I beg to move,
That this House
has considered the removal of drugs from the Cancer Drugs Fund list.
It is a pleasure to serve under your chairmanship, Mr Streeter. I secured this debate to raise the case of a constituent and to allow other Members to discuss the effects that removing drugs from the Cancer Drugs Fund will have and, I suspect, the current consultation on the fund. The latest delisting of some drugs from the fund has happened since the last debate on cancer drugs, and I am sure that many Members have heard from constituents who have been affected.
In November, I was contacted by a constituent, Tina Spencer-Keyse, about her husband Graham, who in 2010, at 51, was diagnosed with myeloma, which is a rarer cancer caused by abnormal cells in the bone marrow, where all blood cells are made. Myeloma is a relapsing and remitting cancer, meaning that there are periods when the myeloma causes symptoms and complications and needs to be treated, followed by periods of remission or plateau, when the myeloma does not cause symptoms and does not require treatment. Because myeloma is relapsing and remitting, it is crucial that clinicians are always one step ahead of the disease and that there is a treatment option for the patient to receive when it returns, especially when other treatment options have already been used.
Until August 2015, Tina and Graham had hoped to use one further drug treatment available for myeloma. Pomalidomide, also known as Imnovid, is used to treat relapsed multiple myeloma patients who have received prior treatment regimens but for whom the disease has continued to grow and spread. Imagine how devastated the Spencer-Keyse family were to find out then that the drug had been removed from the list of drugs available through the fund. Following the delisting, there are no other licensed treatments available for myeloma patients in England. Patients have no other options once the drug they are currently taking fails. They have nowhere else to go. Imagine the frustration, and probably anger, that they and thousands of others feel when a drug that was available just months before is no longer available to them but is still being used by other patients who were prescribed it before the delisting. The situation is such that a doctor might see one patient in the morning and be able to continue prescribing a treatment yet see another patient with the same disease afterwards and not be able to do so, even when they know it could help.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Lady on securing this important debate. Another example of a drug that has been delisted, causing similar frustration, is Abraxane, which is used in the treatment of advanced pancreatic cancer and was removed from the Cancer Drugs Fund in November. First, does she share my concern that although the delisting applies only to England, it causes worries across the rest of the UK as to whether the drug will become unavailable there, too? Secondly, although of course a consistent set of rules must be applied, one of the issues with pancreatic cancer is that 80% of patients are diagnosed when the cancer has already spread. Although Abraxane may only give a few weeks more life, those weeks may double life expectancy.
I accept what Nick Thomas-Symonds says. I have also campaigned for Abraxane to continue because, very sadly, a former Member of this House died from pancreatic cancer in the last Parliament. He had very few weeks to live once he was diagnosed, so it is a particularly unpleasant disease.
On Abraxane, does my hon. Friend agree that if a cancer is fast-acting and the gap between diagnosis and death can be as little as six months, getting an extra month or two means that a person can settle their affairs and get peace of mind? That is very important time.
It is incredibly important time. Any extra few weeks in such a situation is so valuable to those patients.
“NHS England has advised that a draft treatment pathway for patients with multiple myeloma, which takes into account the…impact of treatments removed from the Cancer Drugs Fund (CDF), is currently being finalised.”
I hope he is able to update us today on when those proposals might be published. My constituent and his family would like to know what options, if any, he has.
It is not only drugs for rarer cancers that have been hit. Drugs to treat breast cancer, bowel cancer, prostate cancer, leukaemia and other blood cancers, some gynaecological cancers and cancers that affect the central nervous system have all been removed, which probably amounts to thousands of patients who are now unable to receive treatment. That is absolutely devastating for patients and their families, as the chance to prolong life for a few more months or years has been diminished.
I congratulate my hon. Friend on securing this important debate and on the passion she is showing in putting her case. What does she think about NHS England’s proposal that the Cancer Drugs Fund should become a managed-access fund that pays for promising new drugs for a set period before the National Institute for Health and Care Excellence decides whether the drugs should be routinely available on the NHS? Does she think that is a good idea or not a good idea?
I will come on to that later. If my hon. Friend does not mind waiting a few moments, he will hear what I have to say.
Delisted drugs are still potentially available on an individual basis via an individual funding request. Is the Minister able to say how many of those requests have been successful as a proportion of all requests, and for which drugs? I know he is working extremely hard on this matter, about which he cares passionately, and I thank him for that.
Although there has been recent progress, the UK still lags behind most other developed nations on use and access to cancer drugs. In fact, we do not do as well on outcomes for cancer as many other nations. Nationally, cancer is still the largest killer, accounting for 29% of all registered deaths in 2014, the last year for which Office for National Statistics figures are available. Tracking the history of the Cancer Drugs Fund, a fund for which I have repeatedly supported investment, we can see that it has been on a rocky road to get to where we are now. Drugs have been removed, and the general consensus is that the fund has become unsustainable.
For the first three years, the fund underspent its budget—the opposite problem from the one we have now. In fact, between October 2010 and March 2013, the 10 strategic health authorities that administered the fund underspent by £128 million, or 28% of the fund’s total budget. That is a lot of money that could have been spent treating cancer patients. There was significant geographic disparity in the use of the fund. In the east midlands, which covers my Mid Derbyshire constituency, the number of patients supported by the fund per 1,000 new cancer cases in 2012-13 was just 27. That was the lowest figure in the country and represented a failure of the East Midlands strategic health authority, which was then in control of administering the fund, to promote its use to clinicians and patients. Several of my constituents died prematurely because they were refused funds for the drugs they needed when the fund was always underspent, despite pleading from me on behalf of people who were spending their own money on those drugs.
Since NHS England and Public Health England took control of the fund, the change has been dramatic. Having one central authority administering the fund removes the geographic differences whereby treatment authorities were promoting the fund and treatments at different levels. The effect is such that patient numbers skyrocketed. As last year’s high quality National Audit Office report on the Cancer Drugs Fund notes, the number of patients approved for funding increased by about 30% each year from 2011 to 2015, which should be viewed as a success for patients. Thanks to the fund, 84,000 patients have been able to access treatments that they would otherwise have been denied. The success is such that, in 2014-15, almost one in five patients started a new cancer drug through the Cancer Drugs Fund. What was meant to be a temporary measure is now a mainstay of cancer treatment in England.
Obviously, such growth comes with a price; the cost of funding the scheme spiralled out of control. Following the Government’s decision to extend the fund to March 2016, NHS England increased the annual budget from £200 million to £280 million for 2014-15 and 2015-16. In January 2015, it increased the budget for 2015-16 again to £340 million, meaning that the fund now has an expected lifetime budget of £1.27 billion.
