Cancer Medicines: Appraisals

Debate between Siobhain McDonagh and Will Quince

Tuesday 13th June 2023 Westminster Hall

[Will Quince]

My hon. Friend is absolutely right, and I regularly meet the pharmaceutical industry, not least because of VPAS, which I will come on to discuss because it has been raised by a number of Members. While I understand the concern, it is absolutely right that assessment of clinical and cost effectiveness reflect up-to-date clinical pathways, evidence and evaluative methods and processes. However, my hon. Friend is absolutely right to say that we should also hear and understand the views and concerns of the pharmaceutical industry so that we have a rounded, balanced view and the full picture, to make sure that there are no unintended consequences because of the action that is being taken.

The hon. Member for Strangford mentioned non-uniform pricing and VPAS, so let me come on to that specifically. The tricky thing is that the negotiations for the next VPAS are currently under way. Given that there are ongoing discussions, it would not be appropriate for me to go into too much detail, because of the commercial sensitivity. It would also be inappropriate to set up a working group to review NHS England’s policy on non-uniform pricing. What I would say is that if changes were made to the wording in the next VPAS on commercial flexibilities, they would be reflected in an updated commercial framework for new medicines.

The hon. Members for Strangford and for Denton and Reddish raised clinical trials. We are doing a huge amount of work in that space because I recognise some of the issues and challenges that the hon. Member for Denton and Reddish set out. That is why we commissioned the O’Shaughnessy review into clinical trials, and why we accepted Lord O’Shaughnessy’s recommendations in full. We should take a step back for one moment and look at the work that we did as a country and an industry on clinical trials, particularly relating to covid. We basically shut down huge numbers of clinical trials to focus on a vaccine. To be fair, this country absolutely led the way in that, and we should be very proud of what we did, but we have not been fast enough in switching clinical trials back on and we have lost some of our competitive edge in relation to other countries, as the hon. Gentleman pointed out. The reality is that it is a race; clinical trials are globally competitive, and other countries, including Spain, have seized the advantage and are fighting hard for market share. We have to make sure we are a competitive place. That is about clinical trials but also our regulatory environment.

The hon. Member for Midlothian (Owen Thompson) made good points about the MHRA. We are absolutely looking at its processes and procedures, and we are putting an extra £10 million into it over the next two years to ensure it is a world-class regulator that is one of the fastest and most effective and efficient. It is already highly respected, but we must ensure that it does things at the right speed. That is very much on my radar, and as I said we are accepting the recommendations.

The hon. Member for Denton and Reddish also raised the cancer drugs fund. Since 2016, NICE has been able to recommend medicines for use through the Government’s £340 million cancer drugs fund, which enables patients to receive promising new treatments for a time-limited, managed access period while further evidence is being collected. That is then considered by NICE when determining whether a medicine should be routinely funded by the NHS. Since that fund was created in 2016, it has helped more than 91,000 patients in England, and more in other places, to access innovative medicines.

[Siobhain McDonagh]

Those 91,000 did not include people suffering from a glioblastoma. We are not anywhere near NICE. We have not got that far. The drugs are not there. There is nothing. None of this works for people with glioblastoma. I do not want to mislead the Minister into thinking that I care only about my sister, Margaret. I draw hon. Members’ attention to early-day motion 1233, in my name, to commend the life of Laura Nuttall, a young woman diagnosed with a glioblastoma aged 18. She died on 22 May. I want to pass on all our condolences to her mum, Nicola, her sister, Gracie, and her father. Laura was a shining light and an ambassador for the Brain Tumour Charity. Although she was told that had only a year to live, she managed to live for four and a half years and secured a 2:1 in her degree. Laura highlighted that brain tumours are the greatest killer of people under the age of 40, who are being let down.

[Will Quince]

I totally take the hon. Lady’s point when she says that it is not all about her sister, Margaret— I know that from her contributions. Often in this place, we draw on our personal experiences, which enable us to bring to life powerfully and emotively what others are experiencing. I thank her for sharing Laura’s experience, and I send my condolences to Laura’s friends and family.

The hon. Lady is absolutely right that the cancer drugs fund can bring forward only innovative medicines that have gone through the clinical trials process. I will be very happy to work with her and meet her again to discuss how we get more research in this space. That is the key to so much, in relation to tacking brain tumours.

The hon. Member for Strangford spoke about the challenges presented by combination therapies. The commercial framework also recognises that realising the full potential health benefits from combination drug therapies can be challenging, given the requirement for commercial confidentiality and the need to maintain competition. Having said all that, NHS England has a proven ability to negotiate commercial agreements that secure combination treatments for patients. Just last month, deals were struck to enable NICE to recommend Keytruda and Lenvima for hundreds of women with advanced endometrial cancer. Progress is being made, but again, I would be happy to discuss the issue further.

