Cancer Drugs

Lady Hermon Excerpts

Tuesday 20th October 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the availability of cancer drugs.

As the turnout this morning indicates, the subject of the debate is of concern to us all. There are more Members from Northern Ireland present than usual, but that may be an illustration of the concerns of our constituents across Northern Ireland on this matter.

I did some background research before I came down to the Chamber, and I discovered that in September 2013, the British Medical Journal asked:

“Which way now for the Cancer Drugs Fund?”

In July 2015, the Health Service Journal said:

“Cancer commissioning overhaul could save 30,000 lives”

and The Daily Telegraph on 4 September led with the headline:

“Thousands of cancer patients to be denied treatment”.

On 5 September, The Independent reported:

“NHS cuts to drugs fund mean thousands of cancer patients in England will be denied life-extending treatments”.

Finally, The Guardian stated on 23 September:

“UK NHS cancer patients denied drugs due to inflated prices”.

All those headlines highlight a clear problem when it comes to cancer drugs, which is of the utmost importance and which is, unfortunately, too close to home for many of us. There are many organisations that help those affected, but I would like to mention Macmillan Cancer Support, which is very much in my mind. The charity stated that 2.5 million people in the UK are living with cancer in 2015. The fact that that is slightly less than 5% of our total adult population indicates that this problem is enormous. It is hard to find anyone whose life has not been touched by this horrendous disease in some way.

My father, who passed away this year, had cancer on three occasions. He survived all three of them and lived to the ripe old age of 85, having first been diagnosed some 36 years ago. I have always said that the skill of the surgeons, the care of the nurses and the prayer of God’s people saved him on those three occasions. For many of us, cancer is not simply something that others talk about; it is something that affects each and every one of us.

My father is only one example. In my office every week, people come to me who are suffering from cancer. Some are also in the throes of benefits problems; very often, in addition to the trauma of health issues caused by their cancer, people have to deal with benefits difficulties. We have to work out how to get them into the benefits process and take the financial pressure off them at such a crucial time.

[Lady Hermon (North Down) (Ind)]

I congratulate the hon. Gentleman on securing the debate, which concerns the availability of cancer drugs throughout the UK, not simply in Northern Ireland; I am surprised that more Members are not present. Greater availability of off-patent drugs would help in the fight against cancer and reduce cost to the NHS. Will the hon. Gentleman support that call and the private Member’s Bill on the topic?

[Jim Shannon]

I thank the hon. Lady—my hon. Friend—for her contribution, and I am happy to add my support. Indeed, I attended a meeting of the all-party group on off-patent drugs last Thursday, and it is important that we support its campaign.

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[David Simpson (Upper Bann) (DUP)]

I congratulate my hon. Friend the Member for Strangford (Jim Shannon) on securing this debate. On a more humorous note, I heard him mention that he has never missed a debate that the Minister has participated in; I think we could safely say that he has not missed any debates in the past five or 10 years. He is a champion in his own constituency when it comes to cancer research and pushing for cancer drugs, and I congratulate him publicly today on his work and his effort.

I welcome the opportunity to participate in this debate. In recent days, our newspapers, TV screens and social media have been flooded with reports about cuts to cancer treatments. One of the latest reports I read indicated that 5,500 patients could miss out under the Government’s plan to reduce the availability of cancer drugs.

Today, cancer is a word that has become all too familiar in our households. As we come together to debate the availability of drugs, some 2 million people are battling cancer. They are husbands, wives, mothers, fathers, sons or daughters. The impact of cancer is much greater and much more widespread than it might appear if we consider only those who are statistically labelled.

Recently I had the opportunity to visit the state-of-the-art facilities at the Queen’s University Centre for Cancer Research and Cell Biology in Belfast. It is making fantastic headway in understanding cancer: how it is formed; how it develops; and ultimately how we can slow down its growth, and eradicate faulty genes and molecules in tumours. The centre was recently awarded almost £4 million to continue its work in research and in developing cancer treatments.

I am proud that Almac, a pharmaceutical company that is a world leader in cancer drug discovery, has its headquarters in my constituency of Upper Bann. Its founder, the late Sir Allen McClay, was so dedicated to improving patient care that he donated much of his wealth to the Centre for Cancer Research and Cell Biology. However, while all this work is going on and new drugs and treatments are being identified, we consistently hear reports that there are plans to remove life-prolonging drugs for various cancers, including breast cancer, prostate cancer and bowel cancer, to name just a few.

