Accelerated Access Review

Debate between David Mowat and Mark Durkan

Tuesday 13th December 2016 Westminster Hall

[David Mowat]

There is no dispute that the drug works, and there is no dispute at all that it is life-changing. The issue before us is the extent to which it justifies a price tag of £300 million to £400 million versus other NHS priorities. All I can say on that is that it is right that the decision is not made by politicians, for the reasons given earlier by the right hon. Member for Leigh.

I was discussing the countries that have so far not authorised Orkambi. Neither Scotland nor the Republic of Ireland accepted that it was cost-effective, and it is not used in Scandinavia or Canada either.

[Mark Durkan]

The Minister mentioned Scotland and the Republic of Ireland, where there are clearly challenges—we only have to look at the pictures in The Irish Times yesterday to see the graffiti about Orkambi in Dublin. Will he commit to working with colleagues from across these islands to use the underdeveloped and underused machinery of the British-Irish Council to literally get our act together when it comes to rare diseases? We should combine our purchasing power when negotiating with the drugs companies and ensure that there are much better networks for referral and treatment. We should improve that collaboration and literally get our act together on these islands.

[David Mowat]

I, too, saw the press. I think the Republic of Ireland drugs Minister has talked about writing around to that effect, and it would be a great idea were we to use our combined procurement muscle in that regard. He is certainly pressing at an open door.

I wish to spend a little time talking about Vertex. The company owns the drugs we are discussing and is worth $18 billion. As well as looking at the NICE review last night, I spent quite a lot of time looking at Vertex’s financial position. The company needs to sell these products; indeed, its continued functioning as a major pharmaceuticals company depends on that. Its share price has fallen by a third during the course of this year—I estimate that is a loss of value of something like $7 billion—because its sales are not adequate. There needs to be a meeting of minds here. I am sure that people from Vertex are listening to this debate, as will people from other places, too. We all want a solution whereby the drug becomes available at a cost-effective price, but the negotiation is not a one-way street; Vertex is part of it as well. Were the company to come forward with different pricing data, those would be looked at very quickly. At some point in the future—I know it will be a long time—the drug will be available generically, although I accept that that will not give hope to some of the people we have heard about today.

In the couple of minutes I have remaining, I wish to discuss the accelerated access review, which was a manifesto commitment we made at the election. We set up the review panel. The basic intent was to enable transformative drugs to come forward more quickly and for there to be, as Members have mentioned, a commercial unit in the NHS that is empowered to do deals and bring treatments forward more rapidly. In October the review team and panel published the final report, to which something like 600 stakeholders contributed. It is a valuable piece of work and we know its direction of travel: bringing drugs into the system more quickly, allowing the NHS to set priorities for the drugs its wants, and giving drugs companies some notice and knowledge that if they develop drugs, they will be used. That will mean that a lot of the commercial discussions can happen earlier and progress can be made more quickly.

The Government are reviewing the results of the accelerated access review. There is much in it, if not all of it, that will be accepted, although I am not in the position to accept it today—that is not my role here. We do, though, want to make progress, which should give some hope for the potential of another review of the matters we have been discussing. Nevertheless, I must say again to Government and Opposition Members that the NICE process and the people carrying it out—they are rigorous scientists and serious doctors—need to be treated and understood with respect. We can all agree that the current situation is heartbreaking for many people. The world has a drug that would change people’s lives, but the world has not rolled that drug out to them because of real and reasonable financial issues. I accept that that is a very difficult thing to explain to people and it is very difficult to accept.

Motion lapsed (Standing Order No. 10(6)).

Earlier Cancer Diagnosis: NHS Finances

Debate between David Mowat and Mark Durkan

Tuesday 18th October 2016 Westminster Hall

[David Mowat]

I thank my hon. Friend for that and for reminding us that at the core of the debate is a point we all agree on: early diagnosis is the key, whether it is for cost-saving purposes—I will come on to some of the points my hon. Friend the Member for Basildon and Billericay made on that—or to be cost-effective. There is no question that early diagnosis saves lives and that it is the right thing to do. Whether we argue a bit about precisely how much money is saved is in a way a secondary issue; it saves lives and it is the right thing to do.

I also want to acknowledge the intervention of the hon. Member for Strangford (Jim Shannon), who reminded us about the need for public health and GP awareness. In England we have had a significant increase in the number of referrals and the National Institute for Health and Care Excellence—latterly in England—has changed its guidelines for referral, which, together with the awareness issue, has increased significantly the number of people diagnosed in stages 1 and 2. We need to continue to make progress on that.