Was taking drugs off the list a solution to the fund’s problems? It was certainly the easiest way to regain control of costs, but it hit patients hardest rather than solving the problems with NICE’s approval processes, which was the underlying reason for the fund’s creation. The rapid response to regain control of the budget also means that no new treatments were added to the Cancer
Drugs Fund from January 2015. The decision whether to keep drugs on the fund’s list or remove them was based on their clinical effectiveness and cost, but from the start, the fund did not keep records of treatment outcomes. Surely it is hard to obtain a full understanding of drugs’ full efficacy if a full analysis is not available by which to judge them. The failure to collect data on patient outcomes until July 2015 is truly disgraceful and undermines any proper evaluation of the fund’s success.
I am particularly attracted to the question asked by Caroline Flint during a Public Accounts Committee oral evidence session on the Cancer Drugs Fund last year. She asked why the Department of Health did not
“knock the heads of the SHAs together to ensure that there was some sort of common collection of data”,
instead of just recommending it. Fortunately, NHS England and Public Health England have resolved the problem—today, every new Cancer Drugs Fund patient is automatically identified on the systemic anti-cancer therapy database—but five years to fix a problem is far too long, and a failing of the fund.
Although data outcomes are now mandated, the rate of return has been far from perfect. In 2014-15, many records lacked important data. Most shockingly, 93% of patient records submitted did not have an outcome summary. Will the Minister inform us whether there will be penalties for trusts that consistently fail to produce the required data on cancer treatments?
The lack of data collection also undermines efforts to establish whether the price paid for drugs is equal to their outcomes. As the chief executive of the NHS admitted himself, the NHS has not been good enough at negotiating a price for drugs. Many drugs have been delisted because they were deemed too expensive. The drug Imnovid, which would benefit my constituent Graham, costs the NHS £115,000 a year, compared with £90,000 in Spain.
The failure to negotiate the best price was demonstrated by the fact that when threatened with removal from the list, some manufacturers were able to offer a lower price for their drugs. I understand that Imnovid was already offered at a discounted price, but I cannot blame drug manufacturers for not immediately offering the lowest price that they can afford. They need profits to use on research and development and to show value for their investments. Will the lack of positive outcomes from the price negotiations be addressed in the new CDF proposals? Also, can the Minister provide information on the number of negotiations between NHS England and drug manufacturers that have been positively resolved, and which drugs they relate to?
The new Cancer Drugs Fund proposals aim to distribute more evenly the financial risk of placing a drug in the fund, but the Rarer Cancers Foundation strongly suggests that the NHS has not been flexible in negotiating with pharmaceutical companies on value propositions for treatments in the fund. Can the Minister confirm whether NHS England rejected multi-treatment cost reductions from drug companies because they would have fallen outside of NHS England’s standard operating procedure? Likewise, from evidence given to the Public Accounts
Committee, it is clear that some companies have offered financial schemes stating that if the medicine does not work as expected, its cost will be returned to the NHS, but have been turned down in favour of straight discount schemes. Together, such schemes would offer a win for the taxpayer and would have allowed more drugs to be made available for the fund.
My final comments concern the proposed reforms to the appraisal process for drugs on the fund, which under current plans will be put solely in the hands of NICE. The proposal is that the CDF should become a managed access fund for new cancer drugs, as my hon. Friend Julian Knight mentioned, with clear entry and exit criteria. It would be used to enable access to drugs that appear promising but for which NICE indicates that there is insufficient evidence to support a recommendation for routine commissioning. At the end of the period, the drug would go through a short NICE appraisal, using the additional evidence.
For those looking for treatment for rarer cancers, such as myeloma, there are a number of questions about the new proposals that need to be addressed to ensure access to new treatments. As I understand it, under the new proposals, only a limited number of patients will have treatment funded through the CDF, and the industry is expected to fund additional patients. The consultation sets out NHS England’s proposal to limit funding for each drug on the CDF to the number of patients required to be treated in order to gain further evidence for use in NICE appraisal. The consultation is not clear what data NICE might require to be gathered during the CDF funding phase or the indicative size of patient populations. It is therefore difficult to assess whether the proposals would result in more or fewer patients getting access to treatment than the current arrangements.
What consideration is there for drugs for rarer cancers, which will have smaller patient pools creating only a small amount of data? Does the appraisal process have flexibility for such drugs? It is not clear whether pharmaceutical companies will be willing to fund patients for the 24 months required to allow data to mature if they think the likelihood of NICE approval at the end remains small. That could result in patients losing out once again on innovative treatments, or a situation in which drugs are put on the fund list and taken off in 24-month cycles, leading to uncertainty for patients about which drugs they have access to, just like the uncertainty caused by the current delisting.
I would like reassurances from the Minister that patients seeking treatment after the number of patients required to be treated in order to gain further evidence has been reached will not be denied treatment given to others in their situation. Does he believe that the changes to the NICE process outlined in the consultation are sufficient to ensure that more cancer treatments will receive positive NICE recommendations? Patients should be at the centre of any new decisions about the fund. Finally, I ask the Minister how the views of patients will be given greater weight in the new CDF arrangements.
I have been listening carefully to my hon. Friend. Does she agree that the crux of the matter is that the NICE evaluation criteria for those sorts of drug have not been adequate? The whole genesis of the Cancer Drugs Fund is in a failure of NICE. We need to get the NICE criteria right; then we would not need a drugs fund in the current format.
Resolving data collection issues, negotiating value for the taxpayer and making the NICE assessment process flexible for innovative new drugs and drugs designed to treat only a small number of patients are vital for the fund to work successfully when it re-launches in April. Will the Minister please look again at the delisted drugs and give hope to people such as Graham that they can spend longer with their loved ones? Failing to do so will fail to help those whom the fund is designed to help most: cancer patients and their families.
Colleagues, we have 40 minutes until the winding-up speeches begin at 3.30, so we are looking at six-minute speeches, by voluntary submission. I will call Jim Shannon first, as he has to go and chair an important all-party parliamentary group; I hope that colleagues will accept that. He has promised me to speak for no more than five minutes.
Thank you, Mr Streeter. You have put me on a sticky wicket. I congratulate Pauline Latham on securing this debate. It is good to be here and to be involved. About six months ago, I had a similar debate on the availability of cancer drugs, at which I think she was present. We hoped that six months later we might be back to say that things were better or had advanced, but unfortunately they are not, or not in the way that we would like.
I would just like to mention the many organisations that are helpful, because every one of us will have some cancer organisations close to their heart. Mine are Cancer Research UK, Macmillan Cancer Support and Marie Curie, because I have a very good friend, Irene Brown, who is terminally ill and she is in the Marie Curie centre in Belfast. The treatment that Marie Curie gives is second to none, and people only have to be there to be part of that family that helps.
The Macmillan charity says that 2.5 million people in the UK were living with cancer in 2015. It says that 5% of our total adult population are affected, which shows the problem is enormous. For many of us, cancer is not simply something that others talk about; it is something that affects each and every one of us every day. My father was a survivor of cancer on three occasions. I put that down to the skill of the surgeon, the prayers of God’s people—something that many of us here would understand—and the care of the nurses. He survived and lived for another 36 years, dying just last year, at the ripe old age of 85. The marvellous steps that modern medicine has taken are fantastic.