[Lady Hermon]

One of the greatest concerns is about the cost of these drugs. The hon. Gentleman said that one of the famous manufacturers of cancer drugs is based in his constituency. How often does he have the opportunity to meet people from that company? Would it be helpful for a cross-party delegation to meet the senior management of that company, to persuade them to reduce the cost of their drugs? I am sure that they could; where there is a will, a way will be found.

[David Simpson]

I welcome that intervention—the hon. Lady makes a very good point. If Sir Allen were alive today and witnessing the cuts in the availability of these life-prolonging drugs, which were once in the headlines as good news stories, he would come out with his old statement: “Bang your heads together and get a resolution to this.” It is a good idea to have such a delegation. I meet Almac staff on a regular basis. Almac is a pioneer in this sector; it is working with Government very closely; and I understand that the pricing of its drugs is not ridiculous.

However, I will make a parallel point. Well over a year and two months ago—perhaps more—it was announced at the Budget that the Health Minister would introduce funding so that a vaccine for meningitis B could be given to children. It took a year and two months—perhaps even more time—for that policy to be implemented, because the pharmaceutical companies were holding out for more money than the Government could afford to pay. They were asking ridiculous prices, because they had the sole remedy for a complaint, so could exploit that situation.

The message needs to go out to some of the pharmaceutical companies that we are dealing with life here. And as one hon. Member said earlier, even if there are only two or three months of life left, people want to hold on to that life as long as they possibly can, because where there is life there is hope, and hope is what people want to hold on to.

A number of weeks ago in this House, I attended an awareness day for secondary breast cancer, and I was shocked to learn that the Government do not keep data on people who are living with this incurable disease, which is remarkable. In the other House, Baroness Morgan of Drefelin has highlighted the issue: because the Government, the NHS and the pharmaceutical industry have again failed to agree realistic prices for new drugs, some women will die sooner than they should.

Bowel cancer is the fourth most common cancer in the United Kingdom. Experts say that around two thirds of those who seek NHS treatment for advanced bowel cancer treatment are likely to face an earlier death under the plans to scale back spending. That is wrong. Like many Members, I regularly meet—possibly on a weekly basis—constituents who are battling cancer or who have just been diagnosed with cancer. I recently met a family who told me of their agonising fate as their father had been diagnosed with lung cancer. Like many families, they have carried out their own extensive research and confirmed with their oncologist that there are drugs out there that could prolong his life. Millions of pounds have been spent on developing these drugs, which could perhaps either save people’s lives or prolong them. However, that family were told, “Sorry, but we can’t give it to him, because it’s just too expensive.”

Where do we draw the line when it comes to someone’s life and life expectancy, and the family who are left behind? I realise that the Government have very hard decisions to make. I appreciate that, but anyone in Westminster Hall today who has either suffered from cancer or known a family member or a loved one suffer from cancer would go to the ends of the earth to try to help them and to resolve this issue, because life is precious. As I say, the Government have hard decisions to make, but I do not think that anyone here today would or should put a price tag on a loved one’s life.

More needs to be done. Families living with cancer need all the help they can get, through the Government, through counselling, through drugs or through whatever help they can find. I trust that the Government will consider that when it comes to the funding of these drugs.

--- Later in debate ---

[George Freeman]

The hon. Gentleman makes an important point. I will be discussing the matter with the Minister for Universities and Science and the Medical Research Council. We need to make sure that we move to a more networked and collaborative model of science funding. Traditionally, we have tended to fund established centres of excellence, which is important, but we also need to make sure we build networks. Cancer networks in research and treatment have been incredibly powerful in driving the advances that we have discussed. He makes a very good point. I was delighted to see the leadership of the Queen’s centre recently recognised by Cancer Research UK with a £3.6 million grant.

I want to talk about the wider landscape of cancer treatment and then turn to the drugs question.

[Lady Hermon]

I am grateful to the Minister for allowing me to intervene on him before he moves on to a different point. I am pleased that Her Majesty’s Opposition have made it clear in the debate this morning that they are going to support the Off-patent Drugs Bill, a private Member’s Bill. It would be helpful to many MPs who have had emails from constituents, as I certainly have, to find out what the Government’s attitude is to the Off-patent Drugs Bill. I encourage the Minister to say, “Yes, the Government will support it,” although I do not want to put the exact words into his mouth.

[George Freeman]

I will come to that important point as I deal with some of the questions that have been raised.