[Mark Durkan]

I commend the hon. Member for Basildon and Billericay (Mr Baron) for leading the debate and for the leadership he has provided on one-year survival rates through the APPG. Does the Minister accept the basic premise that value of life and value for money are not in competition? They are perfectly compatible. We can have better use of money with better outcomes because of better-timed treatments, and that also means there is better evaluation and research, which will feed into better education in a virtuous circle, to meet the point made by the hon. Member for Mole Valley (Sir Paul Beresford).

[David Mowat]

I thank the hon. Gentleman for his intervention and completely agree with the point he made. In this instance, there is no competition between saving money, saving lives and doing the right thing. In a sense, there is a secondary question as to just how much cost is saved, and the balance of cost saving versus doing more diagnostically, because in order to save lives, which is a highly cost-effective thing to do and the right thing to do, we need to do more on early diagnosis.

I have not yet got to the start of my remarks and I have a lot of pages to get through, so I will not be giving too much detail. It is worth acknowledging that cancer survival rates are increasing in the UK. In terms of improvement, between 2011 and 2015 we think something like 12,000 lives a year were saved. That exceeds the goals we set out in the cancer outcomes strategy in 2011.

Last year we saw a 91% increase in urgent GP referrals of patients with suspected cancer—that is another 822,000 patients. That shows a massive increase in NHS resources and all that goes with that, and we are beginning to see those early referrals, and the different guidelines GPs are using to refer, start to come through in the one-year survival statistics. However, as my hon. Friend the Member for Basildon and Billericay reminded us, that does not mean that we are the best in Europe. We need to continue the drive to improve.

The cancer strategy produced by the cancer taskforce is the backbone of what we are trying to achieve. The—I think it is fair to say—acclaimed strategy it produced, “Achieving World-Class Cancer Outcomes”, was published last year. It had 96 recommendations in it, and the Government accepted all 96. We are now putting in place an implementation taskforce. We believe that if we are able to make the progress we expect by 2020, a further 30,000 lives a year can be saved.

Recommendation 96 is the one we are talking about today. It essentially says that we need to do a lot more on early diagnosis because of the cost savings that will potentially arise from that. There are differing views in the Department of Health as to whether for all cancer types in all instances earlier diagnosis does save costs because of the increase in cost and effort associated with the diagnosis—the early screening and all that goes with that. That was not addressed overtly in Cancer Research UK’s “Saving lives, averting costs” report, which was mentioned by my hon. Friend. He quoted numbers of several millions of pounds, and there is no doubt that stage 4 cancer costs massively more to treat than stage 1 cancer, but whether or not there are clear cost savings in all instances and even if we dispute the detail of some of those numbers, we go back to the point made by the hon. Member for Foyle (Mark Durkan) that early diagnosis is the right thing to do. My hon. Friend also mentioned that there are not enough health economists in the NHS; the truth is there are not enough of lots of things in the NHS. Early diagnosis is certainly cost-effective in terms of lives saved, even if there may be some dispute as to whether it saves costs in all instances.

My hon. Friend mentioned the work being done by Macmillan, which I acknowledge. It is a three-year study, which we are looking forward to.

Financial Services Bill

Debate between David Mowat and Mark Durkan

Monday 6th February 2012 Commons Chamber

[Mark Durkan (Foyle) (SDLP)]

Like the hon. Member for North East Cambridgeshire (Stephen Barclay), I shall address areas in which we need to proof and improve the Bill before it goes to another place.

I first want to express support for the hon. Member for Walthamstow (Stella Creasy) in respect of consumer credit protection. Not only lenders of consumer credit should be under the FCA, but debt collectors, brokers, retail services that sell insurance products and those offering debt management services.

Similarly, I support the hon. Member for Rutherglen and Hamilton West (Tom Greatrex). Contrary to suggestions made earlier in the debate that the Bill is about putting Parliament back in charge, it is notable that inquiries and investigations under part 5 go to the Treasury. There is no reference whatever to Parliament in that measure, unlike in section 14 of the Financial Services and Markets Act 2000, which clearly states that any such report will be laid before Parliament.

The Financial Secretary no doubt anticipated that I would mention credit unions in Northern Ireland, because their regulatory status will change in the wider context of the changes heralded by the Bill. He was good enough to receive a pick-up band of Northern Ireland MPs last week to discuss our outstanding concerns on the detail. I can assure him that we are pursuing those. We have not yet eliminated him from our inquiries, but we are making the necessary representations to the FSA and will make them to its successor, the FCA.

