Access to Medical Treatments (Innovation) Bill (Money)

Debate between Andy Slaughter and Philippa Whitford

Tuesday 3rd November 2015 Commons Chamber

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

There are many ways for a surgeon to share their experience if they have carried out an operation in the heat of the moment to save someone’s life. The BMJ publishes things on a weekly basis and can share interesting cases. The danger of the Bill is that the database is being used as a fig leaf to make it sound like access to innovative treatments. The hon. Member for Daventry (Chris Heaton-Harris) said that a doctor would have to prove that something was safe, but the first person prescribing liquorice for cancer has no method of proving that it is safe. That is the basis of research.

Phase 1 trials involve a small group of patients who fully consent to undergo treatment and know what they are taking on, based on pre-clinical research. Phase 2 is larger, and phase 3 involves multiple hospitals. We have that process to avoid a couple of doctors in a canteen saying, “That’s not a bad idea. I’ll back you if you back me”, and patients being given something dangerous. The Bill would not, of itself, undermine research in some way, but if patients and the public feel that they are guinea pigs for any old treatment that someone wants to have a bash at, that will undermine research.

It has taken decades to get to our current level of safety, checks and balances. That has been streamlined, and single ethical permissions are carried out once for the whole country, and then recognised in all health boards and areas. That has made things a lot easier, but it is crucial that patients who sign up to a treatment know that there has been a degree of rigour before they are given that drug.

If someone is bleeding to death in the middle of the night, of course a surgeon can innovate because every operation is slightly different, but we are talking about access to medical treatment that will predominantly involve drugs that have not had sufficient pre-clinical work. That is of concern to research charities and the royal colleges—I am a member of the Royal College of Surgeons—because of patient safety. The absolute concern is not even the secondary impact on research; it is the impact on patient safety and people finding that they are being given something totally unproven.

[Andy Slaughter (Hammersmith) (Lab)]

The hon. Lady is making a good point, and I agree with everything she says. As a lawyer rather than a doctor, I think the problem with the Bill is that—unintentionally, I am sure—it also undermines carefully constructed jurisprudence on clinical negligence, and it is dangerous for that reason.

[Dr Whitford]

Of course the Bill is well intentioned, and its title will attract support from people who think that it means getting access to drugs to which we do not currently have access. It is not that any doctor can prescribe anything—we cannot. We can prescribe drugs that are licensed and recognised, and have a basic safety profile. In Westminster Hall we often debate access to expensive, innovative, brand-new treatments, but that is not about our right as a doctor to prescribe them; it is about who will pay for them because some of those drugs are expensive. As the Minister has said, that would still be an issue. In what sense would a commissioning group have evidence to allow a doctor to prescribe a drug that has absolutely no basis, but that would have to be funded?

The Bill is basically a bit of a mess. What problem is it trying to answer? People think it means that they will get earlier access to new drugs, but drugs should be taken forward on the correct path to protect patients and doctors. Doctors need to know that what we are doing is right, and not some random thing that has been on a database after somebody tried something once and it seemed to work. We know that there are placebo and random effects.

Junior Doctors’ Contracts

Debate between Andy Slaughter and Philippa Whitford

Wednesday 28th October 2015 Commons Chamber

[Dr Whitford]

I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.

[Andy Slaughter]

I am grateful to the hon. Lady for busting this myth about weekend death rates—these might be sick people admitted at weekends who die within the 30 days. In fact, fewer people die in hospitals on Saturdays and Sundays than on other days. The Secretary of State is not giving the right impression of the figures.

[Dr Whitford]

I agree.

Since coming here, I have heard stories of people unable to access diagnostic imaging or to work up patients, but there is no argument about that from the profession. That is what we need to focus on, yet a lot of this seems to be about routine. There are fewer doctors at weekends because we do not do routine work. We have teams of people doing toenail and blood pressure clinics in the week. Professor Jane Dacre estimates that doing those at weekends would require 40% more doctors. We cannot do that. We need to make sure that hospitals at weekends have enough people and the right people to be secure, but junior doctors are already there—it is not they who are missing—and emergency services already have a consultant on call. We might need more discussion about their being physically in, but that is a discussion to have with the profession, whereas what we heard on 16 July, which gave the public the impression that senior doctors only worked 9 to 5, Monday to Friday, was very hurtful to the entire profession.