On the wider issue of cancer treatment, I want to highlight the announcement that the Secretary of State recently made on setting out our cancer strategy and the work of the cancer taskforce. We have set out important measures on a wider treatment regime for cancer. By 2020, NHS patients will be given a definitive cancer diagnosis or the all-clear within 28 days of being referred by a GP. This will be underpinned by an extra £300 million a year by 2020. We are launching a new national training programme that will equip another 200 staff to develop the skills and expertise to carry out endoscopies by 2018. We have a commitment from NHS England to implement the independent cancer taskforce’s recommendations on molecular diagnostics. This will mean that around 25,000 additional people a year will have their cancers genetically tested to identify the most effective treatments.

I have been absolutely insistent since day one when we launched the genomics programme that this deep science project should be embedded in NHS England. Patient recruitment for the project comes through the 11 genomic medicine centres in NHS England, and NHS England is now developing an infrastructure for doing genomic and molecular diagnostics in the mainstream NHS. We want the NHS to be the first health service in the world to launch genomic medicine for all as part of our universal 21st-century offering. A lot of work is going on at the moment on how we build the infrastructure for molecular diagnostics.

Our aim is that, by 2020, everyone diagnosed with cancer will benefit from a tailored recovery package, individually designed to help each patient. We are also committed to empowering patients and giving them much more information, so that those who choose to do so will be able to access personal health information, such as their test results, diagnosis, treatment history and their cancer recovery package, online. By 2017, there will be a new national quality of life measure to help to monitor how well people live after their treatment has ended, enabling priorities for improvements to be identified. We will continue to work with NHS England, charities and patient groups to deliver those commitments. It is important to remember that as people live with cancer—hopefully, more people will live with it—we will need to invest in the support network for how they live with it, and how we continue to monitor and support them and deliver post-treatment care.

I want to emphasise the importance of the role of NICE. Nothing I am about to say in any way undermines our commitment to its independent role and expertise in guiding and supporting decision making on drug access with the latest evidence and health economic leadership. In no way do we want to undermine its position. NICE has led the world. That is a great tribute to it and to the UK’s system. We are clear that if a drug is recommended by NICE, the NHS is legally required to fund it. Over the years, many thousands of people in England have benefited from the cancer drugs that NICE has recommended. These include Herceptin, Yervoy, and Zytiga for prostate cancer.

Most recently, hon. Members will have seen that NICE published final guidance on 7 October that recommends Keytruda, or pembrolizumab, for the treatment of advanced melanoma, after disease progression with Yervoy. I urge NICE to embrace the new technologies. I will talk about that in a moment. I am particularly pleased to be able to announce that in the early access to medicine scheme, which we launched last year as the beginning of the new landscape and which I have asked my accelerated access review to look at beefing up and developing, the first drugs have come through. They have been fast-tracked.

I am delighted to confirm to the House that NHS England has now undertaken routinely to fund the use of NICE-recommended early-access-to-medicine products within 30 days of NICE guidance being published. Colleagues will know that the scheme was established so that an innovative drug may be designated a promising, innovative medicine, and if there is no alternative mainstream therapy, the treatment can be fast-tracked into patients, with their consent, and rapid assessment carried out. The link to NHS England commissioning had not been established, but it is now in place. I am delighted that the first drug has gone through that system, and we hope that more will follow.

[George Freeman]

The hon. Gentleman tees me up perfectly for the next section of my speech, because I want to deal with access to drugs and the Cancer Drugs Fund. We all recognise, not least the Prime Minister, that access to drugs is essential in this landscape, which is why he personally led the launch of the Cancer Drugs Fund—I thank the shadow Minister for paying tribute to that leadership. We have now committed just over £1 billion to the Cancer Drugs Fund—a substantial investment—and just under 80,000 patients have benefited from treatments that otherwise would not have been approved. They are largely treatments that NICE has turned down and the Cancer Drugs Fund has then stepped in to fund.

Because of the cancer field’s leadership in this new model of drug discovery, the rate of new drugs coming through is increasing and going to a targeted patient base. The smaller patient catchment for which industry must recover costs has driven it to raise prices and costs. In many ways, it has challenged NICE’s traditional £30,000 per quality-adjusted life-year model. It is driving huge pressure on our traditional model of health-economic reimbursement.