Moves such as the removal of drugs prevents thousands of cancer sufferers across England and Wales from being able to access the quality treatment they deserve. Thousands of people are disadvantaged, thousands of people lose out and thousands of normal people are in despair. That is the reality of not having access to cancer drugs. I do not know what it is, but I have more people coming to my office suffering from cancer than I can ever recall. I know that there is a 50% survival rate today for those with cancer, which is fantastic—what a step forward—but I see more people with cancer than ever before. I am not sure whether it is due to diet or lifestyle, or whatever it is, but cancer is certainly a greater issue for me than ever.
We understand that, from April, NICE will have the overall say about what drugs and treatments people will receive. We know that we have to be prudent with money, but surely finance should not be the overriding factor when it comes to people’s lives.
I thank my hon. Friend for saying that. Over the last few months and before Christmas, I had the opportunity to meet some of the pharmaceutical companies, and I have to say—and to be careful what I say—that they are not terribly happy with NICE and how it has responded to them. Some of those pharmaceutical companies have reduced their prices and still NICE does not respond in the positive fashion that we would expect it to. That is one of my concerns, certainly.
I would put Queen’s University Belfast up there as one of the universities working in partnership with medical companies, including companies from China and from across the United Kingdom. The partnerships that the university has developed and the innovative drugs that it is coming up with, as well as the investigations and trials that take place there to find new drugs, are impressive. We have new developments in Northern Ireland in cancer research, and we need to see a national strategy. Perhaps the Minister could respond to that point—let me apologise to him again, having already done so beforehand, for not being here for his response to the debate.
My party colleague Simon Hamilton is a Member of the Legislative Assembly and the Minister for Health, Social Services and Public Safety. Health is a devolved matter in Northern Ireland. We have a number of Members from Northern Ireland—there are five here today—which shows the interest in this issue in Northern Ireland. Simon Hamilton has taken the initiative to release £1.5 million to fund specialist cancer drugs. That will allow some of the NICE-approved cancer drugs and treatments to go ahead this year.
That move in Northern Ireland will go some way towards enabling the health service there to reach the cancer target. Each day in Northern Ireland, 23 people are diagnosed with cancer and 11 people die of it. There were more than 331,000 new cases of cancer in 2011 across the United Kingdom, and 161,823 deaths from cancer in 2012. The enormity of cancer—how it afflicts people and how many people die—cannot be underlined enough.
The latest delisting of drugs from the Cancer Drugs Fund looks like a step back rather than a step forward in the fight against cancer. I know that we cannot be completely resistant to change—the Minister knows that and, as elected representatives ourselves, we also know it. If drugs are proving ineffective, they should be delisted, but at the same time, if drugs are effective, let us get them on the list and make them available to those who need them most. We should be here to commend, I hope, the addition of a new form of effective treatment.
To conclude—I am very conscious of what you said earlier, Mr Streeter—the hon. Member for Mid Derbyshire mentioned Abraxane, and here is the postcode lottery. Those living in Northern Ireland do not have any access to Abraxane whatsoever. Those living in England had access to it in March 2014, but not now. People in Scotland have had access to Abraxane since January 2015 and will still have it. In Wales, people have been able to access it since September 2014, but now it looks like that might be affected as well. That is the postcode lottery for cancer drugs. It is completely unacceptable, and I commend the hon. Member for Mid Derbyshire for securing this debate.
It is a pleasure to serve under your chairmanship, Mr Streeter.
I congratulate my hon. Friend Pauline Latham on securing this debate. She asked many pertinent questions that I will be very interested to hear the answers to today.
First, let us look at some good points for a moment, before I give what is quite a Solihull perspective on this issue. This is a unique fund in the NHS—it is the only one of its type. I believe it was originally intended to run until March 2014, with a projected budget of some £650 million. To date, spend has been around £960 million and 84,000 people have been treated under this fund, which is a real positive. This year alone, the spend will be £340 million.
In the main, therefore, policy makers have ensured that resources have been in place. However, perhaps at times the allocation of those resources has not been of the best. As my hon. Friend mentioned, the most recent assessments have seen 23 drugs being delisted, including Abraxane. Imnovid, which was particular to the case of my hon. Friend’s constituent, has also been delisted.
During the recent election campaign and since, Solihull’s breast cancer care group has been in regular contact with me about this issue and more widely about cancer treatment in the NHS. Hon. Members will be aware of the great sensitivity in my constituency about such issues, because unfortunately the rogue surgeon—Mr Paterson—carried out his work in the Solihull area. Many of the botched operations have added to the misery of my constituents and their cancer has been made far worse by his activities. Many people are still waiting for compensation and justice. However, what Solihull’s breast cancer care group and other patient groups in Solihull want is for the Cancer Drugs Fund to stay, and to be fair and transparent in its dealings. They do not want the fund to wither on the vine, but neither do they want it to become a free-for-all for drug companies. They understand that in a market we have to try to get the best possible price.
That is an important point, and I understand that there are still negotiations under way about all the drugs removed from the fund. Manufacturers have an opportunity to reduce the costs to the taxpayer. However, as my hon. Friend has pointed out, it is unfortunate that there are concerns about the negotiation process. Like my hon. Friend, I welcome the fact that data on every new Cancer Drugs Fund patient is now captured—it is quite an oversight that that was not the case before—but
I am concerned at the failure to adequately negotiate good deals for drugs, particularly those to treat rare cancers, so I would add to her calls in that respect.
There are some other aspects of the Cancer Drugs Fund that need to be emphasised. I have been told that patients who are already in receipt of treatment should be able to continue with it. Individual funding requests are an option; however, as many Members present have probably discovered, they can often be very difficult to secure and ad hoc in their processes. I emphasise that point again to Ministers today.
Policy makers have to be careful that the Cancer Drugs Fund does not become a hostage to fortune to the drugs companies and their lobbyists. There must be sensitivity as well. The Cancer Drugs Fund is precious. I am concerned that although 84,000 people have benefited from it, there are 1,700 patients with blood cancer who may miss certain treatments because of the removal of the drugs. The top 10 drugs, it seems, account for 71% of all patients treated. However, there seems to be a black spot when it comes to rarer cancers and drugs that are more difficult to acquire.
There are options for change for the Cancer Drugs Fund. As has been pointed out, NHS England has proposed that the fund should become a managed access fund—effectively, providing drugs in advance of NICE deciding whether or not they should be routinely available. However, my hon. Friend has quite rightly raised issues in that respect.
In conclusion, whatever the future direction of the Cancer Drugs Fund, let us not forget that thousands of people are alive today and thousands of families still have their loved ones because of its advent. We must not lose sight of what the Cancer Drugs Fund has achieved. We must protect those achievements for the future, but be very mindful of the case laid out by my hon. Friend.
