Access to Medical Treatments (Innovation) Bill

Debate between Peter Bone and George Freeman

Friday 29th January 2016 Commons Chamber

[George Freeman]

May I share in the sense of relief? I, too, congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris). As others have said, it is no mean feat to steer a private Member’s Bill through this House. For all sorts of very good reasons, there are many obstacles to doing so. The process is designed to ensure that only those Bills that command a majority, if not unanimous support, and that clearly address something that the House feels is a priority make it on to the statute book. He has achieved something remarkable in getting this far, although he is right to emphasise that he has only come this far and that the Bill now goes on to the upper House. I pay tribute to his work. Everybody here has acknowledged the quiet, careful, considerate decency and tenacity with which he has got around and listened to people.

I genuinely believe that the Bill will be a powerful mechanism in the new landscape of personalised and precision medicines that we are developing in this country. It will help busy clinicians on the frontline of our health and care sector by making easily available at the click of a mouse information on innovative medicines—both new medicines and innovative uses of existing medicines—that they can prescribe or recommend to their patients.

It is a pleasure to have reached this point, having embarked—somewhat bravely, some of my officials might have said—on a process of supporting the intentions behind three Bills that the House has considered over the past 18 months. I have been determined to work with Back Benchers to reach a solution that the House and the Government could support.

The Bill captures the spirit of two others: the Bill tabled in the other House by Lord Saatchi, which was intended to promote a culture of innovation and innovative medicines in our health system, and the Off-patent Drugs Bill tabled by the hon. Member for Torfaen (Nick Thomas-Symonds), which was intended to promote greater use of off-label and repurposed medicines. My hon. Friend the Member for Daventry intends to promote greater access to information. I pay tribute to all three people, because their work in initiating their Bills has led to the House reaching unanimity.

I thank and pay tribute to the hon. Member for Central Ayrshire (Dr Whitford). Ministers do not always agree strongly with Scottish National party Members, but it is nice to be able to do so on this occasion. She brings to the House a lot of expertise in her field as a medical specialist, and she has played an important role in bringing the Bill to this point. I also thank my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who brings her own experience of surviving cancer and a passion for the subject. The Members I have mentioned and others who have spoken today and in earlier debates have brought us to a much better place, with a Bill that commands and deserves respect and support.

I want to say something about Lord Saatchi, who commenced the debate on this subject. Passing legislation through Parliament is always a messy business. The anti-slavery campaigners took years, and all sorts of legislation that we can look back on with great pride had previously fallen at various hurdles. It takes tenacity to make things happen. This is not the same Bill as Lord Saatchi’s and it does not tackle the issue that he wanted to tackle of some clinicians fearing negligence cases, but I believe that it tackles the central issue that he was trying to address by creating a culture that promotes greater use of innovative medicines. I believe that he has secured, in his way, a legacy for his late wife Josephine that he can be proud of.

Lord Saatchi and Members who have spoken today have become part of a growing movement of patients, charities and campaigners who want us to accelerate access to innovative medicines. I often hear demonstrations from my window in the Department of Health, with patients sometimes chaining themselves to railings. I have yet to hear a demonstration asking us to take longer to regulate and assess drugs and bring them to market. Indeed, the demonstrations that I have heard in the past year have been by patients asking for quicker access to medicines. Mothers whose children have rare diseases have been asking why we are not moving more quickly to bring genomically and infomatically targeted medicines to their children. I have taken part in more debates on this subject than on any other in the past year.

I want to mention a number of people who, appropriately, have been referred to today, including the late Les Halpin. He founded Empower: Access to Medicine with a passion that his death would not be in vain and that his experience of dying from a rare disease would inspire and motivate others to invest more in research and accelerate innovative medicines being brought to patients. The campaign, which was started for him, is continuing to grow and build support for the agenda that we have discussed today.

Graham Hampson Silk has also been mentioned. Ten years ago, he was given four years to live, but because of the extraordinary work of NHS clinicians and NIHR researchers at the Birmingham Institute of Translational Medicine, led by the inspired Professor Charlie Craddock and supported by Cure Leukaemia, Graham is alive. He is using his life to campaign for quicker access to innovative medicines. He is alive because Charlie Craddock got him access to a drug that was in research in America, raised money and flew Graham to the States, and then got the drug into the Institute of Translational Medicine. In fact, that institute has pulled into the greater midlands area more than £20 million of free drugs in trials.

