Pancreatic Cancer

Jane Ellison Excerpts

Tuesday 4th March 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and leading it in the knowledgeable and able way that he has led other debates on this important subject. I will do my best to respond to his specific points, but there may be some that I will need to respond to after the debate.

It goes without saying that cancer is a terrible disease, and my hon. Friend spoke movingly of his experience, but all hon. Members know ways in which it has touched them and their families and friends. I pay tribute to the work that he and colleagues in the all-party parliamentary group on pancreatic cancer have done to raise awareness of the disease. Its excellent report, “Time to Change the Story”, does much to counter common misconceptions about the disease.

My hon. Friend drew the House’s attention again to the particularly poor outcome for people who get the disease and the challenges in diagnosis. If we could match the best survival rates in Europe we could save an additional 75 lives a year. Clearly, if we exceeded those survival rates, more people would be saved.

Before I tackle my hon. Friend’s specific point about Abraxane, it is worth giving the context of other work that the Government are doing to support earlier diagnosis. We committed more than £450 million in funding over the four years to 2014-15. Sadly, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose it, especially in its early stages. However, to try to address the situation, the Department helped to fund a six-month pilot with Macmillan Cancer Support of a cancer decision support tool for GPs to help them to identify patients whom they might not otherwise refer urgently for this suspected cancer. Evaluation of the pilot is under way, and if it is found to be helpful, we will work with NHS England actively to promote its use. That tool was highlighted at a recent parliamentary event that some hon. Members might have attended.

We need to do more about earlier diagnosis and public awareness of the symptoms, which are often limited. As is often the way, I suspect that the recent “Coronation Street” story line has done more than many public health campaigns could have done to raise awareness. Yet again, well done to our broadcasters for covering some difficult issues and providing through Hayley’s sad story some important health education. It has reached many people, and we thank them for that.

On Abraxane, I am obviously aware of Pancreatic Cancer UK’s Two More Months campaign, and I congratulate my hon. Friend on this particularly well-timed debate. I am fully sympathetic to his points. As he says, two more months can mean so much to those who are affected by this cancer, and he gave some moving examples. We do not associate the disease with younger people. Sufferers are predominantly older but, as he illustrated, many people suffer at a younger age. I thank those who contributed to the report details of loved ones they have lost. My hon. Friend bears witness to his own loss, which we feel keenly with him.

I listened to my hon. Friend’s request that the recently licensed drug Abraxane should be made available from the cancer drugs fund. As he says, in the light of new evidence from the manufacturer, NHS England’s cancer drugs fund expert clinical panel is reviewing its earlier decision not to add it to its national list. One criterion in the scoring tool used by the panel is evidence of a drug’s impact on quality of life, which is what my hon. Friend spoke about. While I cannot in any way pre-empt the panel’s decision, I can fully understand how important this will be to people with pancreatic cancer. I will ensure that NHS England is made aware of tonight’s debate and the very good attendance. As the hon. Member for Scunthorpe (Nic Dakin) said, that reflects the impatience of parliamentarians, on behalf of their constituents, to see progress on this issue, which we seem to have been stuck on for so long. I undertake to do that immediately in the morning to ensure that the information is with the panel ahead of its deliberations.

My hon. Friend will be aware that Abraxane has not yet been assessed by the National Institute for Health and Clinical Excellence. Partly because of these situations, we established the cancer drugs fund to ensure that cancer patients in England have better access to life-extending or life-improving drugs that are not routinely funded by the NHS. He may also be aware that Novartis’s drug Afinitor is included on the national list for the cancer drugs fund, alongside two other treatments for treating pancreatic and neuro-endocrine carcinomas. More than 44,000 patients have benefited from the cancer drugs fund since October 2010, and we have recently announced an extension to funding for the scheme.

Looking further ahead, NICE is appraising Abraxane for untreated metastatic pancreatic cancer and expects to publish its guidance to the NHS in January 2015. That may seem a long way away, but, as been mentioned, this reflects the robust, evidence-based technology appraisal programme that NICE provides to ensure that clinical effectiveness and cost-effectiveness is taken into account when we look at drugs and treatments. The Government believe that clinically appropriate drugs should be routinely available to NHS patients, and we remain committed to the rapid uptake of NICE-recommended drugs in the NHS.