As ever, Mr Streeter, it is a pleasure to serve under your chairmanship. I congratulate Pauline Latham on securing a debate on this important subject; she has tirelessly raised the issue of access to cancer treatments since she entered the House. She was right to describe the Cancer Drugs Fund as having moved from being a temporary measure to being a mainstay, and therein lies much of the challenge we face today. In that respect, Julian Knight was right to remind us of the many good things the fund has done, and Jim Shannon was right to emphasise the increased number of people with cancer and the need for cancer treatment.
Let us be clear: last year’s delisting of drugs from the Cancer Drugs Fund was a retrograde step for many cancer patients across the country. The decision affected many thousands of patients, and I am sorry to report, as the chair of the all-party group on pancreatic cancer, that that included hundreds of pancreatic cancer patients, because the pancreatic cancer drug Abraxane was removed from the CDF on
Pancreatic cancer has the worst survival rate of any of the 21 most common cancers, with less than 5% of patients surviving five years or longer. That survival rate has barely changed over the last 40 years. Sadly, as my hon. Friend Nick Thomas-Symonds emphasised, pancreatic cancer is often diagnosed late, with about 80% of diagnoses taking place when the disease has spread to another part of the body. Patients diagnosed when the disease is metastatic live, on average, for just two to six more months.
Trials have shown that Abraxane, when used in combination with the standard chemotherapy drug gemcitabine, can extend eligible patients’ lives by an average of about two months more than gemcitabine alone. However, it is important to note that some patients live for significantly longer than two months, with some on the trials living for more than two years, and with a significant increase in the number surviving for more than one year. Clearly, when the average survival rate is between two and six months, even an extra two months’ survival gain represents a relatively large amount of time for patients to spend with their loved ones, and the value of that was indicated earlier.
That survival gain is why Abraxane is now in use around the world. From Germany to the USA, and from Austria to Australia, it is making a small but tangible difference to patients. It is worth noting that Scotland and Wales have also approved Abraxane for use on the NHS. Yet, in England, as of
There has been a significant outcry from members of the public—people such as my constituent, Maggie Watts, who lost her husband, Kevin, to pancreatic cancer in 2009, and the 102,000 people who signed her petition on Change.org calling for Abraxane to be put back on the CDF list.
Why was Abraxane removed? Unlike some other drugs, it was not removed because of cost. Instead, it was decreed that it did not meet the minimum clinical effectiveness threshold when that was raised in 2015. In short, it was removed because the CDF scoring system did not take account of relative survival gain. The scorecard CDF panel members must complete requires them to give a score of zero to a drug that gives an average of less than three months’ life extension. Despite there being few treatments for pancreatic cancer, the system also did not recognise that this cancer has an unmet need in terms of treatment options. Abraxane is the first significant new treatment for nearly two decades, but the scoring system was inflexible, so the drug scored low.
That is the issue: we cannot just compare a new treatment for, say, breast cancer, where the average five-year survival rate is more than 80%, and where there are many effective treatments, with a new drug for a cancer such as pancreatic cancer, which has the lowest survival rate and few treatment options. Put simply, where a cost-benefit analysis takes place in a system with a finite budget, and where drugs for cancers with relatively high survival rates are scored on the same basis as drugs with the lowest survival rates, that system will always work against new drugs for cancers such as pancreatic cancer.
That brings us to the NICE consultation taking place about how the CDF will be used in the future, which the all-party group will be submitting its views on. If a NICE committee defines a drug as an end-of-life drug, it can approve it at a higher cost threshold than other drugs. That is extremely important for cancer drugs and especially for pancreatic cancer drugs. However, the consultation document suggests only minor changes to the end-of-life three-month threshold, which, as hon. Members will gather from my earlier comments, is vital for cancers such as pancreatic cancer. This is where the issue of relative survival gain needs to be properly addressed.
Another way to have addressed issues affecting cancers with the worst survival rates would have been to introduce a system of patient and clinician engagement for pre-defined end-of-life drugs. That system is being used successfully in Scotland. Introducing it here would mean that NICE had to engage more with clinicians and patients to establish what extra benefits certain drugs might bring. NICE committees would then have to give due weight to that PACE evidence, in addition to the clinical and cost-effectiveness data they usually review. Without PACE, Abraxane would not be available in Scotland. The system could make a big difference to patients in England if it were introduced for certain pre-defined cancer types, such as rare cancers—the hon. Member for Mid Derbyshire mentioned the failure we have seen in that respect—and cancers of unmet need with the lowest survival rates.
I thank my hon. Friend Pauline Latham for calling a debate on an issue that is important not only to me and several of my constituents, but to the broader population.
The Cancer Drugs Fund is not fit for purpose. As the chief executive of Cancer Research UK, who chaired the independent taskforce that looked into the fund, pointed out, we have several problems. First, curative treatments cannot be accessed readily enough. Also, insufficient data are collected in the system to prove the benefits of drugs and their effectiveness for patients. Although we welcome the data collection that is taking place now, it is a little too late.
We continue to lag behind other countries in cancer recovery rates and appropriate prescribing. Indeed, 20% of cancer patients present at our accident and emergency wards, and the later a patient presents, the poorer the outcome. As Nic Dakin said, certain cancers, such as pancreatic cancer, are devastating in the speed with which they attack the individual.
It must be remembered that the Cancer Drugs Fund is unique: cancer is the only condition with a dedicated fund. My constituents and I welcome the Prime Minister’s support, but I am a little concerned that cancer is being labelled as a special disease. My surgery often includes patients with other diseases, and we must look across the piece. My concern is that we should have a road map from the accelerated access review so that we can learn how to drive forward advances not only for cancer, but for all areas of medicine. Standing in this hall takes me back six months, to when I first spoke here, about a constituent’s access to the rare-disease drug everolimus.
In a system that is challenged financially, we need to be very sure that any drug for whatever illness is effective and offers value for money. Within that landscape, the CDF has gone from its original four-year spend of £650 million to a six-year spend of £1.27 billion. It could be argued that it has been a victim of its own success.
With improved access to medicines for nearly 80,000 people, but with ever-increasing need and demand, it is right that the Cancer Drugs Fund should sit alongside the cancer strategy as part of the entire commissioning pathway. Non-surgical cancer treatments such as drugs can and should be incorporated into a treatment package of surgery and radiotherapy to deliver an integrated and effective approach. There is a need for radiotherapy machines right across our hospitals, because they deliver extremely high survival rates for cancer patients. We therefore need to be careful about these issues.
For me, the rub has been the lack of thought given to the removal of drugs, and like my hon. Friend the Member for Mid Derbyshire, I have been approached on this issue by constituents—particularly those suffering from pancreatic cancer and, given my history, those with breast cancer. A review in September led to 23 separate treatments being removed from the Cancer Drugs Fund, before we understood what the new horizon will look like for the charities and pharmaceutical companies, how the pathway will progress and whether we have a solution to ensure that our constituents can access drugs. In short, this removed the clinical choice from doctors and, more importantly, from patients. Those patients are my constituents and friends. With the loss of Imnovid and Revlimid—two drugs for myeloma—and the removal of breast, bowel and pancreatic cancer drugs for all those patients, life suddenly became less certain. A new CDF should have clear entry and exit levels for promising drugs. It needs to be a trial area, and defined as such; if, as proposed, it is to be brought into NICE, we need answers to some of the questions that other hon. Members have asked about how the Minister will hold NICE to account. In the cancer drug future, once a drug was approved it would be made available for routine use and would go into baseline commissioning. That would take some of the fear about whether someone would get it out of the system.
