Blood Cancers

Colleen Fletcher Excerpts

Thursday 7th July 2016 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure as always to serve under your chairmanship, Mr Walker. I should start by saying that I am a joint vice-chair of the new all-party group on blood cancer and a member of the all-party group on stem cell transplantation. I am pleased to have the opportunity to speak in this important debate on blood cancer and the cancer drugs fund. I thank the hon. Members for Strangford (Jim Shannon) and for Crawley (Henry Smith) for affording me this opportunity by securing the debate. I also thank the previous speaker, the hon. Member for Erewash (Maggie Throup). I agree with much of what she said, including about the need for more clinical research.

It is true that since its introduction in 2010, the cancer drugs fund has enabled many blood cancer patients in England to access treatments that are unavailable in the mainstream NHS. That has undoubtedly benefited and saved the lives of thousands of patients. However, it is equally true that, latterly, the CDF has also fostered a great deal of uncertainty for many blood cancer patients and their families.

Some have experienced a rollercoaster of emotions as the life-saving treatments they rely on have been made unavailable, then available and then unavailable again in a matter of a few months. That was most acute during the 2015 delisting process, which resulted in 16 indications for seven blood cancer drugs being removed from the CDF. There is considerable concern that under the new system more and more blood cancer drugs will become unavailable as the CDF moves away from being the safety net for patients that it was designed to be. That concern is reinforced by the retention of the flawed process used by NICE for assessing drugs, which has resulted in many blood cancer drugs becoming unavailable. I hope the Minister will offer assurances that blood cancer patients will be able to access the drugs they need under the new process for reviewing and appraising medicines.

We must not forget that the drugs offered through the CDF are just one of many treatment options available for patients with blood cancer. I want to turn briefly to one of those: stem cell transplantation. I intend to make a few points about the inconsistencies in care for blood cancer patients post-transplant. I declare an interest, as my husband Ian was diagnosed with acute myeloid leukaemia in 2014 and received a stem cell transplant soon after in the same year through Anthony Nolan. I have been to its research labs, where his DNA is stored—he got a 10:10 match, so we were hugely excited about that. I was with Ian when he was told he had a life-threatening disease and also when he was told that he had been cured. I therefore know a bit about despair and hope and inconsistency. I travelled with him throughout the journey. Although he is cured, it is a journey that is not entirely over, but the light of hope now outshines the darkness of despair in his case.

If we are to make use of the cutting-edge research that allowed his cure, we surely need to look at the inconsistencies of post-transplant care. It is vital that blood cancer patients who undergo stem cell transplants have access to the care and support they need after their transplants, as well as before and during. Currently, however, there is no long-term patient pathway and as such the provision of services varies greatly across the country, leaving vulnerable patients at the mercy of the postcode lottery, where some get very good support but others get very little.

The problem arises because the transplant period is defined as 30 days before transplant until just 100 days post-transplant. Variations in care and support occur after that period when commissioning responsibility transfers from NHS England to clinical commissioning groups. After that point there are no guidelines on what constitutes a suitable late effects service for patients and no guarantees of appropriate funding for transplant centres to deliver the care that stem cell recipients will continue to require. As such, the result is geographical variations.

Delivering the long-term care that patients need at a consistent standard across the country requires a clear and fully funded patient pathway. It is my belief, and that of Anthony Nolan, the blood cancer charity, that that pathway should cater for each patient for at least five years after transplant and look much further beyond the arbitrary 100-day figure. I hope the Minister will touch on what can be done to ensure that every patient has access to the same standard of care and support. Will he agree to meet with representatives of Anthony Nolan to discuss how best to deliver a comprehensive post-transplant pathway?

Just as consistency around post-transplant care is essential, so too is the need for consistency in the NHS’s policy on second transplants for blood cancer patients. This is not a plea—I hope my husband will not need a second transplant: he is currently well, but living with the after-effects of the drugs needed to see him through this period—but unfortunately NHS England currently has no clear or consistent policy on whether it will fund second stem cell transplants for the small number of patients each year who relapse, even though there are many people alive today because of a second transplant.

Will the Minister offer his assurances that if a patient’s doctor recommends a second transplant, NHS funding will be allocated to ensure that that patient has a second chance of a cure? After all, is that not why we are here today: to ensure that all blood cancer patients have access to the best treatments available for their condition—treatments that offer the best chance of a cure—whether it be a stem cell transplant, a course of radiotherapy or chemotherapy or access to medicines approved by NICE or those available through the CDF?