserves the proper attention of the House of Commons. It is because it transcends party politics that I commend the Government on introducing the Cancer Drugs Fund during the last Parliament. Patients have benefited significantly since the fund’s introduction, and that has to be welcomed. However, we are here today because the progress over recent years to improve access to cancer drugs is now partially at risk.

The Government introduced the Cancer Drugs Fund, but they are now sadly presiding over damaging cuts to the treatment available through it, as we have heard in the debate. At the general election, the Conservatives promised to continue to invest in cancer drugs, but less than six months later they announced that a number of treatments would be removed from the fund, meaning that they would no longer be routinely available to patients. That will have a tragic human cost for cancer patients. Indeed, the Rarer Cancers Foundation has calculated that the reductions could affect as many as 4,100 cancer patients every year. Members from all parts of the House have expressed significant concerns about the impact those reductions will have on all our constituents.

Many important points have been made during this debate, but I would like to add a few of my own. First, can the Minister, whom I have a great deal of respect for, tell us what support is being made available to patients who will now miss out on treatments that have been removed? Will he promise that this is the last time we will see cuts of this nature? The sad truth is that the cuts were an inevitable consequence of an abject failure by Government to fix the drugs pricing system. The Cancer Drugs Fund was always meant to be a temporary measure, but the inability to implement value-based pricing and then value-based assessment during the last Parliament has to some extent led us to the situation we are in today. Cancer Research UK has said that it is

“unacceptable that after five years of conversation, there still isn’t an effective solution in place,”

and I agree. We need a better system of drug pricing that is fair for patients and has the confidence of doctors. At the moment, patients are being badly let down.

Before the election, Labour promised to reform the Cancer Drugs Fund to make it a cancer treatment fund and end the bias towards certain types of treatment. We also promised reform of NICE to ensure a clear route for new treatments to be made available on the NHS. Nobody wants a return to the days when people’s access to treatment was determined by the first two characters of their postcode. Unfortunately, however, the latest promise of reform of the Cancer Drugs Fund has been riddled with confusion and delay. Ministers said the consultation would be published in July, then September, and it finally came out in November. The consultation is expected to run until mid-February, with a new system ready to be in place by April this year. The Minister might be able to hear the scepticism in my voice about whether the Government can deliver meaningful reform of the Cancer Drugs Fund in such a short period, so will he confirm, secondly, that these are still the timescales for delivering reform? If so, will he promise us that the outputs from the consultation will deliver the change being demanded by the cancer community and not leave a half-baked solution?

Although some aspects of the Cancer Drugs Fund proposals are to be welcomed, others cause concern. Beyond some tweaks at the edges, it is not clear that NICE is proposing the fundamental changes to its processes that charities have rightly requested. Breast Cancer Now has warned that the consultation

“does not offer sufficient changes to the way NICE currently operates...to allow drugs to be approved for routine use on the NHS.”

The charity has also said that it is

“concerned that these proposals may result in fewer drugs being made available rather than more.”

Those are troubling comments, so, thirdly, will the Minister respond to those concerns? Can he tell us the extent to which final decisions about treatment access will differ under the reforms? Which drugs that have previously been rejected by NICE will be available?

NHS England has not published an impact assessment for the Cancer Drugs Fund consultation. Members of the cancer community have raised concerns about that with me and asked what NHS England might be attempting to hide, so can the Minister confirm, fourthly, whether NHS England has carried out an impact assessment on the proposed changes? If so, will he promise to place a copy in the Library before the consultation closes, so that Members of this House can give it the scrutiny it deserves?

Beyond the current planned changes, there are disturbing stories of NHS England refusing to discuss price cuts with drug companies, effectively leaving deals on the table that could have helped patients and the taxpayer. Simon Stevens once said that he wanted NHS England to:

“Think like a patient, act like a taxpayer.”

At the moment, it is frankly doing neither. We cannot allow red tape to get in the way of what is right for patients. The reforms must create greater flexibility and pressure for both sides to get round the table and agree deals. 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. Therefore, fifthly, will the Minister promise to intervene in NHS England to ensure it is doing everything it can to secure the best deal from industry for patients and taxpayers? Will he commit to reviewing the processes carried out in other countries for securing access to medicines and ensure that learnings from them are translated into NHS England’s new system?

It is also worrying that the drugs companies and the Secretary of State have negotiated a deal in secret that changes the drugs pricing scheme, effectively creating a half-a-billion-pound funding black hole over the course of the pharmaceutical price regulation scheme. I am fearful that that could lead to more bad news for cancer patients. I have pressed the Minister on that before, so will he tell me, sixthly and lastly, how that funding gap will be filled? Will he guarantee that the shortfall will not lead to any further damaging cuts in cancer patients’ access to treatments?

I want to end my contribution to this debate in the spirit in which I started, because this is not a party political issue. Our shared goal is an NHS that is the best health service in the world for treating cancer, but we will only achieve that if we can ensure that patients can access the most effective forms of treatment. Cancer patients need and deserve an end to the current uncertainty. We on this side of the House will stand with the Government to do all we can to ensure that cancer patients get that fairer deal.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this debate and I thank her for the chance to discuss these important issues, which I know are important to various Members who cannot be here this afternoon. I thank colleagues of all parties who have spoken. It was particularly powerful to hear the personal perspective of my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is a cancer survivor. I pay tribute to the work of Myeloma UK, Cancer Research UK, Macmillan and the other charities that have done, and continue to do, so much work looking after patients and supporting policy and research. As colleagues know, I am passionate that charities should have a bigger role to play in policy making. I have opened the Department’s door and invited them to come to the top table.

