Accelerated Access Review

Derek Thomas Excerpts

Tuesday 13th December 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

The accelerated access review is important because it is designed

“to speed up and simplify the process for getting the most promising new treatments and diagnostics safely…to patients.”

That is good news for all Members of Parliament who have in their constituencies people who need access to innovative treatments. Sir John Bell states that the review

“addresses one of the most important issues the National Health Service is confronting; how best to access innovation for the benefit of patients and to improve health care efficiency.”

It should therefore be welcomed and receive support from both the Government and the NHS.

The report has the dual intentions of improving NHS productivity through better use of technology and of promoting the UK as a destination for life sciences. It is clear about the areas that need to be addressed: horizon scanning, data collection, regulatory decision making, clinical and cost-effectiveness assessment and commercial decision and uptake support.

I shall focus briefly on the data collection element of the report because that is what will enable treatments to come forward and help patients. The accelerated access review sets out a mechanism for collecting data on “strategically important medical technologies”. There is a clear need to collect data on technologies and their impact on the healthcare system. The review suggests that one approach should be a “commissioning through evaluation” system, whereby

“complex medical technologies or diagnostic products that significantly change clinical pathways are rolled out in a number of specialist providers who are well-placed to collect impact data and build expertise around pathway change. Following this period, should the technology prove its value after assessment by NICE, it should enter routine commissioning and benefit from supported uptake”.

In a recent debate that I secured on diabetes, I referred to commissioning through evaluation because I fully support the intent of that objective and believe that collecting data in that manner is an effective means of developing real-world data to support the uptake and use of modern treatments across the NHS. That type of evidence development is currently under way in the NHS, and I would like to look at one current commissioning through evaluation programme, which has been in operation since 2013. The programme launched for several technologies, covering a range of conditions. It included procedures to prevent strokes, improve the mobility of children with cerebral palsy, help patients with heart failure and improve radiotherapy for lung and liver cancer. I recognise that this debate is about cystic fibrosis in particular, but I am trying to make the point that as we collect data and bring forward the treatments, we need to ensure that they get to the people who most need them, including those whom we are talking about today.

The programme to which I have referred was structured in two phases. First was the evidence development phase, in which patients would receive the treatments and data would be collected. Second was the evidence assessment phase, in which data would be analysed and a routine commissioning policy developed. We have now reached the point in the process at which the number of procedures originally commissioned has been reached and patients will no longer be given the procedures until a formal commissioning decision has been made.

However, in answer to a parliamentary question in July, the Department of Health said it would take between one and two years to carry out the analysis. Recently, NHS England has stated that formal commissioning policies will not be in place until 2019. Those patients who would benefit from the procedures face the prospect of a two-year wait.

If we focus on just one procedure, we can see the impact that that will have on patients. Selective dorsal rhizotomy is a procedure that supports children with cerebral palsy to have increased mobility in later life. There is a narrow window in a child’s development in which they can receive the treatment. A two-year gap in commissioning will mean that some children never benefit from the procedure.

This debate was initiated by the hon. Member for Dudley North (Ian Austin), whom I thank for giving me the opportunity to speak. Its title on the Order Paper is “Implications of the Accelerated Access Review for cystic fibrosis and other conditions”. I have referred to other conditions, but I want to finish my speech by reading out a letter from a constituent, Christine Edwards, relating to cystic fibrosis. I need add nothing to what she writes:

“Dear Mr Thomas…My niece’s boyfriend, Taylor, has cystic fibrosis. He is a lovely young man and I think it is tragic that his life expectancy is so short. At the moment he is doing pretty well and his health is strong enough to support him going off to University…he did so this year.

The reality is though he can expect his health to decline and with it, his quality of life. Drugs like Orkambi offer such tremendous hope as slowing lung health decline not only offers him the potential to increase his life span directly but also allow him more opportunity to benefit from future treatment development.”

Christine Edwards also writes:

“The 2,700 people with cystic fibrosis in England desperate to access Orkambi do not have the time to wait for the development of a Strategic Commercial Unit to consider a wide range of commercial arrangements. Nor do they have the time to wait for NICE and NHS England to consult on their processes.”

That letter sums up why the Government must intervene and accelerate access to these transforming medical treatments. As Mrs Edwards states, patients cannot wait.

I therefore call on my hon. Friend the Minister to intervene and ask NHS England to give patients access to these innovations by ensuring a rapid and transparent decision-making process for all the innovative treatments currently undergoing commissioning through evaluation. That process should be supported by examining all available evidence and delaying while a small sample of data is analysed. I also call on the Minister to ensure patient access throughout the assessment phase by continuing to fund the procedures until a routine commissioning policy is in place, and to look at the operation of the system in the future and ensure that the design of any programme delivers continued patient access from the start of the programme through to a routine commissioning policy being in place. Finally, I call on the Minister—this is extremely important and will help large numbers of patients with cystic fibrosis and other conditions—to support wider stakeholder input into the system from those who have experience. That would include working with patient groups and industry representatives and would ensure that the NHS had the most accurate information.