I wanted to talk not just about the implications of the Bill in terms of the lessons of the banking collapse, but about other provisions. The launch of auto-enrolment means that millions more people will save for a pension through the capital markets, including many low-paid workers. In recent months, we have seen that pension savers’ interests are not always put first by the industry. The spotlight has been turned on to excessive and untransparent charges, and conflicts of interests.

The fund management industry’s duties to savers are poorly understood and observed. The Law Commission has confirmed that when firms manage other people’s money or give financial advice, they have strict fiduciary duties to act in their clients’ interests—both individuals and institutions, such as pension funds, that represent large numbers of underlying savers. That fact is, of course, not generally accepted or reflected within the industry. In addition, as we have heard, because those are common law duties, they do not form part of the FSA’s regulatory approach. An explicit reference to fiduciary duty in the Bill would give the FSA a powerful tool to ensure that consumers’ interests are protected.

Examples of where consumers have suffered from those duties not being observed include unauthorised profits, and recent research shows that some fund managers made significant profits from lending out clients’ shares with only two thirds of the income from those activities returned to the fund. Of course, under fiduciary duties, any such profit should go back to the underlying investor. Another example is in relation to the exercise of shareholder rights. Asset managers, acting on behalf of pension savers, should exercise their voting rights at major companies in the best interests of the savers, without regard to the interests of the firm, but we have anecdotal evidence of fund managers being told by superiors to wave through excessive executive pay to avoid upsetting potential clients. So the interests of the business are placed ahead of the savers whose money is at stake.

[David Mowat]

I agree with the hon. Gentleman’s point about the market failure that we have seen in the pension and fund industry in the last decade or so, which is close to being a scandal. He is right that the Bill does not include a fiduciary duty, but it would give the FCA a competition requirement that, if applied properly, would prevent the market failure and the non-transparent charges that are the core of the issue.

[Mark Durkan]

The hon. Gentleman has more confidence in the extensive effect that he expects from the competition requirement. I believe that that should be complemented by this other insertion in the Bill.

During pre-legislative scrutiny—about which we heard earlier—the Joint Committee heard that the Bill was unbalanced. On the one hand, it enshrines the principle that consumers are responsible for their decisions, but on the other it does not place any equivalent responsibility on firms. The Joint Committee recommended that the Bill should

“place a clear responsibility on firms to act honestly, fairly and professionally in the best interests of their customers.”

Meanwhile, the Financial Services Consumer Panel recommended that this should take the form of an explicit fiduciary duty to clients.

In response, the Government have inserted a new principle to which the FCA must have regard, which is that

“those providing regulated financial services should be expected to provide consumers with a level of care that is appropriate”,

having regard to the risks involved and consumer capabilities. But that new wording does not provide a high enough level of protection for customers. It clearly lacks clarity on what might constitute an appropriate level of care and stops short of confirming that those managing other people’s money owe fiduciary duties. We need an explicit clarification in the Bill.

Another area in which the Bill is remiss is the whole principle of stewardship. In the aftermath of the financial crisis, it was widely recognised that major institutional investors had behaved as absentee landlords, not doing enough to challenge risky behaviour at the banks that they owned. This had direct consequences for many of the pension savers whose money those shareholders invested. According to the OECD, in the year after the crisis pension funds lost an estimated 17% of their value.

After the crisis, we had the Walker review, and the Financial Reporting Council established the UK stewardship code, designed to encourage investors to behave as active owners of the companies in which they invest. This agenda is increasingly recognised by both the Government and the Opposition in all the recent, highly publicised arguments about executive pay and what can be done to curb it. Both leading parties in this House have placed great emphasis on more shareholder responsibility. But to date the FSA has treated this as a fairly marginal issue, appearing not to regard it as a consumer issue. It is not clear that it will be regarded any differently by the FCA.

There is no mention of stewardship in the Bill, although it is clearly relevant to the objectives of the PRA and the FCA. In particular, there is a danger that stewardship will continue to fall through the cracks in the new regulatory architecture. The PRA is likely to take little interest, because the ordinary asset managers of the firms in question are FCA-regulated, yet there is little reason to assume that the FCA will accord the issue any higher priority than the FSA does at present.

The proposed duty of co-ordination mentioned earlier by the hon. Member for Cities of London and Westminster (Mark Field) will do little to resolve that issue, because it will focus purely on reducing the burden of regulation on dual-regulated firms, rather than on preventing gaps in regulation between the new authorities. That measure will deal with an overlap as it affects the business; it will not deal with the gaps affecting consumers. Again, there is a hole in the legislation as far as consumer protection is concerned.