ACCESS TO MEDICAL TREATMENTS (INNOVATION) BILL

Chris Leslie Excerpts

Wednesday 16th December 2015 Public Bill Committees

I want to make two other comments. One is about need, and the extent to which fear of negligence is a barrier to innovation. As you may know, Mr Streeter, if I went on “Mastermind”, one of my chosen subjects would be barriers to innovation in the late 20th and early 21st century NHS. I do not want to detain the Committee with—

[Chris Leslie (Nottingham East) (Lab/Co-op)]

You’ve started, so you should finish.

[George Freeman]

As the hon. Gentleman says, I have started so I had better finish. Let me wrap up a lifetime’s work by saying that there are many barriers to the uptake of innovation in the system. It is clear from pretty substantial anecdotal evidence from people on the frontline that latterly, the fear of unreasonable charges of negligent practice features in their consideration. Some institutions—partly for other reasons to do with tightening up commissioning processes and clarifying and rationalising—have given clinicians instructions such as, “We don’t want you to do anything other than these things; by the way, if you did, you might put us in a difficult position and we’d have to make sure we could defend possible litigation claims.” That is often used, anecdotally and apocryphally, to support a more general presumption about sticking to what we know works and what we have always done.

My hon. Friend the Member for Daventry is partly trying to tackle a culture that is rather difficult to prove and ill-evidenced, but that we none the less picked up in the consultation. In my 15-year career, clinicians said to me, “We used to have a culture that was a bit more conducive to innovation, but we’re all now slightly treading on eggshells and worried about any attempt being misconstrued.” I do not want to suggest that such fear is the No. 1 issue or the most important priority. This is a private Member’s Bill. If I were introducing a Government Bill on access to innovative medicine, I would have measures on a number of other issues before that one, but I respect that there is a cultural fear that innovative practice is less encouraged, promoted and supported, which we picked up in the consultation.

That is one thing that I, as a Minister, am keen to tackle through our work at the Department of Health to sponsor the National Institute for Health Research. The Prime Minister and I have set out a strategic objective: every hospital a research hospital, and every patient a research patient. We do not mean that every patient should be experimented on; we mean that, in an intelligent health system, we should be learning from every moment that we treat patients in the NHS.

I do not think fear of litigation is the No. 1 barrier to innovation, but equally, in an open democracy, Members are free to promote legislation on their own account. I have supported the attempt of my hon. Friend the Member for Daventry to have a debate and find a way of accelerating the uptake of innovation because it is a noble purpose.

I hope that what I have said is helpful and clarifies where I think the barriers are and are not. The bigger barriers are siloed funding, strict and specific commissioning structures, organisational barriers between people who diagnose and people who treat and a lack of integrated funding—all the things we spend our time trying to tackle. It is important that the chief medical officer supports the Bill and that Sir Bruce Keogh has said he is absolutely sure that it is safe; he has advised the Secretary of State and I to that effect.

The Bill was in some ways preceded by a different one: Lord Saatchi’s Bill in the House of Lords, which generated a lot of attention and interest. This is a very different Bill. Lord Saatchi’s Bill set out provisions for a registry, which came late in the process of Lords scrutiny of that Bill, with the thinking being, “Oh, we’d better keep a register of innovations that flow as a result of this Bill.”

If I understand it correctly, my hon. Friend’s purpose is different, and I support him strongly in it, because this is another passion of mine. It is not about creating conditions in which every medic is exhorted and encouraged to experiment and record that in a database—that is absolutely not the right approach or what the Bill seeks to do. Importantly, the wording of the preamble in the opening clause focuses the Bill on something quite different, which I support: the provision of information to clinicians on innovative medicines coming on stream that are either in research trials, which doctors might want to enrolling their patents in, or off-label uses of drugs. No clinician can be expected to keep in their head 24/7 information about all the innovative medicines out there or, indeed, unlicensed medicines that might be available through the early access to medicines scheme that I launched. That wording intends to clarify that the Bill is different from Lord Saatchi’s Bill, with a focus on giving clinicians access to information about treatments that they consider their patient might be eligible for. For me, that is the best bit of the Bill, and I would strongly support the Committee in continuing to debate it.

The hon. Member for Torfaen proposed a Bill, which did not get a Second Reading, that sought to promote off-label use of medicines. A database for clinicians that gave them, at the click of a mouse, access on their desktop to information about innovative medicines that are available—or, indeed, about off-label, innovative uses of existing medicines—would be a powerful tool to help promote innovation.

[Chris Leslie]

I am focused on the amendments. Will the Minister give us his view on whether he supports amendments 1 to 4? That would help.

[George Freeman]

I do not. I am politely winding my way round to saying that. However, the reasons are important. It is not that I object to amendments at all—I hope the Bill will be heavily amended in Committee to reach that nirvana of all the parties—but, because the clause is important and helps to clarify the Bill’s intention, I suggest that the amendments should not be pressed. However, we might work on a package of amendments on Report that tackle giving clinicians access to information about innovative medicines and the important points made by the hon. Gentleman.

--- Later in debate ---

[Justin Madders]

On amendments 3 and 4, I am happy to work with the hon. Gentleman and, if necessary, table an amendment on Report. I take what he says about this being a conferring Bill, but I think it was important for us to place on record our views about the importance of patient experience. We can have further conversations on that, and if we consider it necessary we will re-table those amendments. However, we will press amendments 1 and 2 to a vote.

I appreciate what the Minister said about the need to focus on innovation barriers. There is something in what he said about it being a cultural issue—there is no doubt about that. I do not think, however, that a piece of legislation of this nature is the right way to tackle that cultural issue. As I said in my opening comments, the Bill carries the risk of unintended consequences. We can all work together to try to tackle some of the barriers, but the Bill is not the way to do it.

Of course, the Minister has had the benefit of legal advice that I have not had on the impact on existing medical negligence law, but I am sure all members of the Committee have seen the representations from Nigel Poole QC, who is the leading authority on clinical negligence in this country. His view is that the Bill does make changes. We cannot get into a debate about who is right or wrong about that, but I focus on what the Minister said about how, even if the Bill only changes the perception of patient safety, that is important in itself. That alone is reason for us to pause and look again at the Bill, and that is why I will press amendments 1 and 2 to a vote.

[Chris Leslie]

To be absolutely clear on the effect of the amendments, as I read them, amendments 1 and 2 would delete the provisions about access to innovative treatment, but would retain the creation of the database. Have I got it right?

[Justin Madders]

Yes, my hon. Friend is absolutely correct. That is why we spent some time talking about those issues. They are really at the heart of the concerns.