Cancer Drugs

Debate between Oliver Heald and Marion Fellows

Tuesday 19th January 2016 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a privilege to serve under your chairmanship, Mr Streeter. I thank the hon. Member for Mid Derbyshire (Pauline Latham) for securing this important debate. I will give the debate a more Scottish context.

For patients with a life-threatening or highly symptomatic illness, getting access to the best treatment is crucial. Living with a condition that has no cure or treatment is difficult, but knowing that you or your loved one is denied access to an available treatment is intolerable. Our biggest problem is accessing new drugs, which are often very expensive and above the limit set for NHS access by the National Institute for Health and Care Excellence—NICE—or its Scottish equivalent, the Scottish Medicines Consortium, the SMC. That results in delayed access to new treatments and, as has been mentioned, it appears to contribute to the UK’s poor cancer outcomes by comparison with other countries. The issue is even worse for those with rare diseases, because the commercial imperative to develop a drug in the first place is weaker, due to low patient numbers.

There is also frustration for clinical researchers who enter patients into trials that lead to a drug’s development in the first place. The UK, and particularly Scotland, punch above their weight in the active recruitment of patients into drug trials for diseases such as cancer. Patients may benefit from gaining access to the new treatment during the trial but, once the trial has been successfully completed, new patients do not get that opportunity, which is demoralising and could undermine research efforts in the future. Some of the drugs that have been researched over the years are now being removed from the list in England.

Once a new drug has gained a licence, NICE and the SMC carry out their assessments. In Scotland, however, the SMC utilises the evidence gathered to carry out just a brief review, with the emphasis being more on the drug’s effectiveness. Cost comes after that.

There are three major differences in the access systems north and south of the border. While both have drug access funds, in England the fund is only for cancer whereas in Scotland it is for any new drugs and rare diseases.

The Cancer Drugs Fund in England, which was meant to be temporary, has enabled patients to access new cancer drugs that would otherwise have been unobtainable. It has now been running for five years and some drugs are being excluded on cost grounds. In Scotland, after a review in 2014, the SMC established the patient and clinician evaluation, which allows reconsideration of a drug while taking into account the wider experience of it and capturing input from patients and clinicians. That gives patients a voice.

[Sir Oliver Heald]

Abraxane fails the test of three months’ effectiveness, but it is useful in producing two. Why is it that the Scottish system allows Abraxane? Will the hon. Lady give us a bit more of an understanding of that? I would like to see the drug back on the list, and if the Scottish system is a way of doing that, it might be worth looking at.

[Marion Fellows]

I thank the hon. and learned Gentleman for his intervention. He has asked me something that I cannot answer definitively at the moment, because I am not a clinician. I am, however, more than happy to come back to him on that. I know that PACE—the patient and clinician engagement group—has done some development on it, but I would like to give the hon. and learned Gentleman a fuller answer and I can do that later, if he agrees.

[Sir Oliver Heald]

indicated assent.

[Marion Fellows]

Where cost is a factor in prescribing drugs it is important that we consider ways of lowering it. The pharmaceutical price regulation scheme could be used. When a drug’s spending threshold is reached, a rebate is paid. In England, it goes back to the Treasury but in Scotland it goes on to further new drugs.

The delisting of cancer drugs because of cost causes untold heartbreak to patients and families—the very people we all represent—and the time has come to find a way of making new drugs accessible to, and affordable for, the NHS by considering arrangements such as multi-year budgeting, which would allow for a lower initial price. Pharmaceutical companies would hopefully be open to that in exchange for getting their drug into use at an earlier stage.

It is important to understand that drug companies fund drug development research for years before they even know if the drug is worth licensing. Many potential drugs fall by the wayside and, as the public purse would never be able to fund such a level of risk, it is necessary that pharmaceutical firms see a return on their investment, to secure ongoing research. That goes back to why some drugs are delisted because of their cost. However, there must also be recognition of the support provided by universities in Northern Ireland and Scotland, and in England, which get Government funding to help towards researching new drugs.

Off-patent drugs can also be used in cancer treatments, usually through repurposing. It is important that we consider that, as it could also lead to a cost—[Interruption.] I am sorry, I will just wind-up my speech. Some of the barriers to treatment can, however, be broken down through negotiation between all interested parties. The aim would be a system that worked equitably for all stakeholders, from patients, doctors and the NHS to Governments and the pharmaceutical industry.