Cancer Drugs

George Freeman Excerpts

Tuesday 20th October 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, at this early hour of the morning. I know that many Members would have liked to have been here for this debate. I suspect that if the debate had been scheduled for the main Chamber, we would probably have half-filled it, given the level of interest. I am delighted to have the chance to respond.

First, I congratulate and pay tribute to my friend, the hon. Member for Strangford (Jim Shannon). He is, as a number of colleagues have observed, a tenacious campaigner on this subject, and I am glad that we have kept up our record of 100% support for each other. He is a parliamentary champion of this cause, and it is a pleasure to work with him on it. He spoke powerfully about his own family’s experience of cancer, as did the hon. Member for Denton and Reddish (Andrew Gwynne). I am sure many Members from all parts of the House have experience of cancer. My father died of throat cancer when I was 19. It is a disease that still, despite all the progress, robs families and stalks the land. I will say something in a minute about the progress that has been made, because it is stunning.

I suspect when many of us were children, that word—cancer—normally spelled a quick and tragic death. Now, more than 2 million people living in Britain have had a cancer diagnosis. Cancer Research UK and all those involved in cancer research have achieved extraordinary things, but it is still a diagnosis and treatment that people dread. Cancer is a serious cause of early death, and it was powerful to have heard such cross-party support for cancer research.

As the hon. Member for Strangford and others observed, cancer does not respect any boundaries, whether they are of geography, income or party politics, although I make the point that it heavily correlates with health inequalities. Many colleagues in the House with constituencies with particularly high incidences of cancers also have constituencies with particularly a high incidence of poverty generally. There is a strong link between life chances and poverty and health and health inequalities. I observe that the Petitions Committee has received a petition on Abraxane, which is a symptom of how widely the concern on this issue goes across the House.

I will try to deal with some of the issues that have been raised. The truth is that the field of cancer research has pioneered the model of 21st-century drug discovery and life science research that is transforming how the sector works. That is driven principally by breakthroughs in genomics, genetic science and informatics—the ability to develop treatments and diagnostics based on being able to predict which patients will respond to which drugs and which patients are likely to be predisposed to a particular disease. Such breakthroughs and the use of big data, big informatics and genomic insights into the use of genomic biomarkers are allowing us to redesign the way in which drugs are discovered and developed. Cancer has led in that field partly because cancer is itself a genetic disease and because of the extraordinary work of Cancer Research UK and various other charities. I pay tribute to their work and leadership not only in deep science, but in the policy-making framework on treatment, diagnosis and care. I will talk about the cancer strategy that CRUK has helped us to put together in a moment.

The role of charities is growing in this space. I recently opened a combined laboratory in Cambridge shared by Cancer Research UK and MedImmune, a subsidiary of AstraZeneca. We have seen partnerships and collaborations between charities and companies before, but this was a joint laboratory, jointly funded with a joint research committee. It is a sign of where this landscape is going. We will see charities become the gatekeepers of patient power, patient tissues and patient genomic information, and gatekeepers of the patient asset in this new landscape of patient-centred research. It is a very exciting time for medical research charities.

Pioneering cancer research has made many cancers diagnosable and treatable diseases. As I have said, more than 2 million people now live with cancer. Diagnosis is still poor in pancreatic and colon cancer, and in many cases there is no proper cure, but about 98% of breast cancers are treatable and curable. That is a stunning breakthrough and I am sure that over the next 20 or 30 years we will see all cancers quickly reach that point. We need to recognise the extraordinary improvements in this field. The role of genetics and informatics is welcomed by the Government. We are doing everything we can through our life sciences strategy, set out by the Prime Minister in 2011, to drive this new landscape.

We have made groundbreaking commitments with the Genomics England programme. We are the first nation to commit to sequence the genomes from 100,000 NHS patients and combine that with clinical data. We have made groundbreaking commitments to open up our data sets to drive this model of 21st-century research. It is important that all of us who understand the power of that work also support it, because our constituents worry about the use of data. We need to make sure we safeguard individual patient data, and we need to make sure we unlock the assets of the NHS throughout the United Kingdom so that we are a genuine powerhouse in the 21st-century model of patient-centred research.

I want to pay tribute to the work of Northern Ireland scientists, academics and companies. The hon. Member for Strangford mentioned the Experimental Cancer Medicine Centre at Queen’s University. He is absolutely right that it is a world-class centre. I visited earlier in the year to commend, congratulate and support the team there. Sometimes the sector appears to be more interested in Oxford, Cambridge and London than in the extraordinary world-class centres out on the corners of the United Kingdom. I went specifically for that reason. The work there is not only world class in terms of the deep science on the cell mechanisms of cancer, but, in embracing the unified life sciences strategy research and treatment, the centre has helped to pioneer leadership in stratified medicine, pulling in inward investment and, interestingly, taking the patient catchment for the lower quartile of cancer outcomes to the upper quartile. That is a sign of how research medicine drives up clinical standards.

