Cancer: Herceptin

– in the House of Lords at 11:27 am on 9th February 2006.

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Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Conservative 11:27 am, 9th February 2006

asked Her Majesty's Government:

Whether they will respond to recent representations by taking steps to ensure that appropriate drugs are made available to patients for the treatment of breast cancer in cases where general practitioners have confirmed the need.

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, breast cancer patients should be managed by specialist cancer multi-disciplinary teams. It would be a doctor in that team who would decide, in consultation with the patient, the most appropriate treatment for their condition, having regard to NICE guidance. The NHS should not refuse to fund treatment simply because NICE guidance is unavailable.

Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Conservative

My Lords, I am grateful to the Minister for that answer, but are the Government aware of the "Panorama" poll of 390 oncologists that was carried out recently in England and Wales? It found that 28 per cent were always allowed to prescribe Herceptin for the early treatment of breast cancer but that 58 per cent were only sometimes allowed to do so. How can it be right that access to treatment for NHS patients who have no insurance for what is, after all, a life-threatening condition depends on where they live and on decisions taken by administrators and accountants, rather than clinicians?

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, there is a general issue of access to cancer drugs and a specific one in relation to breast cancer drugs. It is for individual clinicians to consider with patients, taking into account risks and their medical history, whether a particular drug is an appropriate treatment choice. We have made it absolutely clear to primary care trusts that they should not rule out treatments on principle but consider individual circumstances in reaching their decision. We have equally made it clear that, in the case of Herceptin, PCTs should not refuse it solely on grounds of cost.

We can do no more at this stage, and I suggest that we must not take any steps that undermine either the licensing process for drugs, which have patient safety at their heart, or the NICE appraisal process.

Photo of Baroness O'Cathain Baroness O'Cathain Conservative

My Lords, is the Minister aware that on 27 October last, in evidence to the Health Select Committee in another place, the Secretary of State said that women who had been refused Herceptin on the ground of cost should return to their doctor and ask again to be prescribed the drug? She told the Committee that she,

"wanted to make sure that", the prescribing of Herceptin to eligible women,

"was happening everywhere".

Has the Minister any idea of the impact on an individual of the news that they have breast cancer? The last thing that they want to do is to go back and forth to doctors on the odd chance that they may or may not get Herceptin.

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, there are two sets of issues here: Herceptin in relation to advanced breast cancer and Herceptin in relation to a proportion of women who have early breast cancer. Herceptin is not licensed for the purposes of women who have early breast cancer. The noble Baroness may shake her head, but that is the factual position. The Secretary of State has said that no PCT should rule out the decision by a clinician to prescribe a particular drug on grounds of cost; but there is a wide range of considerations to be taken into account.

Photo of Lord Tebbit Lord Tebbit Conservative

My Lords, does the Minister not agree that it would be particularly unfortunate if any of the factors that he has set out regarding the suitability of the drug, which is a matter for doctors, and possibly of its cost, which is a matter for the health service, were to be settled in court by judges who are not doctors and are not responsible for providing the funds to meet what might be their judgment?

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, if the noble Lord is referring to the case currently before the courts, I do not think that I can comment on it, as it is sub judice.

Photo of Lord Addington Lord Addington Spokesperson in the Lords (Sport), Culture, Media & Sport, Spokesperson in the Lords (Disability), Work & Pensions, Deputy Chief Whip, People With Disabilities, Non-Departmental & Cross Departmental Responsibilities

My Lords, there is a real problem here given that you can be clinically prescribed a drug that you are not going to get. We have been through this before and it is looking again like a postcode lottery. Will the Minister give us some idea of when the Government will introduce a system that will stop this happening?

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, I have said that there are two sets of issues. One is the use of Herceptin in relation to women with advanced breast cancer, for which it is licensed and for which there is NICE guidance. There is little evidence that the drug is not being provided where it is thought to be clinically appropriate. The argument seems to be over the use of Herceptin in relation to women in the early stages of breast cancer. The drug is not licensed for that purpose; it is down to the individual clinician, with the patient, to make a judgement whether it is appropriate in those circumstances. It is then for the PCT to weigh those issues in relation to those patients. That is the system that we have and that system has stood us in good stead over many years in relation to many drugs.

Photo of Lord Walton of Detchant Lord Walton of Detchant Crossbench

My Lords, would the Minister accept that not every case of breast cancer is suitable for treatment with Herceptin; it depends upon the genetic constitution and the nature of the tumour? But is it not the case that individuals with breast cancer and who have a genetic constitution that makes them sensitive to the drug are not always receiving it through their primary care trust? Are the Government making it clear to primary care trusts that such individuals should be given priority for the prescribing of this drug?

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, it is not for Ministers and the Government to give detailed prescriptions to the NHS that override the judgments of individual clinicians in relation to individual patients. All noble Lords must try to hold on to that issue in relation to what is, I freely acknowledge, a very emotional area. I have already stated the Government's position; it is down to individual clinicians to consider with patients whether Herceptin is appropriate—as the noble Lord said, it is not appropriate in all cases—and that PCTs should not rule out treatments, either on principle or for funding considerations.

Photo of Baroness Symons of Vernham Dean Baroness Symons of Vernham Dean Labour

My Lords, does not my noble friend have some difficulty with the figures given by the noble Lord, Lord Forsyth of Drumlean? Of course such decisions should be made on the grounds of medical advice, but if 28 per cent of doctors say that they are never allowed to prescribe the drug in those circumstances, it looks as though these decisions are being taken, not necessarily on principle, but on grounds of cost. Surely, that is ground for concern, given what my noble friend has, quite rightly, articulated as being the Government's policy.

Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, with all due respect to my noble friend, the figure of 28 per cent came from a study produced on "Panorama". I have no idea whether that particular study is valid; I have not seen the research methodology. I can tell the House that as a health Minister one sees many studies that turn out to be methodologically flawed when the information is probed. I am sure that other Ministers in this House have had the same experience. In the particular cases of the alleged 28 per cent, it is down to those doctors to discuss the individual patients causing them concern with the people in the PCT.