I should mention Emily and a number of the other mothers who have been to my office on a number of occasions in the past six months to discuss muscular dystrophy and Duchenne. The extraordinary progress of our medical community in genomics and informatics unlocks new treatments, but the mothers and fathers of children with rare diseases look on with frustration that we are unable to get the insights to benefit their children and families more quickly. As the first Minister for Life Sciences, I am driven every bit as much by their advocacy, passion and commitment.

The truth is that a lot of people are not interested in this space until they get a diagnosis or until someone in their family gets a diagnosis, at which point people become very interested in research, data and genetics. I am very pleased that their names and a number of others have been mentioned. My hon. Friend the Member for Daventry has struck a small blow in the march of that army for accelerated access to innovative medicines.

I want to say something about the landscape in which the Bill will land, the leadership that the UK is showing to create that landscape and the changes that will benefit patients and our NHS. The truth is that the traditional model of drug discovery is breaking down in front of our very eyes—the very long, 15-year, $2 billion process by which traditional pharmaceutical products are developed and brought to patients. That is too long for the industry and patients, and it is too expensive. Increasingly, the breakthroughs in genomics and informatics mean that drugs can be developed for specific patient groups around specific genetic biomarkers with much greater precision and be brought into the system much more quickly. They do not have to go through 15 years of randomised control trials when there is a genomic biomarker that guarantees they will work in certain patients and informatics to support that claim. That allows us to get medicines into targeted groups much more quickly.

That quiet revolution, which the UK is seeking to develop through our various initiatives, is principally driven by two transformational technologies: genomics and informatics. Genomics allows us to understand the cause of so many diseases—in many cases, the cause is inside the cells in our bodies—and to understand, at scale, why different patients respond to different drugs and why they respond to different diseases in different ways. It also allows us to centre our research on the experience of real patients with real diseases in real time.

Allied with informatics, that allows us to use the NHS to look at huge datasets of patients over the past 20 or 30 years, which is an incredibly powerful resource. Large-scale anonymised data allow us to identify patterns. When we re-analyse the data, we find that many of the drugs that have failed in traditional drug discovery, which could happen because of a side effect, a serious side effect or a death in the late stage of trials when the drug is trialled in the largest number of people, are dream drugs for a small sub-segment of the population. Part of that revolution is about allowing us to identify which patients would have responded much more quickly, which cuts down the time, cost and risk for companies in developing and thus reducing the price. It also cuts down the time that patients have to wait and to have more accurate dosing—we can get the right drug in the right dose to the right patients more quickly.

[Mr Peter Bone (Wellingborough) (Con)]

I put on the record my thanks to my hon. Friend the Member for Daventry (Chris Heaton-Harris) for his success in driving the Bill through. I have heard only today that a constituent of mine is getting a treatment for prostate cancer earlier because of the Minister’s intervention. I am sure that that is part of what the Government are driving. I wanted to thank him for that while I had the opportunity.

[George Freeman]

My hon. Friend is very kind. I thank him for his comment and am very pleased to hear that news.

We are putting in place various initiatives to support the new agenda, and seeing the beginnings of some successes. On the request made by the hon. Member for Torfaen, I will be happy to write to him about the proposals and how we envisage the measure working. There is quite a lot of work to be done on how the process of using a NICE evidence review to assess the evidence for an off-label claim. I am not prevaricating for any reason other than that I do not want to pre-empt that work, which we are getting on with.

Oral Answers to Questions

Debate between Peter Bone and George Freeman

Tuesday 5th January 2016 Commons Chamber

[Mr Peter Bone (Wellingborough) (Con)]

8. What his policy is on making docetaxel available as a treatment for prostate cancer.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

Docetaxel is routinely available in England for the treatment of metastatic prostate cancer, where the disease has not responded to hormone treatment. It is not at the moment licensed for use alongside hormone treatment and has not been appraised by the National Institute for Health and Care Excellence for that indication. In the absence of NICE guidance, NHS commissioners are free to make funding decisions on the best available evidence.

[Mr Bone]

I thank the Minister for stating the current practice. A constituent of mine has prostate cancer. His doctor, consultant and oncologist all say that he would benefit from taking docetaxel, but it is not available in Northamptonshire, although it is available in parts of the rest of the country. He has been told that if he goes down the road to the private hospital, he can have it at £2,700 a cycle. Is that not unacceptable? Should he not get the treatment on the NHS and should he not get refunded the monies paid for private treatment?

[George Freeman]

I congratulate my hon. Friend on being a diligent advocate for his constituent Mr Vann. I am delighted to tell him that the result of the STAMPEDE clinical trial has now been published. Today NICE is publishing an evidence review. NHS England will shortly be publishing its interim commissioning policy based on that evidence. That is very encouraging.