What remains to be seen is whether new drugs will have to meet the current inflexibilities of the cost-effectiveness criteria. That is a concern for cancer charities and pharmaceutical companies, which predominantly have the care of the patient, and patient outcomes, at their heart. To deliver cost-effective and timely treatments, as Jim Shannon pointed out, we need a flexible new system. The NICE appraisal process is slow and unwieldy. It should be flexible enough to cope with new cancer drugs and—the Minister is aware of my interest in this—off-patent and repurposed drugs, which can also be effective in the area in question. That is about gathering and delivering the data on the patient for the patient, to allow drugs to be recommended and prescribed, or so that it is possible to return to an individual pathway for a funding request. However, that merely sends us back to where we are today—people not knowing whether they will get the drug or not.
The irony of our system is that with the vibrancy of our life science industry drugs are, often, readily available in Europe or Scotland before patients in England and Wales can access them. That is the bigger problem. We have improved one-year survival rates in the UK; but despite that we lag behind many other countries and our five-year survival rates have shown little progress.
More must be done. In the world of pharmaceuticals and, more importantly, genomics, advances are happening at pace. We need a space where we can trial medicines for use not only in big cohorts but for rarer cancers and diseases. We need a landscape that will allow for the personalised medicine that is coming down the tracks to us. Cancer will not wait for NICE. Nor will it wait for the patient. I know: I have been diagnosed with cancer and pre-cancerous tumours on several occasions. That is why I challenge the Minister on behalf of other cancer patients and my constituents in need, to ensure that the CDF delivers reforms that will improve patient access to effective cancer medicine.
It is a pleasure to serve under your chairmanship today, Mr Streeter. I join other hon. Members in congratulating Pauline Latham on securing a debate on a vital issue at such an important time.
No one is unaffected by cancer, and I am sure every Member present will know of a constituent who has had their cancer treatment improved by access to specialist drugs. However, particularly in light of recent decisions, I am sure that we all know stories of constituents and family members who have not had access to the drugs they need, and who have, sadly, suffered as a result. That is why we are here today to discuss this important subject.
There are many who believe that, wherever they live and whatever their age, cancer patients—and there many different types of cancers—should be able to access clinically effective, evidence-based treatments in a fair, consistent, timely and transparent way from the point of diagnosis. It is therefore deeply regrettable that, given that the Cancer Drugs Fund was already scheduled to come to a close this year, additional funding could not be found to provide the 16 medicines that were delisted last September, at least until a more effective commissioning system for cancer drugs was put in place.
Of course, difficult decisions will always have to be made about the allocation of finite resources, but this has been a particularly hard blow. It is difficult to describe how it must feel for someone to be diagnosed with cancer and then told, as the hon. Member for Mid Derbyshire described, that the life-extending drug they need was funded yesterday but will not be funded today. I take on board the issues about pancreatic cancer, which is one of the severest forms. In fact there are many forms within that spectrum. I note particularly that it was not necessarily resources that were the issue: it was to do with clinical commissioning and clinical effectiveness, and drug trials. Many people who are desperately in need of help and access to drugs, and who feel very unwell, are at the mercy of wider decisions that are part of the NICE agenda and the wider Government agenda.
We may not find ourselves in that position deliberately. However, the Rare Cancers Foundation estimates that it will have been the experience for thousands of patients across Britain and Northern Ireland, and I feel that that suffering should be put on record in our debate today. It is, at the very least, a dire indication of why commissioning reform is needed so badly. It is not too late for the
Government to provide the additional support needed to give relief to the patients who are being denied access to life-extending drugs, but, given that such an announcement is unlikely, I shall turn my attention to the ways in which a new system can be designed, to ensure that the same mistake will not happen again.
The funding given for cancer drugs, whether through a Cancer Drugs Fund or a special medicines fund, must be sustainable and well co-ordinated, and should work alongside comprehensive support for treatment and wider health infrastructure. On that basis, the review of how the Cancer Drugs Fund works with NICE should also consider how specialist drug support can be co-ordinated with more localised radiotherapy, chemotherapy and surgery options. Integrating the Cancer Drugs Fund with the NICE system creates an opportunity to address broader issues within the NICE commissioning process, offering the potential remedy for long-standing issues such as access to necessary specialist drugs.
I will mention by way of background, given that I represent a Northern Ireland constituency, a difficulty that we sometimes have. Many specialist drugs are trialled at Queen’s University Belfast, but because of the commissioning process they are not available to our constituents in Northern Ireland. They have not yet been commissioned, or they are commissioned for England and Wales but not necessarily for Northern Ireland. Therefore I urge the UK Ministers responsible for the issue to engage fully with their counterparts in the devolved Administrations, including Northern Ireland, to make sure that the issue is considered fully, and to turn the potential danger into an opportunity to improve both the NHS and access to specialist drugs. I hope that today the Minister, whom I am glad to see here, will provide us with some form of resolution, and a panacea that will bring relief to many people throughout the UK who are suffering from any of a wide variety of cancers, and particularly sufferers of rare cancers.
I too thank Pauline Latham for obtaining the debate. I feel that I am the most inexperienced of the Members present on this subject, having never been on a health committee, but having been lobbied hard; but I lost my sister some 25 years ago, and I know that everyone has either lost a family member to cancer or knows someone who won, and was cured.
There is a key thing to get across today. Every MP needs to realise the limitations on funding and what we are learning, so that we can all lobby, and help to find a better way forward. I was particularly impressed when President Obama said he wanted all cancers to be cured. I am not sure that that will always be possible, but it is the right aim with which to go forward.
As I have been trying to learn about, and get myself briefed on, the topic, I have realised that we need a more dynamic and flexible approach to what we are doing. It is right to have a fund that allows everyone to get to it, but we must find a way in which everyone does get to it—to the drugs. Taking drugs off the list seems to be the wrong way forward. Can we look for some form of flexibility, so that with drugs that have been removed there is perhaps a different way of getting at them, one step back?
I had two main reasons for wanting to speak today. One, which has been touched on by my colleagues, is the difficulty that comes from Northern Ireland being treated as a devolved country with its own cancer. As we have heard, only £1.5 million is being put forward and the cost of cancer is a phenomenal chunk out of a small budget. People often have to travel elsewhere in the UK to get the drugs and the cures they need.
One such case is this. I was sitting on a train once—before I ended up here—listening to two Northern Irish people speaking loudly about how useless all politicians were, not just here but also in Northern Ireland, because no one had helped them with their cancer. I interrupted them, and it turned out that a politician from the Social Democratic and Labour party was the only person who had, in fact, helped them. One of them had had to sell his house and use all his savings to get the cure he needed, which was available only here in London. My main point is that we have to find a more joined-up way of doing this, so that the drugs are available for everyone, everywhere. Can we consider an approach that includes all four countries?
