HC Deb 15 December 1998 vol 322 cc744-7
3. Mr. Nick St. Aubyn (Guildford)

If he will make a statement on the refusal by some health authorities to fund recently approved drugs for cancer patients. [62444]

The Minister for Public Health (Ms Tessa Jowell)

We want to ensure that cost-effective clinical services, including treatments for cancer, are provided on a consistent national basis. There is unacceptable fragmentation and variation which we are tackling, first by establishing next April the national institute for clinical excellence, which will set standards for clinical excellence and secondly, through the commission for health improvement, which will ensure that those standards are applied in practice.

Mr. St. Aubyn

On 30 June at Health questions, the Minister of State, the right hon. Member for Darlington (Mr. Milburn) told the House: no one will be denied the drugs they need. That is a guarantee."—[Official Report, 30 June 1998; Vol. 315, c. 143.] Yet we hear today from the Minister that there is differentiation in the allocation of drugs that cancer patients need. How can she possibly justify an immediate breach of the promise by her ministerial colleague less than six months ago?

Ms Jowell

Frankly, that is pretty thin. My right hon. Friend was referring to the approach to consultation and the local priorities that would be adopted by primary care groups. The hon. Gentleman's question was about cancer. For the benefit of his constituents, who may feel cheated if he does not receive the answer, I shall set out precisely what is happening in cancer treatments involving Taxol, about which there is some concern.

We asked the Standing Medical Advisory Committee to assess the latest research results and evidence; it endorsed the view that Taxol is the preferred treatment for ovarian cancer. We then wrote to all national health service regional directors of public health to inform them that the committee had endorsed that evidence. Evidence-based guidance on improving outcomes in gynaecological cancers will be published in the spring and will be sent to all health authorities and trusts. It will refer to the use of Taxol in the treatment of ovarian cancer.

Mr. Bob Blizzard (Waveney)

Many cancer patients will have cancer because of smoking. Although no doubt many people will continue to choose to kill themselves through smoking, does my hon. Friend agree—bearing in mind last week's White Paper, particularly its title—that it is unacceptable that those of us who do not smoke should continue to be put at risk of being killed by those who do smoke? What steps will she take to protect non-smokers from the dangers of passive smoking?

Ms Jowell

The title of the White Paper—"Smoking Kills"—is a statement of fact. My hon. Friend is right to suggest that we will not make progress in tackling cancer or heart disease unless we reduce the number of deaths from smoking. He will know that the measures set out in the White Paper include an agreement with the Health and Safety Commission for consultation on the establishment of an approved code to guide practice on smoking at work, which will have legal status if approved. Moreover, the five leading organisations in the hospitality trade have given a commitment to work together to improve ventilation in pubs, wine bars and restaurants where people smoke, and to increase the number of smoke-free public places.

Dr. Evan Harris (Oxford, West and Abingdon)

The hon. Lady said that she had a system for the evidence-based prescribing of Taxol, but will she accept that there will be new drugs, which will not be as widely available as they should be? Does she recognise the fact—I seem to invite her every three weeks to do so—that rationing is taking place in the NHS? That is nothing to be ashamed of—there will always be such tension. Will she at least start a debate with Liberal Democrats and the public and find out how much people are prepared to pay to ensure that rationing—I invite her to use that word—is not as extreme as it is at the moment?

Ms Jowell

I make it clear once again that the NHS will not apply blanket bans to clinically effective treatments. We have also made it clear that the NHS must be able to keep pace with what are, as the hon. Gentleman rightly said, rapid advances and developments, particularly in new drug treatments, so that those treatments are properly assessed for their clinical and cost effectiveness. We must ensure that the status and benefits of the new drugs are established through the work of the national institute for clinical excellence and the commission for health improvement.

Miss Ann Widdecombe (Maidstone and The Weald)

Is there rationing or is there not?

Ms Jowell


Miss Widdecombe

In view of the Minister's unequivocal statement that there is no rationing—which I think will be greeted with disbelief by the medical profession—can she now comment, for the benefit of the House, on the availability not only of the cancer drugs, but of beta-interferon, which is rationed; recombinant, which is rationed; Aricept, which is rationed; and the new anti-psychotics, which are rationed?

Ms Jowell

There are two ways of dealing with precisely the kinds of prescribed drugs to which the right hon. Member has referred. We had 18 years of the Conservatives' way, which produced fragmentation and 3,000 GP fundholders, who all had different systems of prescribing. The alternative—which would be just as unacceptable to the people of this country—would be to define clinical protocols, which would mean that everybody's treatment was preordained in Richmond house.

What we are doing—in, as I am sure the right hon. Lady will forgive me for suggesting, a third way approach to treatment—is establishing the national institute for clinical excellence, which will assess and evaluate new treatments, and we will ensure that those new treatments are made available as quickly as possible to patients, who will benefit from them.

Frankly, the right hon. Lady does her constituents and the people of this country no good by raising spectres that are not borne out in practice. In practice, people will receive treatment on the basis of their clinical need.

Miss Widdecombe

I am tempted to observe that the pantomime season must have come early. May I ask the Minister a straightforward question? Under her Government, are any drugs not being prescribed by practitioners or others on the ground of cost—yes or no?

Ms Jowell

I would be very happy to volunteer to be either the front or the back of the right hon. Lady's pantomime horse. I have already made it clear that the basis on which drugs are prescribed and treatment administered is clinical need and proven clinical effectiveness.