My hon. Friend referred to recent decisions on cancer drugs made by NICE. I am sure he appreciates that there will naturally be fluctuations in the proportions of drugs recommended by NICE each year, so a more accurate picture can be gained from looking at all NICE decisions on cancer drugs to date. That shows that almost two thirds of its decisions on cancer drugs have recommended their use for all or some of the eligible patient population. Far from making appraisals tougher, the most significant change to NICE technology appraisal methods in recent years has been to introduce greater flexibility in the appraisal of potentially life-extending treatments for patients at the end of their lives, and that has helped NICE to recommend a number of new cancer drugs for use on the NHS. That speaks directly to the extremely pertinent points that my hon. Friend made about how someone who has had such a diagnosis will see an extra two months in the context of the end of life, given that the progress of the disease can be very rapid from the point of certain diagnosis.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

Yes, very briefly.

[Jim Shannon]

In an earlier intervention I asked about a UK-wide strategy. Has the Minister considered that for all the regions?

--- Later in debate ---

[Jane Ellison]

The hon. Gentleman has made that point in other contexts before, and it is a perfectly good one. Of course, health is a devolved matter, but as regards research and what we know about drugs, there are lots of aspects on which England has taken a lead and on which the devolved Administrations co-operate. I regularly have exchanges of letters with my opposite numbers. When there are important lessons to be learned on behalf of all our constituents, we would naturally share that information and expect it to be looked at in all parts of our United Kingdom.

Our priority is to make sure that we get the best possible results for all NHS patients with the resources we have. That is why we have asked NICE to look at how drugs are assessed to ensure that patients can get the treatments they need at the best value for the NHS, and that the price the NHS pays is more closely linked to the value a medicine brings. These can sometimes sound like quite cold decisions, but they are designed to help us to have a sense of objectivity in what are always very difficult decision-making processes. I assure my hon. Friend that NICE will carry out a full public consultation before implementing any changes in the way that it makes these assessments.

My hon. Friend referred to NanoKnife, which was also mentioned in an intervention. I am advised, I am afraid, that NICE has published guidance on that procedure which states that current evidence on the safety and efficacy of irreversible electroporation for treating pancreatic cancer is inadequate in quantity and quality, and it recommends that the procedure should currently be used only in the context of research.

My hon. Friend mentioned research funding. We are often asked about the amount of funding put into one area or another and I always like to make the point that, rather than specifying subject areas, the National Institute for Health Research welcomes funding applications for research into any aspect of human health. These applications are subject to peer review and are judged in open competition, with awards made on the basis of the importance of the topic to patients and the NHS, value for money and scientific quality.

I have no idea whether parliamentary interest is part of that mix, but I cannot believe that it hurts at all. Such issues come up regularly, and whenever I meet people from different health institutions and the NHS I always make a point about the things in which Parliament has shown a particularly keen interest to debate and progress.

[Tessa Munt]

Will the Minister give way?

[Jane Ellison]

I do not think I have time, sadly, but I would be happy to speak to my hon. Friend after the debate.

I hope it will be of interest that the Government are investing a record £800 million over five years in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool biomedical research unit in gastrointestinal disease, which has a major focus on pancreatic cancer. Some really interesting things are coming out of the opportunities for biomedical centres.

Recruitment to studies associated with pancreatic cancer by the NIHR clinical research network has also increased more than fivefold, from 447 in 2008-09 to 2,744 in 2012-13, which is another measure of the increased emphasis and interest.

I again pay tribute to my hon. Friend the Member for Lancaster and Fleetwood for his campaigning on this issue and the work he has done to raise its profile in Parliament, and to all hon. Members for the interest they have shown. As I have said, it is great to see such good attendance at this debate. That is on the record and it is of great interest.

[Tessa Munt]

Do NICE and similar organisations accept reviews and evidence from other countries, be they in Europe or America, when they deliberate and make considerations, or is it only home-grown evidence that counts? Is there an acceptance of the views of clinicians from other parts of the world?

[Jane Ellison]

I will, if I may, take my hon. Friend’s question away and respond to it formally. Obviously, it is a matter for NICE and I will make sure that I get an answer for her. My understanding, however, is that an awful lot of peer-reviewed research from all around the world is looked at and that it is the quality of that research that is taken into account. I will respond formally to my hon. Friend and make sure that I have that absolutely right.

In conclusion, I thank those who have participated in this important debate and those who have stayed to show their support for it, which is valuable. This disease remains very difficult to treat, but the Government will continue to work with patients and charities—which have done so much good work—and with researchers, the pharmaceutical industry and, of course, the NHS to improve results for people with pancreatic cancer and to see whether we can make more rapid progress than we have made in the past four decades.

Question put and agreed to.