Cancer Drugs

George Freeman Excerpts

Tuesday 19th January 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this debate and I thank her for the chance to discuss these important issues, which I know are important to various Members who cannot be here this afternoon. I thank colleagues of all parties who have spoken. It was particularly powerful to hear the personal perspective of my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is a cancer survivor. I pay tribute to the work of Myeloma UK, Cancer Research UK, Macmillan and the other charities that have done, and continue to do, so much work looking after patients and supporting policy and research. As colleagues know, I am passionate that charities should have a bigger role to play in policy making. I have opened the Department’s door and invited them to come to the top table.

Few families in the country are untouched by cancer, and I am no different. My father died of throat cancer when I was 19, 18 months after I had met him. My mother-in-law died of myeloid leukaemia a few years ago. The family, like so many families, had to watch her go from a wonderful and healthy, vibrant grandmother to a corpse in 12 to 15 months. It is a tragedy when it happens, but the truth is that our generation has lived through the most extraordinary advances in cancer. Certainly in my childhood it was a death sentence. One sat in the back of cars as a child and heard parents discussing in hushed tones that somebody had a cancer diagnosis, which meant they would die. Now that has changed: 2 million people live with cancer and it has become a treatable disease. In some cases, it has become a preventable disease. That is why it is such a pleasure to see my hon. Friend the Member for Bury St Edmunds here. Many others in the country today work and live with cancer. It is a stunning tribute to the success of our life sciences sector and our academic and clinical scientists.

My hon. Friend the Member for Mid Derbyshire talked about Tina and Graham and their experience of cancer. We should always remember—I do every day—that at the heart of difficult policy decisions there are people living with the disease. As constituency MPs and parliamentarians we need to bring that personal perspective to policy making. Certainly as a Minister I try to do that. My hon. Friend highlighted the trauma experienced by patients who, at diagnosis, think they will be eligible for a drug but find they have been caught by the timing of the CDF review, which means that the drug is tantalisingly taken away from them. We can all sympathise with that. As in all Administrations, when change comes, somebody normally gets caught at the point of change and it is very difficult. My hon. Friend also made a powerful point about data being crucial, and I accept that we need to do better on data. I have picked out those comments, but we have had excellent comments from across the House.

I want to set the context before dealing with specific questions. In the past 20 or 30 years, we have seen incredible transformations in biomedical research and in our ability to develop new treatments and diagnostics. My own 15-year career in biomedical research saw us go from the early days of genetics to extraordinary abilities to drive diagnosis and personalised therapy. One looks at Herceptin for breast cancer, a genomic biomarker theranostic partner drug. We have guaranteed that it works in patients who have that genetic biomarker. This is the future: much more genomic targeting of drugs. Genomics and informatics are transforming the way in which drugs are developed.

I arrived in the House of Commons six years ago. As a Government adviser on life sciences, I supported the Prime Minister in putting a life sciences strategy in place that built on the previous Government’s good work. We set out an ambition for the NHS to become not only a passive recipient of new therapies, but an active partner in the development of them, making available our genomic and informatics leadership and our clinical research, which is at the heart of the life sciences strategy: two cylinders pumping together, with the NHS not just as a purchaser but a partner in development.

Although we have had phenomenal revolutions in genomics and informatics and in the pace of discovery—pioneered in cancer, which is why cancer has led with this pressure on our funding mechanisms—they give rise to great challenges: rising costs of treatment; ever more expensive drugs; smaller patient catchments, which puts a coach and horses through the traditional model of reimbursement; and the end of a one-size-fits-all blockbuster model of drug discovery, which is what NICE was originally set up to deal with. Those are very big challenges and I am putting policy responses in place. However, they are also big opportunities. As the world’s only integrated comprehensive healthcare system, nowhere is better equipped in the world to unleash the power of genomics and informatics for public good. I believe Nye Bevan would be banging the table today and saying, “The NHS was about the collective use of our health assets to prevent disease. Come on! Let’s harness the extraordinary ability of our NHS,” which is what we are doing.

As we reform the way in which NICE works, there is an opportunity for us to take the lead in the development of these new drugs and new specialised therapies, and to pioneer new models of reimbursement as well. It will not happen overnight—that is the honest truth—but it will happen over the next few years. That is why we have set out a 10-year strategy, and I am absolutely honoured and privileged to be at the beginning of a five-year Parliament as the Minister for Life Sciences with a chance to drive the reforms through. That is at the heart of the accelerated access review that I have launched, which I will talk about in a moment.