We have heard from others that we have an extremely good Queen’s University link-up with Almac and with other countries, and we also have, in my patch, Randox. We have fantastic pharmaceutical companies leading the way in Northern Ireland. However, it was from a meeting with one of those companies that a story we have touched on today emerged. The company tried to sell the diagnostic system to our local NHS, but it could not. It sold it to a company in America, which repackaged it, and the Northern Ireland health service then bought it from that company for an extra few million. We have heard about the difference in costs between Spain and Britain. There must be a system for looking at the procurement process, to ensure that we are more dynamic in how we buy things, so that the drugs are there and available to everyone.
Those are the two main points I wanted to make. One is: let us work it all together and get a better use of drugs. I am glad that we have had the debate today, and I am thankful for having had the chance to speak.
It is a privilege to serve under your chairmanship, Mr Streeter. I thank 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 in 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.
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.
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.
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.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate Pauline Latham on securing this important debate and on the depth of knowledge she has demonstrated. We might not share the same political allegiances, but we share a commitment to improving the lives of people affected by cancer, as do all Members—those who have contributed to the debate and all those in the House of Commons. The nature of the cross-party debate we have had today stands as a testament to that. I thank my hon. Friend Nic Dakin and the hon. Members for Strangford (Jim Shannon), for Solihull (Julian Knight), for Bury St Edmunds (Jo Churchill), for South Down (Ms Ritchie), for South Antrim (Danny Kinahan) and for Motherwell and Wishaw (Marion Fellows) for their contributions too.
Cancer transcends party politics. Each and every one of us has had a constituent, family member or friend affected by cancer. It is a disease that sadly touches us all, and it deserves the proper attention of the House of Commons. It is because it transcends party politics that I commend the Government on introducing the Cancer Drugs Fund during the last Parliament. Patients have benefited significantly since the fund’s introduction, and that has to be welcomed. However, we are here today because the progress over recent years to improve access to cancer drugs is now partially at risk.
The Government introduced the Cancer Drugs Fund, but they are now sadly presiding over damaging cuts to the treatment available through it, as we have heard in the debate. At the general election, the Conservatives promised to continue to invest in cancer drugs, but less than six months later they announced that a number of treatments would be removed from the fund, meaning that they would no longer be routinely available to patients. That will have a tragic human cost for cancer patients. Indeed, the Rarer Cancers Foundation has calculated that the reductions could affect as many as 4,100 cancer patients every year. Members from all parts of the House have expressed significant concerns about the impact those reductions will have on all our constituents.
Many important points have been made during this debate, but I would like to add a few of my own. First, can the Minister, who I have a great deal of respect for, tell us what support is being made available to patients who will now miss out on treatments that have been removed? Will he promise that this is the last time we will see cuts of this nature? The sad truth is that the cuts were an inevitable consequence of an abject failure by Government to fix the drugs pricing system. The Cancer Drugs Fund was always meant to be a temporary measure, but the inability to implement value-based pricing and then value-based assessment during the last Parliament has to some extent led us to the situation we are in today. Cancer Research UK has said that it is
“unacceptable that after five years of conversation, there still isn’t an effective solution in place,” and I agree. We need a better system of drug pricing that is fair for patients and has the confidence of doctors. At the moment, patients are being badly let down.
Before the election, Labour promised to reform the Cancer Drugs Fund to make it a cancer treatment fund and end the bias towards certain types of treatment. We also promised reform of NICE to ensure a clear route for new treatments to be made available on the NHS. Nobody wants a return to the days when people’s access to treatment was determined by the first two characters of their postcode. Unfortunately, however, the latest promise of reform to the Cancer Drugs Fund has been riddled with confusion and delay. Ministers said the consultation would be published in July, then September, and it finally came out in November. The consultation is expected to run until mid-February, with a new system ready to be in place by April this year. The Minister might be able to hear the scepticism in my voice about whether the Government can deliver meaningful reform to the Cancer Drugs Fund in such a short period, so will he confirm, secondly, that these are still the timescales for delivering reform? If so, will he promise us that the outputs from the consultation will deliver the change being demanded by the cancer community and not leave a half-baked solution?
Although some aspects of the Cancer Drugs Fund proposals are to be welcomed, others cause concern. Beyond some tweaks at the edges, it is not clear that NICE is proposing the fundamental changes to its processes that charities have rightly requested. Breast Cancer Now has warned that the consultation
“does not offer sufficient changes to the way NICE currently operates...to allow drugs to be approved for routine use on the NHS.”
The charity has also said that it is
“concerned that these proposals may result in fewer drugs being made available rather than more.”
Those are troubling comments, so, thirdly, will the Minister respond to those concerns? Can he tell us the extent to which final decisions about treatment access will differ under the reforms? Which drugs that have previously been rejected by NICE will be available?
NHS England has not published an impact assessment for the Cancer Drugs Fund consultation. Members of the cancer community have raised concerns about that with me and asked what NHS England might be attempting to hide, so can the Minister confirm, fourthly, whether NHS England has carried out an impact assessment on the proposed changes? If so, will he promise to place a copy in the Library before the consultation closes, so that Members of this House can give it the scrutiny it deserves?
Beyond the current planned changes, there are disturbing stories of NHS England refusing to discuss price cuts with drug companies, effectively leaving deals on the table that could have helped patients and the taxpayer. Simon Stevens once said that he wanted NHS England to:
“Think like a patient, act like a taxpayer.”
At the moment, it is frankly doing neither. We cannot allow red tape to get in the way of what is right for patients. The reforms must create greater flexibility and pressure for both sides to get round the table and agree deals. Other countries seem to be able to make the drugs available without spending more money on their health services, which implies that they are better at striking deals, or at least are more flexible in doing so. Therefore, fifthly, will the Minister promise to intervene in NHS England to ensure it is doing everything it can to secure the best deal from industry for patients and taxpayers? Will he commit to reviewing the processes carried out in other countries for securing access to medicines and ensure that learnings from them are translated into NHS England’s new system?
It is also worrying that the drugs companies and the Secretary of State have negotiated a deal in secret that changes the drugs pricing scheme, effectively creating a half-a-billion-pound funding black hole over the course of the pharmaceutical price regulation scheme. I am fearful that that could lead to more bad news for cancer patients. I have pressed the Minister on that before, so will he tell me, sixthly and lastly, how that funding gap will be filled? Will he guarantee that the shortfall will not lead to any further damaging cuts in cancer patients’ access to treatments?
