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.
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.
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?
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.
My Lords, is the Minister aware that on
"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.
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.
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?
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.
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?
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.
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?
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.
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.
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.