National Breastfeeding Week

Debate between Peter Bone and George Freeman

Wednesday 24th June 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Glasgow Central (Alison Thewliss) for initiating the debate and for her leadership of it. I particularly commend her for tweeting a picture of herself breastfeeding to help launch and publicise the Breastfeeding Network and the campaign this week.

I commend the hon. Members for Dulwich and West Norwood (Helen Hayes), for Aberdeen North (Kirsty Blackman) and for Washington and Sunderland West (Mrs Hodgson) for raising in a short time a number of very important issues. They include issues about the importance of breastfeeding and about women in the workplace; issues, which we had all hoped would become legacy issues, about prejudice and discrimination; and important issues about geographic variation and inequality, including the importance of cultural leadership in changing attitudes.

There were specific questions on policy, which I will try to come to in a moment. I just want to take this opportunity to celebrate and promote National Breastfeeding Week, which runs from 20 to 28 June. It is an excellent initiative and it is particularly good to see it so active on Twitter, which may be to the credit of the hon. Member for Glasgow Central, and to see the plethora of activities going on around the country and the sharing of good practice and experiences by women and health professionals in place-based and virtual networks. That is genuinely inspirational, and the Department and I look forward to seeing other activities organised by local groups around the country this week.

It will not have escaped your beady eye, Mr Bone, that I am, on a gender basis, the least qualified person in the room to be responding to the debate, but I am pleased that the shadow Minister, the hon. Member for Washington and Sunderland West, highlighted the fact that I am the Minister responsible for life and health sciences. This issue goes to the heart of our thinking more broadly about how we unleash the power of the NHS and our health system more generally to support and drive public health.

Before coming to the House, I worked in biomedical research. I had the great privilege of working at the Institute of Child Health, which is doing extraordinary work on the importance of pre and post-natal nutrition for long-term health outcomes. Extraordinary data are beginning to appear on the importance of early nutrition in determining our long-term health. As the Minister responsible for the National Institute for Health Research, as well as the whizzy high science of tomorrow’s technologies, I can say that we also have at the heart of the NHS a commitment to ensure, through the institute, that we are constantly using the power of our health system to drive public health and to promote best practice.

The Department of Health is working closely with our partners at UNICEF, the Royal College of Midwives, the Institute of Health Visiting, NHS England and Public Health England to co-ordinate our awareness messaging this week. This debate provides an invaluable opportunity for Members of Parliament to discuss these important issues.

It may help if I begin by setting out the Department’s view on breastfeeding in England, which is the only place for which I can speak. It is widely agreed that breastfeeding delivers significant health benefits for both the mother and her baby and is more cost-effective for mothers than other methods of infant feeding. A mother’s milk provides a perfect balance of nutrients and vitamins for the first six months of a child’s life. That is why the World Health Organisation and the Department of Health encourage exclusive breastfeeding for the first six months.

The Department is aware, however, that infant feeding choices are complex and personal, based as they are on individual and family circumstances. That is right. Not all mothers choose to or are able to breastfeed. In line with UNICEF’s Baby Friendly guidelines, all mothers should be supported to make informed decisions and to develop a close relationship with their babies soon after birth.

The evidence shows that, in addition to providing all the nutrients and vitamins that a baby needs, breast milk also protects him or her from infections and diseases. Breastfed babies are less likely to develop diarrhoea, vomiting and chest infections, leading to fewer hospital visits; and they are less likely to become obese both as children and in later life. Breastfeeding can also reduce the chances for some women of getting diseases such as breast or ovarian cancer later in life. The evidence and data also show that breastfeeding as soon as possible following birth helps to start the bonding process between a mother and her baby. We know that secure parent-child attachment results in better social and emotional wellbeing among children. Furthermore, evidence shows that that, in turn, has important implications in terms of life prospects for the infant.

I am pleased that the breastfeeding initiation rate in England has increased from about 62% in 2005-06 to 73.9% in the third quarter of 2014-15. The Office for National Statistics will publish the full-year figures in a couple of weeks. However, breastfeeding initiation rates vary widely across clinical commissioning group areas, from 43.9% in NHS South Sefton to 93.4% in NHS Lambeth.

While we understand that cultural differences exist in different areas, it is important that all new mothers receive the best quality of care no matter who they are or where they live. We encourage local commissioners and services to use their resources, and opportunities such as National Breastfeeding Week, to reduce such variations and increase overall breastfeeding rates.