Again, I thank the hon. Member for Strangford for securing this important debate and for his continued interest in the appraisal of cancer medicines and access to cancer treatments for NHS patients. I also thank other Members who have made such powerful contributions.

If one message comes across, Mrs Harris, I hope that Members are assured that the Government and I remain firm in our commitment to making the most promising and effective new cancer treatments available to NHS patients. The hon. Member for Denton and Reddish said that this is not a political issue, and I agree. It would be impossible to find anyone in the House who does not want to ensure that patients across the United Kingdom get access to the most innovative and cutting-edge medicines for cancer and other diseases, as quickly as possible. We all have a common endeavour there.

It is important to acknowledge the huge role that NICE has played, with its world-leading health technology assessment. It has enabled NHS patients to be at the forefront of access to new cancer treatments, in a way that also represents value for the taxpayer. I recognise the point that has been well made today, that we must always seek to improve and to go further and faster. I look forward to working with all Members present and others across the House to achieve that.

Brain Tumour Research Funding

Debate between Siobhain McDonagh and Will Quince

Thursday 9th March 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

First, let me congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing this debate on a very important topic and for his personal commitment to making progress on this devastating condition. Like him, I pay tribute to the life and work of Tessa Jowell, who, after a long and distinguished career on these Benches, left a legacy that lives on in the numerous initiatives that the Government are supporting.

I also thank hon. Members from across the House for their valuable interventions and comments today— I will come to them in turn—especially in regard to NIHR support for cancer research, the Tessa Jowell Brain Cancer Mission and our commitment across Government to cancer research funding.

Before I turn to the contributions of individual Members, I want to touch on Government commitments, particularly the Baroness Tessa Jowell Brain Cancer Mission. As my hon. Friend the Member for St Ives said, in 2018 the Government announced funding through the NIHR of £40 million over five years for brain tumour research as part of the brain cancer mission. I would like to draw on Tessa’s words. She said that this

“is not about politics but about patients and the community of carers who love and support them. It is…about the NHS but it is not just about money. It is about the power of kindness”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1169.]

We are grateful to all those who have provided care and support and who have campaigned for better funding for research, and to those involved in brain tumour research for keeping this nation at the forefront of scientific progress. Research, as many Members have set out this afternoon, remains key to progress. There are many challenges with brain tumour research, some of which have been set out today, but as Tessa implored us, we must not leave this in the “too difficult” box. I will now try to address the comments made by hon. Members in turn.

My hon. Friend the Member for St Ives rightly praised the work of the Realf family, whose petition led to significant funding and focus on brain tumour research. He rightly pushes us to ensure that we are spending the allocated funding on brain tumour research, and he asks us to look at the NIHR’s processes to make them more user-friendly. He followed the report in calling for a brain cancer champion, as did the right hon. Member for Hayes and Harlington (John McDonnell). I want us to be world leading in this sphere, so I will take that point away and ask the Secretary of State. Indeed, my hon. Friend the Member for St Ives might pick this up and run with it himself, given how he runs the APPG and given this superb report.

I will come back to research more generally a little later, but my hon. Friend talked about applications and the application process. As part of the £40 million fund, all the applications assessed as fundable in that open competition have been funded—in total, that is 13 of 95 applications, and a further three are under consideration. I very much encourage researchers to make those applications. We have to get it right, and I will come back to this later.

My hon. Friend touched on funding committees, which play a hugely important role. We have a diverse range of applications for funding and, as a result, there is a broad range of expertise sitting on the panels. The panels may or may not include people who specialise in brain tumour research. I understand the frustration of applicants, and work is already being done by the Tessa Jowell Brain Cancer Mission, through customised workshops and the work of researchers, to enable people to resubmit their funding applications after understanding why they were not successful.

The right hon. Member for Leeds Central (Hilary Benn) rightly praised the work of Brain Tumour Research. I understand his point about not only patients but consultants hearing the phrase, “There is nothing more I can offer or do for you.” We have to do what we can to change that. He rightly says the brain is a very complex organ, which is why treatment and research are so complicated—I will come back to this point if I have time.

My hon. Friend the Member for Scunthorpe (Holly Mumby-Croft) talked about the heartbreaking experience of David. She asked us simply to get the money into the hands of researchers, and I wish it were that simple. Understandably, this does not sit in the hands of Ministers—it would be totally inappropriate if it did. It sits in the hands of clinicians and experts in this field, but I completely understand the sense of urgency with which she makes the point. We spend around £1.3 billion a year on research, and we have to ensure that it is well spent and leads to research that gets treatments and drugs to patients in this country and around the globe.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) gave the most powerful testimony, sharing her sister Margaret’s experience. I am so very sorry to hear of her experience, which must have been very difficult to share. She spoke about cancer diagnosis and treatment, and we have come on so much, but I recognise that this is not universal across all cancer types and that we have much more to do.