I want to end my contribution to this debate in the spirt in which I started, because this is not a party political issue. Our shared goal is an NHS that is the best health service in the world for treating cancer, but we will only achieve that if we can ensure that patients can access the most effective forms of treatment. Cancer patients need and deserve an end to the current uncertainty. We on this side of the House will stand with the Government to do all we can to ensure that cancer patients get that fairer deal.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend Pauline Latham on securing this debate and I thank her for the chance to discuss these important issues, which I know are important to various Members who cannot be here this afternoon. I thank colleagues of all parties who have spoken. It was particularly powerful to hear the personal perspective of my hon. Friend Jo Churchill, who is a cancer survivor. I pay tribute to the work of Myeloma UK, Cancer Research UK, Macmillan and the other charities that have done, and continue to do, so much work looking after patients and supporting policy and research. As colleagues know, I am passionate that charities should have a bigger role to play in policy making. I have opened the Department’s door and invited them to come to the top table.
Few families in the country are untouched by cancer, and I am no different. My father died of throat cancer when I was 19, 18 months after I had met him. My mother-in-law died of myeloid leukaemia a few years ago. The family, like so many families, had to watch her go from a wonderful and healthy, vibrant grandmother to a corpse in 12 to 15 months. It is a tragedy when it happens, but the truth is that our generation has lived through the most extraordinary advances in cancer. Certainly in my childhood it was a death sentence. One sat in the back of cars as a child and heard parents discussing in hushed tones that somebody had a cancer diagnosis, which meant they would die. Now that has changed: 2 million people live with cancer and it has become a treatable disease. In some areas, it has become a preventable disease. That is why it is such a pleasure to see my hon. Friend the Member for Bury St Edmunds here. Many others in the country today work and live with cancer. It is a stunning tribute to the success of our life sciences sector and our academic and clinical scientists.
My hon. Friend the Member for Mid Derbyshire talked about Tina and Graham and their experience of cancer. We should always remember—I do every day—that at the heart of difficult policy decisions there are people living with the disease. As constituency MPs and parliamentarians we need to bring that personal perspective to policy making. Certainly as a Minister I try to do that. My hon. Friend highlighted the trauma experienced by patients who, at diagnosis, think they will be eligible for a drug but find they have been caught by the timing of the CDF review, which means that the drug is tantalisingly taken away from them. We can all sympathise with that. As in all Administrations, when change comes, somebody normally gets caught at the point of change and it is very difficult. My hon. Friend also made a powerful point about data being crucial, and I accept that we need to do better on data. I have picked out those comments, but we have had excellent comments from across the House.
I want to set the context before dealing with specific questions. In the past 20 or 30 years, we have seen incredible transformations in biomedical research and in our ability to develop new treatments and diagnostics. My own 15-year career in biomedical research saw us go from the early days of genetics to extraordinary abilities to drive diagnosis and personalised therapy. One looks at Herceptin for breast cancer, a genomic biomarker theranostic partner drug. We have guaranteed that it works in patients who have that genetic biomarker. This is the future: much more genomic targeting of drugs. Genomics and informatics are transforming the way in which drugs are developed.
I arrived in the House of Commons six years ago. As a Government adviser on life sciences, I supported the Prime Minister in putting a life sciences strategy in place that built on the previous Government’s good work. We set out an ambition for the NHS to become not only a passive recipient of new therapies, but an active partner in the development of them, making available our genomic and informatics leadership and our clinical research, which is at the heart of the life sciences strategy: two cylinders pumping together, with the NHS not as a purchaser but as a partner in development.
Although we have had phenomenal revolutions in genomics and informatics and in the pace of discovery—pioneered in cancer, which is why cancer has led with this pressure on our funding mechanisms—it gives rise to great challenges: rising costs of treatment; ever more expensive drugs; smaller patient catchments, which puts a coach and horses through the traditional model of reimbursement; and the end of a one-size-fits-all blockbuster model of drug discovery, which is what NICE was originally set up to deal with. Those are very big challenges and I am putting policy responses in place. However, they are also big opportunities. As the world’s only integrated comprehensive healthcare system, nowhere is better equipped in the world to unleash the power of genomics and informatics for public good. I believe Nye Bevan would be banging the table today and saying, “The NHS was about the collective use of our health assets to prevent disease. Come on! Let’s harness the extraordinary ability of our NHS,” which is what we are doing.
As we reform the way in which NICE works, there is an opportunity for us to take the lead in the development of these new drugs and new specialised therapies, and to pioneer new models of reimbursement as well. It will not happen overnight—that is the honest truth—but it will happen over the next few years. That is why we have set out a 10-year strategy, and I am absolutely honoured and privileged to be at the beginning of a five-year Parliament as the Minister for Life Sciences with a chance to drive the reforms through. That is at the heart of the accelerated access review that I have launched, which I will talk about in a moment.
I urge everyone to recognise that the Government are not complacent. We have put £250 million extra into Genomics England. We are the first country on earth to do, at scale, full genome sequencing in cancer and rare diseases. Rare cancers are particularly well served. We have led on data and informatics for research in the NHS, often at a high political price, but it is essential if we are to drive this forward. We have set up the precision medicine catapult, the cell therapy catapult and the £700 million Crick Institute. We have protected, increased and ring-fenced science budget increases. We have announced and secured a multi-billion pound drugs budget, and more will be announced shortly. We have set up the rare diseases consortium, the accelerated access review, the early access to medicines scheme and a £1.2 billion commitment to the Cancer Drugs Fund, so I hope colleagues will acknowledge, as some have, that we are serious about trying to both invest and reform this space.
The Cancer Drugs Fund was set up with strong leadership from the Prime Minister. Because of the progress in cancer putting pressure on NICE’s systems, NICE’s clinically led, world class, independent advice rejected many of the new cancer therapies that did not fit well with its scoring system, so the Prime Minster said that we must make the money available to make sure cancer patients do not suffer while we reform the system. The fund is now £1.2 billion; another £340 million was invested this year. Some 84,000 people have received life-extending drugs that they would not otherwise have got.
The hon. Gentleman makes an interesting point about the balance of responsibilities between NICE and NHS England. The system was set up so that NHS England is statutorily bound by NICE’s recommendations. Part of the problem in recent years has been that even treatments approved by NICE can take up to two, three and in some cases five years to be rolled out across NHS England. Much as we all love the NHS, we accept—even the NHS accepts—that there is a problem with patchy roll-out. That is also to do with data, which various colleagues have touched on.
The Minister used the words “world class” in respect of NICE, but its scoring system was such that drugs did not get authorised, and many that the drugs fund includes were not authorised by NICE. Those two things do not seem to be consistent. Should we not look carefully at what NICE’s criteria are, as they have done in Scotland, and make them more appropriate?
The answer is yes. That is why I have set up the accelerated access review, which is doing precisely that. NICE is heavily involved in contributing to setting up the reforms, giving it new flexibilities and changing the way we adopt, assess and reimburse new medicines. I meant that NICE is recognised internationally. Indeed, other countries follow its health technology assessments, and its methodology and protocols. The challenge now is to update them for a world of genomics and informatics, with a much more targeted and precision medicine landscape. I accept that in that context we are not yet world class—we have more to do—but NICE is a world class organisation. Given the chance to update its systems, I believe it will lead the world in that field.