[Jim Shannon]

I visited Queen’s University in Belfast in the summer. They told me that they wished to see more partnerships and relationships with other universities, including on the mainland. The funding strand needs to be encouraged and we need to be a part of that. Will the Minister take that on board? I am sure he knows all about it, but I simply remind him.

[George Freeman]

The hon. Gentleman makes an important point. I will be discussing the matter with the Minister for Universities and Science and the Medical Research Council. We need to make sure that we move to a more networked and collaborative model of science funding. Traditionally, we have tended to fund established centres of excellence, which is important, but we also need to make sure we build networks. Cancer networks in research and treatment have been incredibly powerful in driving the advances that we have discussed. He makes a very good point. I was delighted to see the leadership of the Queen’s centre recently recognised by Cancer Research UK with a £3.6 million grant.

I want to talk about the wider landscape of cancer treatment and then turn to the drugs question.

[Lady Hermon]

I am grateful to the Minister for allowing me to intervene on him before he moves on to a different point. I am pleased that Her Majesty’s Opposition have made it clear in the debate this morning that they are going to support the Off-patent Drugs Bill, a private Member’s Bill. It would be helpful to many MPs who have had emails from constituents, as I certainly have, to find out what the Government’s attitude is to the Off-patent Drugs Bill. I encourage the Minister to say, “Yes, the Government will support it,” although I do not want to put the exact words into his mouth.

[George Freeman]

I will come to that important point as I deal with some of the questions that have been raised.

On the wider issue of cancer treatment, I want to highlight the announcement that the Secretary of State recently made on setting out our cancer strategy and the work of the cancer taskforce. We have set out important measures on a wider treatment regime for cancer. By 2020, NHS patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will be underpinned by an extra £300 million a year by 2020. We are launching a new national training programme that will equip another 200 staff to develop the skills and expertise to carry out endoscopies by 2018. We have a commitment from NHS England to implement the independent cancer taskforce’s recommendations on molecular diagnostics. This will mean that around 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments.

I have been absolutely insistent since day one when we launched the genomics programme that this deep science project should be embedded in NHS England. Patient recruitment for the project comes through the 11 genomic medicine centres in NHS England, and NHS England is now developing an infrastructure for doing genomic and molecular diagnostics in the mainstream NHS. We want the NHS to be the first health service in the world to launch genomic medicine for all as part of our universal 21st-century offering. A lot of work is going on at the moment on how we build the infrastructure for molecular diagnostics.

Our aim is that, by 2020, everyone diagnosed with cancer will benefit from a tailored recovery package, individually designed to help each patient. We are also committed to empowering patients and giving them much more information, so that those who choose to do so will be able to access personal health information, such as their test results, diagnosis, treatment history and their cancer recovery package, online. By 2017, there will be a new national quality of life measure to help to monitor how well people live after their treatment has ended, enabling priorities for improvements to be identified. We will continue to work with NHS England, charities and patient groups to deliver those commitments. It is important to remember that as people live with cancer—hopefully, more people will live with it—we will need to invest in the support network for how they live with it, and how we continue to monitor and support them and deliver post-treatment care.

I want to emphasise the importance of the role of NICE. Nothing I am about to say in any way undermines our commitment to its independent role and expertise in guiding and supporting decision making on drug access with the latest evidence and health economic leadership. In no way do we want to undermine its position. NICE has led the world. That is a great tribute to it and to the UK’s system. We are clear that if a drug is recommended by NICE, the NHS is legally required to fund it. Over the years, many thousands of people in England have benefited from the cancer drugs that NICE has recommended. These include Herceptin, Yervoy, and Zytiga for prostate cancer.

Most recently, hon. Members will have seen that NICE published final guidance on 7 October that recommends Keytruda, or pembrolizumab, for the treatment of advanced melanoma, after disease progression with Yervoy. I urge NICE to embrace the new technologies. I will talk about that in a moment. I am particularly pleased to be able to announce that in the early access to medicine scheme, which we launched last year as the beginning of the new landscape and which I have asked my accelerated access review to look at beefing up and developing, the first drugs have come through. They have been fast-tracked.

I am delighted to confirm to the House that NHS England has now undertaken routinely to fund the use of NICE-recommended early-access-to-medicine products within 30 days of NICE guidance being published. Colleagues will know that the scheme was established so that an innovative drug may be designated a promising, innovative medicine, and if there is no alternative mainstream therapy, the treatment can be fast-tracked into patients, with their consent, and rapid assessment carried out. The link to NHS England commissioning had not been established, but it is now in place. I am delighted that the first drug has gone through that system, and we hope that more will follow.

[Mark Durkan]

I welcome the Minister’s words on the progress of early access, but does he recognise that since 2011 NICE has turned down every new breast cancer medicine, while the cancer drugs fund has approved six new breast cancer treatments in NHS England? Between April 2013 and March 2015, that represented more than 2,000 extra life-years for patients coming from the CDF—life-years that NICE did not deliver.