I urge everyone to recognise that the Government are not complacent. We have put £250 million extra into Genomics England. We are the first country on earth to do, at scale, full genome sequencing in cancer and rare diseases. Rare cancers are particularly well served. We have led on data and informatics for research in the NHS, often at a high political price, but it is essential if we are to drive this forward. We have set up the precision medicine catapult, the cell therapy catapult and the £700 million Crick Institute. We have protected, increased and ring-fenced science budget increases. We have announced and secured a multi-billion pound drugs budget, and more on that will be announced shortly. We have set up the rare diseases consortium, the accelerated access review, the early access to medicines scheme and a £1.2 billion commitment to the Cancer Drugs Fund, so I hope colleagues will acknowledge, as some have, that we are serious about trying to both invest in and reform this space.

The Cancer Drugs Fund was set up with strong leadership from the Prime Minister. Because of the progress in cancer putting pressure on NICE’s systems, NICE’s clinically led, world class, independent advice rejected many of the new cancer therapies that did not fit well with its scoring system, so the Prime Minster said that we must make the money available to make sure cancer patients do not suffer while we reform the system. The fund is now £1.2 billion; another £340 million was invested this year. Some 84,000 people have received life-extending drugs that they would not otherwise have got.

[Andrew Gwynne]

The situation is worse than described. There were drugs that NICE had approved, but the primary care trusts refused access to those treatments.

[George Freeman]

The hon. Gentleman makes an interesting point about the balance of responsibilities between NICE and NHS England. The system was set up so that NHS England is statutorily bound by NICE’s recommendations. Part of the problem in recent years has been that even treatments approved by NICE can take up to two, three and in some cases five years to be rolled out across NHS England. Much as we all love the NHS, we accept—even the NHS accepts—that there is a problem with patchy roll-out. That is also to do with data, which various colleagues have touched on.

[David Mowat]

The Minister used the words “world class” in respect of NICE, but said that its scoring system was such that drugs did not get authorised, and that many that the drugs fund includes were not authorised by NICE. Those two things do not seem to be consistent. Should we not look carefully at what NICE’s criteria are, as they have done in Scotland, and make them more appropriate?

[George Freeman]

The answer is yes. That is why I have set up the accelerated access review, which is doing precisely that. NICE is heavily involved in contributing to setting up the reforms, giving it new flexibilities and changing the way we adopt, assess and reimburse new medicines. I meant that NICE is recognised internationally. Indeed, other countries follow its health technology assessments, and its methodology and protocols. The challenge now is to update them for a world of genomics and informatics, with a much more targeted and precision medicine landscape. I accept that in that context we are not yet world class—we have more to do—but NICE is a world class organisation. Given the chance to update its systems, I believe it will lead the world in that field.

In the autumn statement we fully funded the NHS’s five-year forward view, including its cancer strategy, with a commitment to £10 billion extra per year by 2020. We frontloaded that with £6 billion, as was asked for, to allow it to make the investments necessary to modernise. That is a half-trillion pound commitment to spending on the NHS over this Parliament, so I gently point out to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), that to describe that as a cut is testing the admirable elasticity of the English language.

On the importance of NICE and independent, clinically led decision making, much as at times like this I yearn to reach for a big lever, pull it, make a decision and send hon. Members out dancing and cheering and send patients home happy, I think we all understand that it is right that such decisions are not taken by MPs or Ministers; they must be taken by clinicians, based on the very best evidence from the very best independent advice. That is how this system works: NICE makes an independent judgment using the very best systems available to it. I take the point made by my hon. Friend the Member for Warrington South (David Mowat) that that needs to be, and it is being, updated to give NICE more flexibility to reflect the challenges of precision medicine—treatments that have a very definable, predictable response in a very small number of patients. NICE’s advice goes to NHS England, which makes the clinical judgment about treatment protocols. It is right that the Cancer Drugs Fund is based on that clinical decision making.

Nevertheless, there is an anomaly. Although we expect NHS England to be guided by NICE, in one therapeutic area, with the best of intentions, we have created a fund that sits at the end of the process, so that NHS England has a fund to buy drugs that NICE has said no to. That is an anomaly in the system. The point of the review is to take the CDF commitment to fund earlier, so that NICE can use it as an assessment fund to enable it to look earlier in the process at new drugs that are coming on stream and then give NHS England advice. That is in keeping with our general policy of opening up a space between research and medical practice in which we use data from the front-line treatment of patients and from the system to inform our procurement and reimbursement system.

Rather than “finger in the air” theoretical models of health-economic benefits, we are within touching distance of a system that is able to use real data in realtime from real patients with real diseases to drive real models of cost-benefit and health economics, and we are trying to wire the system in order to deliver that exciting prize. Members will understand that, where funding is finite—£1.3 billion is a big commitment, but it is finite—the system must re-prioritise which drugs it purchases. That is difficult for those who are in the process of getting a diagnosis and expecting a treatment that is then withdrawn, but I stress that no patient who is in receipt of a treatment that is withdrawn has that treatment withdrawn from them specifically. If they are getting a drug, they continue to get it.