In the autumn statement we fully funded the NHS’s five-year forward view, including its cancer strategy, with a commitment to £10 billion extra per year by 2020. We frontloaded that with £6 billion, as was asked for, to allow it to make the investments necessary to modernise. That is a half-trillion pound commitment to spending on the NHS over this Parliament, so I gently point out to the shadow Minister, Andrew Gwynne, that to describe that as a cut is testing the admirable elasticity of the English language.
On the importance of NICE and independent, clinically led decision making, much as at times like this I yearn to reach for a big lever, pull it, make a decision and send hon. Members out dancing and cheering and send patients home happy, I think we all understand that it is right that such decisions are not taken by MPs or Ministers; they must be taken by clinicians, based on the very best evidence from the very best independent advice. That is how this system works: NICE makes an independent judgment using the very best systems available to it. I take the point made by my hon. Friend David Mowat that that needs to be, and it is being, updated to give NICE more flexibility to reflect the challenges of precision medicine—treatments that have a very definable, predictable response in a very small number of patients. NICE’s advice goes to NHS England, which makes the clinical judgment about treatment protocols. It is right that the Cancer Drugs Fund is based on that clinical decision making.
Nevertheless, there is an anomaly. Although we expect NHS England to be guided by NICE, in one therapeutic area, with the best of intentions, we have created a fund that sits at the end of the process, so that NHS England has a fund to buy drugs that NICE has said no to. That is an anomaly in the system. The point of the review is to take the CDF commitment to fund earlier, so that NICE can use it as an assessment fund to enable it to look earlier in the process at new drugs that are coming on stream and then give NHS England advice. That is in keeping with our general policy of opening up a space between research and medical practice in which we use data from the front-line treatment of patients and from the system to inform our procurement and reimbursement system.
Rather than “finger in the air” theoretical models of health-economic benefits, we are within touching distance of a system that is able to use real data in realtime from real patients with real diseases to drive real models of cost-benefit and health economics, and we are trying to wire the system in order to deliver that exciting prize. Members will understand that, where funding is finite—£1.3 billion is a big commitment, but it is finite—the system must re-prioritise which drugs it purchases. That is difficult for those who are in the process of getting a diagnosis and expecting a treatment that is then withdrawn, but I stress that no patient who is in receipt of a treatment that is withdrawn has that treatment withdrawn from them specifically. If they are getting a drug, they continue to get it.
My hon. Friend the Member for Mid Derbyshire mentioned pomalidomide, a drug used to treat relapsed myeloma. The CDF clinical panel looked at it, reviewed it, and, based on its independent, best-in-class assessment, the score was too low so the panel recommended that it not be approved. As I understand it, the panel is currently looking at other treatments for multiple myeloma, including panobinostat. I checked with the panel before the debate, and can say that final guidance on that treatment for that condition is imminent.
I remind Members that any patients receiving drugs continue to be treated, and that no drug will be removed if it is the only proven therapy available on the NHS. Sometimes in debates such as this we give the impression that we are taking away a drug, patients will stop getting it, and patients who have no other treatment will be left without treatment. That is not what happens. We should remember that there is an individual funding request mechanism—the IFR—for patients with exceptional conditions that are not met by other drugs. That is there specifically so that if any constituents have a unique claim on clinical exceptionality, their clinicians can make that case.
I should highlight the fact that two new drugs were approved in the previous CDF round. We sometimes forget that new drugs are being approved. We do not get requests for debates in Westminster Hall to congratulate the system on their approval, but it is worth mentioning them. The system approved panitumumab for bowel cancer and ibrutinib for cell lymphoma. Those approvals have been widely welcomed by patients and charities in the relevant sectors. I am delighted that, through the early access to medicine scheme that we introduced last year, which, with patient consent and their clinician’s approval, enables unlicensed drugs to be fast-tracked, we have now got pembrolizumab through, tested, into patients and purchased by NHS England several years earlier than would have been the case. That is a precursor of what we want to do much more widely through the accelerated access review.
It is no coincidence that one reason for the delay that was referred to earlier is that I am very keen for the CDF review to be done at the same time as the accelerated access review. Had we not done that, colleagues would have been saying to me, “How ridiculous, Minister, that you have reviewed the Cancer Drugs Fund and closed it before you have received the recommendations of the accelerated access review this spring.” I wanted to ensure that we are building a landscape that is logical and fit.
Does my hon. Friend the Minister accept that it is worth while to look at the difference between a condition that goes from diagnosis to death over, say, 18 months, where an extra two months of life is proportionately quite small, and one of these very fast-acting cancers, such as pancreatic, where a person gets only six months and giving them an extra two would be very important in allowing them to settle their affairs and come to terms with the world?
My hon. and learned Friend makes an important point. I urge colleagues, as elected representatives, to make such points to NHS England through the CDF review, which closes on
In the limited time I have left, I want to touch on some of the questions that came up. Colleagues asked about performance measures for data. It is important that we use the data from the CDF better. We are introducing measures to ensure that the contracts for 2016-17 specify that trusts that do not submit complete datasets will be penalised. One hundred per cent. of trusts are now submitting data, so we have closed that door. Some of the horses may have bolted, but we are getting properly on top of the data.
My hon. Friend the Member for Mid Derbyshire asked first about a draft treatment pathway for multiple myeloma. NHS England advises that that is currently in the process of being finalised. It has been the subject of public consultation and is being revised to take account of the comments received and the potential impact of treatments that have been removed from the CDF. The treatment pathway is due to be published in 2016. Secondly, on individual funding requests, NHS England does publish data on its website, including the number of individual funding requests for each drug on the national CDF list. Thirdly, on the issue of penalties for failing to produce data, we have built specific performance measures into the systemic anti-cancer therapy database.
My hon. Friend also mentioned multi-drug treatment cost reductions. It would not be appropriate for me to comment on NHS England’s individual commercial discussions with companies, but I can say that I am actively looking at ways to integrate better the Department of Health negotiators with NHS England commissioners through the accelerated access programme, so that we can get the benefit of time, cost and risk reductions in the pathway in more enterprising pricing mechanisms. I am confident that there is interesting progress to be made in that space.
I am aware that it is traditional for the Minister to leave a little time for the Member who secured the debate to wind up. I have around 15 questions that I have not had the chance to answer, so with your permission, Mr Streeter, I will write to the Members who contributed to the debate. I close by reiterating our commitment, as a Government, to get on top of the issues that have been raised. I hope that Members can see that, as the first Minister for Life Sciences, I am making progress in the direction that has been highlighted.
I thank all Members who have taken part in this very important debate. Turning to my hon. friend the Minister, I would just like to say that imminent is great, but it might not be imminent enough for my constituent, Graham. He needs help now. I accept that the Minister is doing all he can to accelerate things, but imminent might not be soon enough.
Question put and agreed to.
That this House has considered the removal of drugs from the Cancer Drugs Fund list.