Rheumatoid Arthritis: Anti-TNF Drugs (Hansard, 3 April 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the National Institute for Clinical Excellence expects to give guidance to the National Health Service on the clinical and cost effectiveness of etanercept and infliximab for rheumatoid arthritis in October this year, provided that no appeals are made.

§ Lord Roberts of Conwy
My Lords, I am grateful to the Minister for that Answer. Will he ensure that NICE sets the cost of these drugs against the high cost of rheumatoid arthritis to this country, estimated at£1.3 billion per annum, as well as the benefits which accrue to sufferers who do not respond to standard treatments?
Will he also remind those health authorities across the land which are using reference to NICE as an excuse for denying funds for the purchase of those drugs that that is discouraged, if not prohibited, under the terms of his relevant circular?

§ Lord Hunt of Kings Heath
My Lords, NICE is required to assess evidence on all the clinical and other health-related benefits of treatment and to judge whether on balance they would represent a cost-effective use of NHS and personal social services resources. That provides the right framework for dealing with the important issue which the noble Lord raised.
Policy guidance issued to health authorities was set out in National Health Service Circular HSC/1999/176. In the light of that overriding guidance, we made clear that health authorities and primary care groups and trusts should not wait for guidance from NICE but should develop policies for the managed introduction of those drugs, as for any other clinical development, based on the availability of evidence as to their clinical and cost effectiveness. The guidance should not be used as a mechanism for failing to take a decision. If the noble Lord has particular cases in mind, I should be happy to investigate them.

§ Lord Ashley of Stoke
My Lords, the Government offer advice to health authorities, as my noble friend explained. However, what action can they take when those health authorities choose to ignore their advice and refuse to fund the kind of drugs mentioned?

§ Lord Hunt of Kings Heath
My Lords, if the advice from NICE is that a certain drug should be used for certain conditions, we expect the health authority to implement that guidance. The whole basis of the establishment of NICE is that it enables us to ensure much greater consistency in the introduction and use of cost-effective drugs and other treatments.
As part of our appraisal of the success of NICE, we are monitoring to ensure that health authorities implement such guidance.

§ Lord Walton of Detchant
My Lords, is the Minister aware that research has shown that the sensitised white blood cells which attack the joints in rheumatoid arthritis produce a substance called "tumour necrosis factor" and that the drugs to which he referred are the first which have been shown directly to counteract that particular factor and thus strike at the heart of the pathological process which is responsible for the disease? Is it not remarkable that these remedies, which were developed in the United Kingdom, are freely available in the USA, Holland and Germany but very scantily available in the UK?

§ Lord Hunt of Kings Heath
My Lords, I am most grateful to the noble Lord for clearly explaining the potential effectiveness of those drugs. I must agree with him that the clinical evidence for the two drugs is convincing. The history of the NHS over many years involves the inconsistent and patchy introduction of new treatments and drugs which have been found to be more effective than previous ones. The purpose of establishing the national institute was to ensure that we achieve a more consistent introduction and use of such drugs.

§ Lord Clement-Jones
My Lords, Ministers claimed that the introduction of NICE would end postcode prescribing. That was said to be its key function. The Minister mentioned that the acceptance of the NICE guidelines were being monitored but can he give more details of that? Can he also describe the nature of the enforcement that is taking place? Surely, if we are to end postcode prescribing it is vital that the appraisals and recommendations of NICE are put into practice.

§ Lord Hunt of Kings Heath
My Lords, indeed it is, which is why we are monitoring the introduction of he guidance. We expect health authorities fully to implement that guidance and we should be most concerned if instances were brought to our attention showing that was not happening. The whole purpose of NICE is to ensure consistent approaches throughout the NHS.

§ Lord Morris of Manchester
My Lords. I am very often informed by correspondents that these drugs, so 719 important in the treatment of rheumatoid arthritis, are, as my friend the noble Lord, Lord Walton, explained, available in many other countries. How do I answer their question: why cannot they be made available here without that most painful form of rationing known as "postcode prescribing"?

§ Lord Hunt of Kings Heath
My Lords, I agree with my noble friend that postcode prescribing, which has been an endemic problem in the National Health Service, is unjustified given the national nature of the service. But I believe that the introduction of NICE is the best way to enable a consistent approach to be taken and to allow for the speeding up of the introduction of effective medicines and treatment. The whole benefit and purpose of NICE is to provide advice, based on the most careful judgment, as to whether a particular treatment or drug is effective, including cost-effective. Once that advice has been given it will lead to its speedy implementation throughout the National Health Service. I believe that that is the best way to deal with postcode prescribing.

§ Earl Howe
My Lords, is there evidence to show that what the Minister has just said is correct? Does the noble Lord agree that, surely, it is one thing for NICE to make a judgment about a particular treatment, but it remains for health authorities to fund that treatment once the judgment has been forthcoming, and that has not always been seen to happen in practice?

§ Lord Hunt of Kings Heath
My Lords, the noble Earl raises two points. It is surely right to expect health authorities to fund the implementation of NICE guidelines from their allocations which, as the noble Earl will be aware, are at a record level. We expect health authorities to implement those guidelines, and we are monitoring that at the moment. If we find an instance in which it has not been implemented we take it up vigorously with the health authority concerned.