The hon. Lady made a very strong case for clinical trials, and she spoke about the need to travel abroad. We cannot do every clinical trial in the UK, although I sometimes wish we could. There is global competition, but I give her my personal assurance that clinical trials are high on my agenda. I want to make sure that our United Kingdom has the best environment for clinical trials. We have launched the O’Shaughnessy review, and we are working with the NHS, the MHRA and NICE. We are trying to encourage patients through the NHS app to sign up to clinical trials. Of course, raising awareness of clinical trials is a huge area of interest and importance for me.

[Siobhain McDonagh]

I completely understand all the work that the Minister and everybody else is doing, but can he explain why it is not happening?

[Will Quince]

I will specifically address brain tumour research, but clinical trials are taking place in acute trusts across the country. There are fewer clinical trials in this area than I would want, and I will explain why a little later. Finally, I pass on my very best wishes to Margaret.

My hon. Friend the Member for Buckingham (Greg Smith) urges us to act on the report’s recommendations, and he is right to do so. I will look at those recommendations very carefully. He touched on the £40 million, and I will come on to that a little later. He also mentioned childhood brain tumours. There is insufficient time to go into the level of detail I would want to on that subject, and I would be happy to meet him and members of the all-party group to discuss what more we can do on childhood brain tumours and the treatment thereof.

The right hon. Member for Hayes and Harlington talked about the courage and fortitude of families. He shared Sonya’s experience and talked about the importance of support for loved ones, and I will raise those issues with my counterparts at the Department for Work and Pensions. My hon. Friend the Member for Meon Valley (Mrs Drummond) shared the impact on the Fearn family, which outlines why it is so important that we get this right. She touched on the importance of awareness, and how in this area there is a high prevalence of late presentation and late diagnosis, and the impact that has on prognosis.

The hon. Member for Luton North (Sarah Owen) told Amani’s story and how the family had to fundraise to travel to take part in an international clinical trial. Of course, I send my condolences to Amani’s family, and I would be happy to meet Khuram and Yasmin to discuss this further. The hon. Lady asked where the money allocated is. It sits within NIHR and remains there; funding is allocated and it awaits suitable, fundable applications, so that is where we need to focus our efforts.

My hon. Friend the Member for Great Grimsby (Lia Nici) rightly praised the work of the all-party group, which probably makes this the right time to turn to the report, “Pathway to a Cure”. I very much welcome the group’s investigation and report. I acknowledge the problems and issues that have been identified. Let me be clear: we want to fund more high-quality research to accelerate the field and help patients. The report makes a number of recommendations for actions by research funding agencies, such as the MRC and NIHR, on co-ordinating action and making funding available. Crucially, the report is clear that to make advances in brain tumour research we must bring together diverse disciplines. There are detailed recommendations here, with potentially far-reaching consequences, and the MRC, NIHR and I will consider responses and come back to colleagues.

Members from across the House will understand that this debate is not necessarily the place for a detailed response to the report and every recommendation. Notwithstanding the strong case made today on the importance of research, we have to tread carefully. This is not the first condition into which I have probed and asked lots of questions about why we have not been funding all the research, and why funding is sitting unallocated, given the bids that have come in. We have to tread carefully because the clinicians and scientists rightly push back, saying that lowering the scientific quality bar for access to scarce public research funds, which would not be won in open competition, is unlikely ultimately to be a good solution. We must get this right, and at the heart of that is ensuring that we support applicants to make high-quality bids, which will then translate into funding awards. Of course, we want to fund the best science to help patients and ensure that our country remains at the forefront of scientific progress.

All Members, from across the House, rightly mentioned the crucial importance of research in tackling cancer. A theme of the report and the debate has been that of co-ordinating action along the translational pathway; that starts with the fundamental science and early translation, typically supported by the MRC, and goes through to the applied health and care research, which is funded by the NIHR. Working with the NIHR, the MRC has developed guidance and toolkits for teams to help them to navigate the scheme that is best suited to their proposal. However, I have heard today that we are not giving the right support to those making applications, and where applications are rejected we need to look into that further.

Oral Answers to Questions

Debate between Siobhain McDonagh and Will Quince

Monday 14th March 2022 Commons Chamber

[Will Quince]

My hon. Friend is absolutely right. Through the spending review and the record £2.6 billion of investment in special school places, that will be delivered.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

4. What steps he is taking to help close the digital divide for children without access to the internet or adequate devices at home.