HL Deb 20 November 2001 vol 628 cc998-1000

2.45 p.m.

Lord Roberts of Conwy

asked Her Majesty's Government:

Whether, following reports of a possible trial of beta interferon drugs for multiple sclerosis sufferers, they would support a clinical trial of anti-TNF drugs for rheumatoid arthritis sufferers.

Lord Hunt of Kings Heath

My Lords, following a recommendation from the National Institute for Clinical Excellence, we are currently holding discussions with the manufacturers of beta interferon and glatiramer acetate to establish whether those drugs might be secured for patients in the NHS in a manner that could be considered cost effective. NICE is currently appraising anti-TNF drugs for rheumatoid arthritis and we anticipate that its guidance will be published in March. We will consider carefully all its recommendations, including any for further research.

Lord Roberts of Conwy

My Lords, I am grateful to the Minister for that Answer. I remind him that there are 600,000 sufferers from rheumatoid arthritis in the United Kingdom. It is a very painful and often progressive disease. Many of them cannot get anti-TNF drugs, even though the best clinical judgment in the country prescribes them, because of the shortage of funds in the NHS. Will the Government set up some special funding for that treatment rather than allowing this dreadful suffering to continue?

Lord Hunt of Kings Heath

My Lords, I certainly agree that rheumatoid arthritis is a distressing illness. Many members of our community suffer a great deal of pain and distress as a result of it. It was because of issues around the anti-TNF drugs that the noble Lord has mentioned that we referred the question to the National Institute for Clinical Excellence. The purpose of the institute is to give definitive advice on whether a particular drug is clinically effective and cost effective. I expect that the Government and the National Assembly for Wales will receive the outcome of that advice next spring. We must await that moment before any further decisions can be made. I do not believe that a special fund is the answer. We must have a proper process of independent advice so that proper decisions can then be made.

Lord Walton of Detchant

My Lords, I accept the Minister's points. But does he accept that although for many years traditional treatments such as gold and, more recently, non-steroidal anti-inflammatory agents have been helpful for some patients with rheumatoid arthritis, the first really effective treatment to strike at the heart of the disease and to have shown itself as likely to prevent its advance is the anti-tumour necrosis factor? Is it not therefore important that the treatment should be made widely available? At the moment it is subject to the problem of postcode prescribing.

Lord Hunt of Kings Heath

My Lords, that is exactly why we have referred the drugs to the National Institute for Clinical Excellence. The tradition of the NHS is for postcode prescribing under which a particular drug can be obtained in one part of the country and not in another. The existence of the institute enables independent judgment to be made on the clinical and cost effectiveness of a particular drug. If the institute so advises, there will be uniform provision of the drug across the country. I understand the impatience of patients over NICE reaching its conclusions, but we must await the outcome of the process. At the moment we are in the middle of it.

Lord Morris of Manchester

My Lords, I too appreciate my noble friend's concern and he will understand my interest in the question. Is it known why more than three times more women than men develop this cruelly devastating condition; and does it not conflict with the founding principles of the National Health Service that postcode rationing can still discriminate between them?

Lord Hunt of Kings Heath

My Lords, the answer to the first question is that I am not aware of any specific evidence as to why more women than men should be affected, although I shall draw the noble Lord's question to the attention of those responsible for NHS research and development. On the general point, postcode prescribing is unacceptable in a national health service. That is why we set up the National Institute for Clinical Excellence. The longer that it does its work and the more advice that it gives to the Government, the more we will eradicate postcode prescribing.

Lord Addington

My Lords, if taken sufficiently early, the drug in question can prevent a condition becoming debilitating. Should it not be a basic consideration, whenever any such drugs are considered, whether they can prevent a condition becoming disabling? Should that not be at the front of all of NICE's considerations?

Lord Hunt of Kings Heath

My Lords, that is one of the factors on which NICE will have to make a judgment. Before NICE was introduced, new and innovative drugs were often taken up very slowly. We have already seen that the result of NICE decisions is that, once it has given advice that a drug is likely to be clinically effective and cost effective, take-up in the NHS is quicker. We are also seeing that the initial results of advice given by NICE is considerably to increase the amount that the NHS spends on drugs.

Baroness Gardner of Parkes

My Lords, is it not a fact that NICE considers clinical effectiveness only in terms of the cost of the drug? Is it not important to consider the cost of the social care of patients if they are not given the drug and therefore rely on the state for everything? Should that not be a further factor to be considered in the equation?

Lord Hunt of Kings Heath

My Lords, I understand the point raised by the noble Baroness. However, NICE's approach is fully consistent with what is described in the jargon as a societal perspective. That certainly falls within NICE's responsibility to promote clinical effectiveness and cost effectiveness.