Increased awareness of the health risks associated with not breastfeeding has brought about a drive in recent years to improve breastfeeding support and increase breastfeeding prevalence rates. Support and information is currently available to health professionals and parents through a range of channels such as the NHS Choices website under the Start4Life banner; the national breastfeeding helpline; the UNICEF UK Baby Friendly initiative; and local peer support programmes.

Parents-to-be and new mothers and fathers can also sign up to the Start4life information service for parents. Subscribers receive regular free emails, videos and text messages that offer high quality advice and information based on the stage of pregnancy and the age of the child. That service includes breastfeeding and signposts parents to other quality-assured information about parenting, relationship support and benefits advice.

In the past five years, I am delighted to say that we have recruited more than 2,100 more midwives into the NHS. We are training a further 6,400, who will provide women with the information, advice and support they need to breastfeed. In addition, appropriately trained and supervised maternity support workers play an important role in supporting women with breastfeeding and helping midwives to run parentcraft classes. In the past five years, 2,000 new health visitors have been recruited and we are on track to reach our target of 4,200 by the end of the year.

I will try to answer the important questions raised in the few minutes available; if I am beaten by the clock, perhaps I can write to hon. Members. The hon. Member for Glasgow Central mentioned the National Infant Feeding Network. In 2014, the Department of Health provided £30,000 to UNICEF UK to support the establishment of the network, which shares and promotes evidence-based practice on infant feeding and early childhood development to deliver optimum outcomes. It comprises 600 infant feeding specialists and supports 30,000 health professionals who, in turn, are responsible for caring for more than 650,000 mothers.

The network approached the Department for funding support in 2015. Unfortunately, its request could not be accommodated because it came in too late for the 2015-16 budget. However, we continue to work closely with the network co-ordinators on future funding.

The hon. Lady also raised the breastfeeding rights of women in the workplace. Specific health and safety requirements relating to new and expectant mothers at work are contained in regulations 16 to 18 of the Management of Health and Safety at Work Regulations 1999. A woman can ask her employer to provide a private, safe and healthy space to allow her to express milk and a fridge to store it in.

On the UNICEF UK Baby Friendly initiative, I repeat that we want to encourage more women to breastfeed. That is why we welcome the revised Baby Friendly standards that support feeding and relationship building. It is great to see that, across the UK, 91% of maternity services and 88% of health visiting services are working towards Baby Friendly accreditation. In the UK, 49% of maternity services, 51% of health visiting services, 37% of university midwifery courses and 9% of health visiting courses currently have full Baby Friendly accreditation.

On the infant feeding survey, I am happy to confirm that the Government’s policy is to improve outcomes for women and their babies. To do that, we need current information to inform policy and service delivery. The statistics that NHS England regularly gathers capture data from all women using NHS services, rather than from the periodic survey samples. From 2016, the maternity and children’s dataset will, for the first time, link a mother’s health and behaviours during pregnancy and post-natally to outcomes for herself. I will happily write with more details on that and on the issue of breast milk substitutes, since I am defeated by the clock.

[Mr Peter Bone (in the Chair)]

The Minister is certainly not defeated by the clock; it is at 5.44 pm that the debate will now finish.

[George Freeman]

Thank you, Mr Bone. I apologise; I was merely stretching my legs as I saw the clock hit the 5.30 button. I was not expecting the vote. I am delighted that I have more time to finish dealing with the two questions. There was an important question on breast milk substitutes.

For mothers who choose to use formula milk, it is important that measures are in place to protect babies’ health and that all the parents have the information they need to make the right choice. The Government provide advice for parents on maternal and infant nutrition via NHS Choices and the NHS Start4life information service.

The international code of marketing of breast milk substitutes is an international health policy framework to regulate the marketing of breast milk substitutes. In view of the vulnerability of babies in the early months of life and the risks involved in inappropriate feeding, the marketing of breast milk substitutes requires special treatment. Baby Friendly accreditation requires services to implement the requirements of the code, which goes further than UK law in regulating marketing activity. To meet the Baby Friendly standards, services must ensure that there is no promotion of breast milk substitutes, bottles, teats or dummies in any part of the facility or by any of the staff.

The Infant Formula and Follow-on Formula (England) Regulations 2007 are designed to ensure that all types of infant formulae meet the nutritional needs of babies, while ensuring that breastfeeding is not undermined by the advertising, marketing and promotion of such products. The regulations include strict controls on the promotion, labelling and composition of infant and follow-on formula and set out clear guidance for infant formula manufacturers on how the regulations should be implemented.

Finally, there was a question about the National Infant Feeding Network, which I think I have dealt with. If there are any other issues, I will happily respond by letter. I shall leave enough time for the hon. Member for Glasgow Central to close the debate.