Multiple Sclerosis: Beta Interferon (Hansard, 12 July 2000)

§ Lord Hunt of Kings Heath
My Lords, NICE has not yet made any recommendations concerning Beta Interferon for the treatment of the distressing condition of multiple sclerosis. It is consulting interested parties, including patient groups, on its provisional conclusions and will carefully consider all comments before coming to a final view.

§ Lord Dubs
My Lords, is my noble friend open to persuasion that Beta Interferon is the only hope for some MS sufferers, but that there is also a need for a wide range of treatments from drugs to physiotherapy and dietary advice? Does he agree that NHS provision at present is patchy and sometimes on the inadequate side, and that a multi-disciplinary approach is the best way forward for dealing with this distressing disease?

§ Lord Hunt of Kings Heath
My Lords, the NICE recommendations are provisional. Interested parties, including the Government, can make comments to NICE, which will consider the results of such consultation before coming to a final decision. At this stage, no such firm recommendation has been made.
On the more general concern of my noble friend about the provision of overall services to those who suffer from multiple sclerosis, I recognise that there are elements of patchiness in the support that the NHS provides. That is one reason why, alongside the review of Beta Interferon, we have asked NICE to produce 229 clinical guidelines on the management of the services in the NHS, which I am sure will lead to a much more consistent approach.

§ Lord Astor of Hever
My Lords, can the Minister confirm that NICE will consider the report in the journal Pharmaco Economics that the long-term use of Beta Interferon can save money by slowing down the onset of MS?

§ Lord Hunt of Kings Heath
My Lords, one of the advantages of the process by which interested parties are able to comment on provisional recommendations is that it enables any new evidence to be put to NICE for consideration. I am sure that NICE will consider any new evidence that is available that will enable it to come to its final recommendation.

§ Lord Walton of Detchant
My Lords, does the Minister agree that if the provisional conclusions of NICE were to be confirmed, that would fly in the face of the carefully considered advice given by the Association of British Neurologists which is entirely in favour of giving Beta Interferon to patients with the relapsing and remitting form of the disease, as at present it is the only effective treatment? Surely those provisional recommendations must have been made on financial rather than scientific grounds. Does he also agree that if that provisional conclusion were to be accepted, it would perpetuate the worst features of postcode prescribing by recommending that existing patients receiving the drug could continue to have it but that no new patients could have it prescribed under the NHS?

§ Lord Hunt of Kings Heath
My Lords, we are discussing a provisional recommendation of NICE. I believe that it would be wholly inappropriate for me to give a definitive government view on that recommendation. The Government are preparing to make a submission to NICE that will ask a number of questions about the recommendation and raise a number of technical issues. I believe that we need to await the final recommendations of NICE before the Government can come to an absolutely firm conclusion on these issues. In relation to existing users of services, we have said that existing users of Beta Interferon will be able to remain on that treatment as long as they derive benefit from it.

Lord Grenfell
My Lords, does the Minister agree that a reported 30 per cent reduction in relapses has an enormously beneficial impact on the MS sufferer, not the least of which is that it increases the opportunities for resuming gainful employment? Does he also agree that the early and direct involvement of MS patients in the appraisal process is essential to a proper appraisal of the benefits of Beta Interferon?

§ Lord Hunt of Kings Heath
Yes, my Lords, I well understand the comment made by my noble friend. My understanding is that the provisional 230 recommendation made by NICE points to evidence of what it described as "modest clinical benefit" in relapsing/remitting MS and that that may suggest one relapse avoided in a two-and-a-half year period. Clearly, that is a factor that NICE has had to take into account, but we need to await its final recommendations.
I agree with the involvement of users in the appraisal process by NICE. Patients' user groups are involved as interested parties in being able to bring their views to the attention of NICE. The board of NICE contains non-executive directors who bring an outside perspective. We encourage as much communication as possible between NICE and user groups on such important matters.

§ Baroness Masham of Ilton
My Lords, does the Minister know whether there will be any right of appeal if patients are turned down for drugs such as Beta Interferon?

§ Lord Hunt of Kings Heath
My Lords, if recommendations are made by NICE, there is a process of appeal by interested parties which would certainly involve user groups.

§ Baroness Northover
My Lords, does the Minister agree that clinical effectiveness should properly be the remit of NICE, while priorities in funding must be decided by accountable politicians? Given that this is only the second, and in fact an interim, report from NICE in vast and fast-moving area, is he satisfied that NICE is sufficiently well funded to do its job properly?

§ Lord Hunt of Kings Heath
My Lords, NICE receives about £10 million a year to undertake its functions. I believe that the organisation has some high calibre people and that it is up to the job that we have given it. I believe that it is reasonable to ask it to look at both clinical and cost-effectiveness. It is absolutely right as a principle that we should seek to use the resources in the most cost-effective and clinically-effective way possible. I agree that the issue of resources and affordability is an issue for Ministers, but it is absolutely right to ensure that we focus our resources on what is best and that that should involve some judgment of cost-effectiveness.

§ Baroness Carnegy of Lour
My Lords, will the Minister undertake to convey to his right honourable friend the Secretary of State for Health the question raised by the noble Lord, Lord Walton, and its implications, which are extremely important and which the Minister seemed to dismiss?

§ Lord Hunt of Kings Heath
My Lords, I am sorry, but I do not believe that I dismissed the question raised by the noble Lord, Lord Walton; I thought that I answered it. In such circumstances, the views expressed in your Lordships' House are always brought to the attention of Ministers.

§ Lord Clement-Jones
My Lords, will the Minister undertake to look at the procedures of NICE in the 231 future, both in regard to taxanes and Beta Interferon? We have a situation where a provisional decision has been kept highly confidential. It is therefore difficult to find out on what that decision was based. The appeal then takes place in a cloud of secrecy based, we assume, on some kind of commercial confidentiality excuse which does not appear to be valid. Will the Minister look carefully at that situation over the next few months?

§ Lord Hunt of Kings Heath
My Lords, yes. There will come a time when we will need to review the whole NICE process in order to make judgments in the light of experience. I certainly accept that we need to review the issue of whether or not the provisional recommendation should be made public.