My hon. Friend the Member for Mid Derbyshire mentioned pomalidomide, a drug used to treat relapsed myeloma. The CDF clinical panel looked at it, reviewed it, and, based on its independent, best-in-class assessment, the score was too low so the panel recommended that it not be approved. As I understand it, NICE is currently looking at other treatments for multiple myeloma, including panobinostat. I checked with NICE before the debate, and can say that final guidance on that treatment for that condition is imminent.

I remind Members that any patients receiving drugs continue to be treated, and that no drug will be removed if it is the only proven therapy available on the NHS. Sometimes in debates such as this we give the impression that we are taking away a drug, patients will stop getting it, and patients who have no other treatment will be left without treatment. That is not what happens. We should remember that there is an individual funding request mechanism—the IFR—for patients with exceptional conditions that are not met by other drugs. That is there specifically so that if any constituents have a unique claim on clinical exceptionality, their clinicians can make that case.

I should highlight the fact that two new drugs were approved in the previous CDF round. We sometimes forget that new drugs are being approved. We do not get requests for debates in Westminster Hall to congratulate the system on their approval, but it is worth mentioning them. The system approved panitumumab for bowel cancer and ibrutinib for cell lymphoma. Those approvals have been widely welcomed by patients and charities in the relevant sectors. I am delighted that, through the early access to medicine scheme that we introduced last year, which, with patient consent and their clinician’s approval, enables unlicensed drugs to be fast-tracked, we have now got pembrolizumab through, tested, into patients and purchased by NHS England several years earlier than would have been the case. That is a precursor of what we want to do much more widely through the accelerated access review.

It is no coincidence that one reason for the delay that was referred to earlier is that I am very keen for the CDF review to be done at the same time as the accelerated access review. Had we not done that, colleagues would have been saying to me, “How ridiculous, Minister, that you have reviewed the Cancer Drugs Fund and closed it before you have received the recommendations of the accelerated access review this spring.” I wanted to ensure that we are building a landscape that is logical and fit.

[Sir Oliver Heald]

Does my hon. Friend the Minister accept that it is worth while to look at the difference between a condition that goes from diagnosis to death over, say, 18 months, where an extra two months of life is proportionately quite small, and one of these very fast-acting cancers, such as pancreatic, where a person gets only six months and giving them an extra two would be very important in allowing them to settle their affairs and come to terms with the world?

[George Freeman]

My hon. and learned Friend makes an important point. I urge colleagues, as elected representatives, to make such points to NHS England through the CDF review, which closes on 11 February. We represent 70,000 or 80,000-odd people, so it is appropriate to make the point that for different diseases there is a big difference between the benefits of extra time for patients.

In the limited time I have left, I want to touch on some of the questions that came up. Colleagues asked about performance measures for data. It is important that we use the data from the CDF better. We are introducing measures to ensure that the contracts for 2016-17 specify that trusts that do not submit complete datasets will be penalised. One hundred per cent. of trusts are now submitting data, so we have closed that door. Some of the horses may have bolted, but we are getting properly on top of the data.

My hon. Friend the Member for Mid Derbyshire asked first about a draft treatment pathway for multiple myeloma. NHS England advises that that is currently in the process of being finalised. It has been the subject of public consultation and is being revised to take account of the comments received and the potential impact of treatments that have been removed from the CDF. The treatment pathway is due to be published in 2016. Secondly, on individual funding requests, NHS England does publish data on its website, including the number of individual funding requests for each drug on the national CDF list. Thirdly, on the issue of penalties for failing to produce data, we have built specific performance measures into the systemic anti-cancer therapy database.

My hon. Friend also mentioned multi-drug treatment cost reductions. It would not be appropriate for me to comment on NHS England’s individual commercial discussions with companies, but I can say that I am actively looking at ways to integrate better the Department of Health negotiators with NHS England commissioners through the accelerated access programme, so that we can get the benefit of time, cost and risk reductions in the pathway in more enterprising pricing mechanisms. I am confident that there is interesting progress to be made in that space.

I am aware that it is traditional for the Minister to leave a little time for the Member who secured the debate to wind up. I have around 15 questions that I have not had the chance to answer, so with your permission, Mr Streeter, I will write to the Members who contributed to the debate. I close by reiterating our commitment, as a Government, to get on top of the issues that have been raised. I hope that Members can see that, as the first Minister for Life Sciences, I am making progress in the direction that has been highlighted.