Health: Multiple Sclerosis

Earl Howe Excerpts

Wednesday 2nd February 2011 Lords Chamber

[Lord Walton of Detchant]

To ask Her Majesty’s Government what steps they are taking to increase the proportion of multiple sclerosis patients who receive disease-modifying drugs.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, patients with multiple sclerosis can receive treatment with a number of disease-modifying drugs where their clinicians consider they will benefit. More than 12,000 have benefitted from such drugs through the risk-sharing scheme established in 2002. In addition, another drug, Tysabri, has subsequently been licensed for use in the NHS and recommended by the National Institute for Health and Clinical Excellence.

[Lord Walton of Detchant]

My Lords, I thank the noble Earl for that Answer. As he made clear, following the introduction of interferons in the past 20 years, a number of effective drugs have been introduced and have been shown by research to have a beneficial effect upon the course of the disease, particularly in the relapsing and remitting form of the condition. However, is he aware that in the UK only 12 per cent of patients with multiple sclerosis are at present receiving these drugs? A recent report from the Department of Health shows that, in that respect, this country stands 13th out of 14 comparator countries. Surely we can do better.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Lord, with his extensive knowledge of neurology, is perhaps the best person in this House to inform us on this subject. He is of course right—and there is considerable comment on the fact—that, particularly as regards the new drug Tysabri that I mentioned, the uptake has been lower than was perhaps expected. Professor Sir Mike Richards’ report on the extent and causes of international variations in drug usage outlines that low use of Tysabri in the UK could be the result of caution and/or scepticism among some neurologists about the benefits of the drug, particularly as regards its side-effects. However, the precise causes of the variations are a matter of speculation.

[Lord Hylton]

Does the noble Earl know—I expect that he does—that there is a treatment which extracts the stem cells from the patient’s blood and reinjects them in crucial spots? This treatment is available in Baghdad, Beirut and Kurdistan. Will the Government make it available in this country, for the benefit of multiple sclerosis sufferers?

[Earl Howe]

My Lords, I have extensive briefing on some upcoming and promising treatments that may or may not emerge in the National Health Service, but I have to say that that is not one of them. I shall go away and ask the department to inform me.

[Lord Winston]

My Lords, in addition to the important point made by the noble Lord, Lord Walton, about drugs that should be available under the National Health Service, is the Minister aware that some years ago a Select Committee for Science and Technology inquiry gave clear evidence that, in small doses, cannabis is of great benefit to some patients who have spasms and other problems with multiple sclerosis? Do the Government have any plans to allow the use of that drug in those circumstances?

[Earl Howe]

My Lords, the noble Lord will know that a drug called Sativex was recently licensed, which is derived from an extract of cannabis, as he will be aware. Having said that, I believe that NICE has issued no guidance to the NHS on the use of Sativex, so it is for local primary care trusts to make funding decisions based on an assessment of the available evidence and on the basis of the patient’s individual circumstances. As the noble Lord rightly said, Sativex treats the symptoms of severe spasticity caused by MS and is not a disease-modifying drug as such.

[Baroness Gardner of Parkes]

My Lords, I declare an interest as I have a daughter who has had multiple sclerosis for 30 years. For the past 13 years, she has been on beta interferon, which has been of great benefit to her. I understand from the press that there is a possibility of oral drugs rather than weekly injections in the future. Can the Minister tell us what stage that is at? I understand that the issue is still being considered by NICE as it is in the early stages. What progress is being made?

[Earl Howe]

My noble friend is absolutely right. There are two drugs, Cladribin and Fingolimod, which are oral treatments but they have not yet received licences. The trial results for Fingolimod are promising, but it is premature to say that the treatment will remove the need for the drugs in the risk-sharing scheme. Clearly, oral treatments are likely to have advantages over alternative treatments given by injection or infusion, but some concern has been expressed about possible side-effects and the likely cost to the NHS.

[Lord Dubs]

My Lords, does the Minister agree that many patients who are on those drugs also need the support of MS nurses, of which there are very few? Indeed, in some parts of the country there are none at all. What can be done about that?

[Earl Howe]

In recent years the number of specialist MS nurses has increased—I understand that the number has almost doubled—partly as a result of the risk-sharing scheme introduced in 2002. However, we hear anecdotal reports that the numbers are dwindling, which is a matter of concern. Under the new NHS architecture, which will be characterised by clinically-led commissioning responding to the health needs of the local area, we will see that the workforce planning that will emerge will lead to the training of more of these specialist nurses.

[Baroness Finlay of Llandaff]

During the current transition phase of the NHS as we move towards the new arrangements, what appeal mechanisms are there for patients who wish to be considered for disease-modifying drugs to be referred for neurological assessment where their general practitioner is not doing so or where they cannot find out who is the person to approve payment?

[Earl Howe]

My Lords, at the moment, the appeal process is to the primary care trust. Under the Government's proposals, the appeal will be, in the first instance, to the GP-led consortium and, thereafter, if appropriate, to the NHS commissioning board.

[Baroness Jolly]

My Lords, medication is clearly critical for patients with MS, but a whole range of aids are also available. How does my noble friend think that those aids might be more readily available under the new, reformed NHS?

[Earl Howe]

Again, my Lords, the requirement for aids will emerge from two driving processes: one will be the clinically led commissioning process and the other will be patient-led groups. Neurological Commissioning Support is already driving forward an extremely coherent and up-to-the-minute commissioning pattern of pathways for the emerging GP consortia. Patient power will have a big influence as well.