Cancer Drugs

Mark Durkan Excerpts

Tuesday 20th October 2015 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

As other hon. Members have said, it is truly a pleasure to serve under your chairmanship, Mr Hollobone. I want to begin by commending the hon. Member for Strangford (Jim Shannon) on securing this debate and giving us an opportunity to discuss an issue that is important to many people and families in every constituency that is represented in this House. The issue is important not just because of the scale of cancer’s impact, but because people are confused about some of the policies: the policy language and all the different funding mechanisms that seem to afflict delivery of treatments and options for new drugs.

I endorse much of what the hon. Member for Scunthorpe (Nic Dakin), who chairs the all-party group on pancreatic cancer, said about Abraxane. I, too, am an officer of that group. Abraxane is a perfect but terrible example of exactly the confusion and concern that people feel. Here is a drug that was supported by NHS England, but will be withdrawn on 4 November. People do not understand why, in this day and age, with evidence-based policy and all the intelligence that we are supposed to have at the disposal of the public policy system, we have a snakes-and-ladders system that means that drugs are available in some places but not others, or are available for certain periods but then are not.

As the Minister will probably tell us, part of the problem goes back to pressure on the Cancer Drugs Fund. The fund was a positive innovation, but it was meant to be a transitional step—something to make good the problems with the National Institute for Health and Care Excellence and its approval system, which was leading to poor rates of approval for many cancer drugs. Most of us, across all political parties, thought that there was a problem with drugs breaking through the NICE approval thresholds. The Cancer Drugs Fund was a deliberate innovation aimed at ensuring that in the short term more drugs would be available and used under that specialist mechanism, with the intention that underlying problems and issues with the NICE regime would be resolved.

Now, the Cancer Drugs Fund has ended up with its own budget pressures. Thankfully, the Government have topped up the fund over various periods, but that applies to NHS England. In Northern Ireland, where my constituency is, we did not have a bespoke cancer drugs fund and we were caught in the twilight zone of drugs seeming to be available and being discussed in debates such as this as though they were available when they were not available in Northern Ireland. The terrible irony is that some of the drugs that were available under the Cancer Drugs Fund were the subject of clinical trials.

The hon. Members for Strangford and for the hon. Member for Upper Bann (David Simpson) referred to the centre at Queen’s. What I am probably most proud of in my political contribution is that as Deputy First Minister I insisted on securing funding for the regional cancer centre in Belfast. We designed it as part of the reinvestment and reform initiative. When we negotiated with Tony Blair and Gordon Brown, I made it clear that we wanted a down-payment for the new borrowing power. The first thing we wanted to do was invest in the cancer centre at Queen’s, without messing around with public- private partnerships or anything else. We wanted a straight-up investment.

That cancer centre, like so many others, is working miracles every day, but alongside the miracles performed by those who carry out surgery or lead the radiotherapy units that the right hon. Member for Oxford East (Mr Smith) discussed, there seem to be debacles with funding policy and schemes.

There is a question about what will happen. We are supposed to be looking at a merger of NICE and the Cancer Drugs Fund. The fund is meant to move on from next year, but people who are directly involved and who deliver cancer services and campaign on cancer policy have no clear feeling about what is happening. People’s hopes are at stake, and they are confounded by what has happened with Abraxane and many other drugs that will no longer be available from 4 November.

We are blessed in this debate because the Minister not only speaks a lot about innovation, but in many ways has become a bit of a byword for innovation—and not just in life sciences. I hope that he and his colleagues can be truly innovative in the policy instruments and funding mechanisms that they hope to introduce. A key issue, which other Members have touched on, concerns not just provision of funding but control of prices and their negotiation. We must make sure not only that we have funding mechanisms that we understand, but that there is real leverage in price negotiation if we are to make those drugs truly available.

In these islands, we have a number of different Administrations and perhaps we need to do more to achieve combined purchasing power strength. One of the most neglected and underused creations of the Good Friday agreement is the British-Irish Council, which brings together all eight Administrations across these islands. That is a very good example of where those eight Administrations need to collaborate much more effectively, combining their leverage to make sure that there is a more consistent and compatible policy on available drugs, services and treatments, and to provide strength in combined purchasing when negotiating.

Devolution gives us the benefit of being able to innovate and take things forward in slightly different ways. I look forward to hearing the word from Scotland—from the hon. Member for Motherwell and Wishaw (Marion Fellows)—because, as we have heard in previous debates, Scotland moved to a new drugs fund that combined elements of the Cancer Drugs Fund with responses dealing with rare diseases. That, too, is subject to its own pressures and there are difficulties about what gets through and what passes the requirements test for funding and availability.

Obviously we do not have clinical expertise or a full understanding, but we are meant to be able to assist with policy constructs and governance, and we can do more. We should encourage the Minister to work with colleagues, not just in the devolved Administrations, but also with the Irish Government—all eight Administrations across these islands—to do more with the drugs companies and to achieve better understanding.

That would be a great help to the many people who provide key services, innovating, researching, and conducting clinical trials, not just in the cancer centre at Queen’s, but in other locations throughout these islands. It makes it much easier for them if they know that they are working against a better policy-meshed backdrop at the level of government; that the challenge funds are there for their research work; and that the collaboration that they are trying to achieve with commercial companies is matched by real price leverage and positive price control effort, as well as conscious usage planning on the part of Governments.

As the right hon. Member for Oxford East said, the issue is not just cancer drugs. Surgery is a key issue and none of us wants to understate its importance, nor that of radiotherapy. In my constituency, thankfully, a radiotherapy unit will open in 50 weeks’ time. It will be a cross-border unit, again using some of the models and ideas in the Good Friday agreement. The new radiotherapy unit, which will be part of the new cancer centre at Altnagelvin hospital, is funded by the Irish Government as well as the Northern Ireland Administration. It will make a huge difference to many people, assisting them on their cancer journey and making sure that they have less arduous physical journeys.

I look forward to the Minister’s response and the ongoing work that I know he wants to do. I hope that he takes that work forward with colleagues throughout all the Administrations in these islands and not just with his Whitehall colleagues.

--- Later in debate ---

[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.