[George Freeman]

The hon. Gentleman tees me up perfectly for the next section of my speech, because I want to deal with access to drugs and the Cancer Drugs Fund. We all recognise, not least the Prime Minister, that access to drugs is essential in this landscape, which is why he personally led the launch of the Cancer Drugs Fund—I thank the shadow Minister for paying tribute to that leadership. We have now committed just over £1 billion to the Cancer Drugs Fund—a substantial investment—and just under 80,000 patients have benefited from treatments that otherwise would not have been approved. They are largely treatments that NICE has turned down and the Cancer Drugs Fund has then stepped in to fund.

Because of the cancer field’s leadership in this new model of drug discovery, the rate of new drugs coming through is increasing and going to a targeted patient base. The smaller patient catchment for which industry must recover costs has driven it to raise prices and costs. In many ways, it has challenged NICE’s traditional £30,000 per quality-adjusted life-year model. It is driving huge pressure on our traditional model of health-economic reimbursement.

As Members have said, and as the National Audit Office report recently highlighted, the CDF was originally established as an interim measure to ensure that cancer patients were not denied drugs while we fixed the landscape. Although I have been in post only 15 months, I hope colleagues can see that the reviews of accelerated access and the CDF are not accidentally aligned. We are currently looking at how we make sure we support access to innovative medicines. Where cancer has led, other therapeutic areas will follow.

The genomic and informatics revolution will require NICE to change how it works. The explosion of progress in this field is what has put so much pressure on the CDF. Ever more treatments are coming online, but NICE is turning down ever more treatments on very well respected health-economic grounds. Those are difficult judgments about what represents health-economic value for the system and for patients. The CDF does not have a built-in discounting mechanism: it effectively takes the price on the basis of which NICE has rejected the drug and agrees to pay it. We want to look at whether we might use our extraordinary purchasing power to use the fund in a more productive way to get earlier access and, in return, discounts. That is what the accelerated access review is all about.

It is important to confirm that if NHS England decides to de-list a drug, any patients who have received a drug through the cancer drugs fund will continue to receive it. Where patients, particularly those with rarer cancers, are unhappy with a recommendation to de-list and their clinicians advise it, they can initiate individual cancer funding requests, an important avenue that many patients are successfully using.

I want to discuss the accelerated access review and respond to some of the questions that have been asked. I launched the review this time last year, asking and challenging the system to answer three big questions. Given the NHS’s extraordinary position as a universal, single-payer health system with leadership in genomics and informatics, the review is about asking what we can do to accelerate how we get innovation to patients. I have asked three specific questions. First, what can we do to shorten the time, cost and risk of getting innovation to that all-important moment of first use in patients? How can we make things quicker both for the patients who need it and for researchers, so that they can get those all-important human clinical data?

Secondly, what can we do to help NICE to embrace new flexibilities and pathways and to use genomics and informatics to update its systems, in order to deal with the issues raised by a number of colleagues relating to the end of the one-size-fits-all blockbuster model so that, in the 21st century, NICE has more tools at its disposal and more adaptive pathways—to use the jargon—to open up those flexibilities?

Thirdly, I have asked the accelerated access review to look at what barriers we can knock over and what incentives we can put in place to speed up the roll-out of innovative drugs and device diagnostics across the system. Unfortunately, there is great variation in the pace at which innovation is rolled out. In many ways, the CDF has pioneered on the very problems with which the system is now confronted. I am convinced that the CDF will be part of the solution. I cannot prejudice NHS England’s consultation, but I can reassure Members that, through the accelerated access review and the comprehensive spending review, we are looking at what we might be able to do to ensure that our commitment to funding innovative cancer medicines through the CDF also supports the broader landscape for innovative medicines. We will have to wait to hear the detail in the comprehensive spending review and subsequent announcements at the end of the consultation.

I want to deal quickly with one or two of the points made in the debate. The hon. Member for Upper Bann (David Simpson) made an important point about the different parts of the United Kingdom co-operating. As the UK Minister for Life Sciences, I am very conscious of leadership in Scotland, Wales and Northern Ireland, and would be interested to follow up on his point about using the broader network.

The hon. Member for Scunthorpe (Nic Dakin) asked me about NICE looking at exceptional circumstances. The accelerated access review is looking at whether we can give NICE more freedoms and flexibilities. The hon. Member for Motherwell and Wishaw (Marion Fellows) made an important point about the Scottish model—the innovative medicines fund there, the Scottish Medicines Consortium and the importance of patient voice, of which I am very conscious. She also discussed health inequalities, which are important.

Various colleagues asked about Abraxane. NICE is in the process of developing guidance on Abraxane for pancreatic cancer, which it expects to publish very shortly. The hon. Member for Strangford made an important point about data. We recognise that we need to be much better at gathering and using the data from the CDF. A data-sharing agreement between NHS England and Public Health England was signed in July.

In closing, I thank the shadow Minister for his support for the cancer drugs fund. We are intent on it remaining focused on access to drugs; we are tackling the wider treatment regime through the cancer strategy I have set out.

[Lady Hermon]

rose—