Few families in the country are untouched by cancer, and I am no different. My father died of throat cancer when I was 19, 18 months after I had met him. My mother-in-law died of myeloid leukaemia a few years ago. The family, like so many families, had to watch her go from a wonderful and healthy, vibrant grandmother to a corpse in 12 to 15 months. It is a tragedy when it happens, but the truth is that our generation has lived through the most extraordinary advances in cancer. Certainly in my childhood it was a death sentence. One sat in the back of cars as a child and heard parents discussing in hushed tones that somebody had a cancer diagnosis, which meant they would die. Now that has changed: 2 million people live with cancer and it has become a treatable disease. In some cases, it has become a preventable disease. That is why it is such a pleasure to see my hon. Friend the Member for Bury St Edmunds here. Many others in the country today work and live with cancer. It is a stunning tribute to the success of our life sciences sector and our academic and clinical scientists.

My hon. Friend the Member for Mid Derbyshire talked about Tina and Graham and their experience of cancer. We should always remember—I do every day—that at the heart of difficult policy decisions there are people living with the disease. As constituency MPs and parliamentarians we need to bring that personal perspective to policy making. Certainly as a Minister I try to do that. My hon. Friend highlighted the trauma experienced by patients who, at diagnosis, think they will be eligible for a drug but find they have been caught by the timing of the CDF review, which means that the drug is tantalisingly taken away from them. We can all sympathise with that. As in all Administrations, when change comes, somebody normally gets caught at the point of change and it is very difficult. My hon. Friend also made a powerful point about data being crucial, and I accept that we need to do better on data. I have picked out those comments, but we have had excellent comments from across the House.

I want to set the context before dealing with specific questions. In the past 20 or 30 years, we have seen incredible transformations in biomedical research and in our ability to develop new treatments and diagnostics. My own 15-year career in biomedical research saw us go from the early days of genetics to extraordinary abilities to drive diagnosis and personalised therapy. One looks at Herceptin for breast cancer, a genomic biomarker theranostic partner drug. We have guaranteed that it works in patients who have that genetic biomarker. This is the future: much more genomic targeting of drugs. Genomics and informatics are transforming the way in which drugs are developed.

I arrived in the House of Commons six years ago. As a Government adviser on life sciences, I supported the Prime Minister in putting a life sciences strategy in place that built on the previous Government’s good work. We set out an ambition for the NHS to become not only a passive recipient of new therapies, but an active partner in the development of them, making available our genomic and informatics leadership and our clinical research, which is at the heart of the life sciences strategy: two cylinders pumping together, with the NHS not just as a purchaser but a partner in development.

Although we have had phenomenal revolutions in genomics and informatics and in the pace of discovery—pioneered in cancer, which is why cancer has led with this pressure on our funding mechanisms—they give rise to great challenges: rising costs of treatment; ever more expensive drugs; smaller patient catchments, which puts a coach and horses through the traditional model of reimbursement; and the end of a one-size-fits-all blockbuster model of drug discovery, which is what NICE was originally set up to deal with. Those are very big challenges and I am putting policy responses in place. However, they are also big opportunities. As the world’s only integrated comprehensive healthcare system, nowhere is better equipped in the world to unleash the power of genomics and informatics for public good. I believe Nye Bevan would be banging the table today and saying, “The NHS was about the collective use of our health assets to prevent disease. Come on! Let’s harness the extraordinary ability of our NHS,” which is what we are doing.

As we reform the way in which NICE works, there is an opportunity for us to take the lead in the development of these new drugs and new specialised therapies, and to pioneer new models of reimbursement as well. It will not happen overnight—that is the honest truth—but it will happen over the next few years. That is why we have set out a 10-year strategy, and I am absolutely honoured and privileged to be at the beginning of a five-year Parliament as the Minister for Life Sciences with a chance to drive the reforms through. That is at the heart of the accelerated access review that I have launched, which I will talk about in a moment.

I urge everyone to recognise that the Government are not complacent. We have put £250 million extra into Genomics England. We are the first country on earth to do, at scale, full genome sequencing in cancer and rare diseases. Rare cancers are particularly well served. We have led on data and informatics for research in the NHS, often at a high political price, but it is essential if we are to drive this forward. We have set up the precision medicine catapult, the cell therapy catapult and the £700 million Crick Institute. We have protected, increased and ring-fenced science budget increases. We have announced and secured a multi-billion pound drugs budget, and more on that will be announced shortly. We have set up the rare diseases consortium, the accelerated access review, the early access to medicines scheme and a £1.2 billion commitment to the Cancer Drugs Fund, so I hope colleagues will acknowledge, as some have, that we are serious about trying to both invest in and reform this space.

The Cancer Drugs Fund was set up with strong leadership from the Prime Minister. Because of the progress in cancer putting pressure on NICE’s systems, NICE’s clinically led, world class, independent advice rejected many of the new cancer therapies that did not fit well with its scoring system, so the Prime Minster said that we must make the money available to make sure cancer patients do not suffer while we reform the system. The fund is now £1.2 billion; another £340 million was invested this year. Some 84,000 people have received life-extending drugs that they would not otherwise have got.

[Andrew Gwynne]

The situation is worse than described. There were drugs that NICE had approved, but the primary care trusts refused access to those treatments.

[George Freeman]

The hon. Gentleman makes an interesting point about the balance of responsibilities between NICE and NHS England. The system was set up so that NHS England is statutorily bound by NICE’s recommendations. Part of the problem in recent years has been that even treatments approved by NICE can take up to two, three and in some cases five years to be rolled out across NHS England. Much as we all love the NHS, we accept—even the NHS accepts—that there is a problem with patchy roll-out. That is also to do with data, which various colleagues have touched on.