As Members have said, and as the National Audit Office report recently highlighted, the CDF was originally established as an interim measure to ensure that cancer patients were not denied drugs while we fixed the landscape. Although I have been in post only 15 months, I hope colleagues can see that the reviews of accelerated access and the CDF are not accidentally aligned. We are currently looking at how we make sure we support access to innovative medicines. Where cancer has led, other therapeutic areas will follow.

The genomic and informatics revolution will require NICE to change how it works. The explosion of progress in this field is what has put so much pressure on the CDF. Ever more treatments are coming online, but NICE is turning down ever more treatments on very well respected health-economic grounds. Those are difficult judgments about what represents health-economic value for the system and for patients. The CDF does not have a built-in discounting mechanism: it effectively takes the price on the basis of which NICE has rejected the drug and agrees to pay it. We want to look at whether we might use our extraordinary purchasing power to use the fund in a more productive way to get earlier access and, in return, discounts. That is what the accelerated access review is all about.

It is important to confirm that if NHS England decides to de-list a drug, any patients who have received a drug through the cancer drugs fund will continue to receive it. Where patients, particularly those with rarer cancers, are unhappy with a recommendation to de-list and their clinicians advise it, they can initiate individual cancer funding requests, an important avenue that many patients are successfully using.

I want to discuss the accelerated access review and respond to some of the questions that have been asked. I launched the review this time last year, asking and challenging the system to answer three big questions. Given the NHS’s extraordinary position as a universal, single-payer health system with leadership in genomics and informatics, the review is about asking what we can do to accelerate how we get innovation to patients. I have asked three specific questions. First, what can we do to shorten the time, cost and risk of getting innovation to that all-important moment of first use in patients? How can we make things quicker both for the patients who need it and for researchers, so that they can get those all-important human clinical data?

Secondly, what can we do to help NICE to embrace new flexibilities and pathways and to use genomics and informatics to update its systems, in order to deal with the issues raised by a number of colleagues relating to the end of the one-size-fits-all blockbuster model so that, in the 21st century, NICE has more tools at its disposal and more adaptive pathways—to use the jargon—to open up those flexibilities?

Thirdly, I have asked the accelerated access review to look at what barriers we can knock over and what incentives we can put in place to speed up the roll-out of innovative drugs and device diagnostics across the system. Unfortunately, there is great variation in the pace at which innovation is rolled out. In many ways, the CDF has pioneered on the very problems with which the system is now confronted. I am convinced that the CDF will be part of the solution. I cannot prejudice NHS England’s consultation, but I can reassure Members that, through the accelerated access review and the comprehensive spending review, we are looking at what we might be able to do to ensure that our commitment to funding innovative cancer medicines through the CDF also supports the broader landscape for innovative medicines. We will have to wait to hear the detail in the comprehensive spending review and subsequent announcements at the end of the consultation.

I want to deal quickly with one or two of the points made in the debate. The hon. Member for Upper Bann (David Simpson) made an important point about the different parts of the United Kingdom co-operating. As the UK Minister for Life Sciences, I am very conscious of leadership in Scotland, Wales and Northern Ireland, and would be interested to follow up on his point about using the broader network.

The hon. Member for Scunthorpe (Nic Dakin) asked me about NICE looking at exceptional circumstances. The accelerated access review is looking at whether we can give NICE more freedoms and flexibilities. The hon. Member for Motherwell and Wishaw (Marion Fellows) made an important point about the Scottish model—the innovative medicines fund there, the Scottish Medicines Consortium and the importance of patient voice, of which I am very conscious. She also discussed health inequalities, which are important.

Various colleagues asked about Abraxane. NICE is in the process of developing guidance on Abraxane for pancreatic cancer, which it expects to publish very shortly. The hon. Member for Strangford made an important point about data. We recognise that we need to be much better at gathering and using the data from the CDF. A data-sharing agreement between NHS England and Public Health England was signed in July.

In closing, I thank the shadow Minister for his support for the cancer drugs fund. We are intent on it remaining focused on access to drugs; we are tackling the wider treatment regime through the cancer strategy I have set out.

[Lady Hermon]

rose—

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[Jim Shannon]

Thank you for chairing the debate, Mr Hollobone. I thank all right hon. and hon. Members who participated. A vast array of excellent knowledge was on display today from those who gave speeches and made interventions. Some great ideas were put forward, particularly that of the hon. Member for Foyle (Mark Durkan) about combined purchasing power. The Minister and shadow Minister were both on to that; it is something we can use better to develop the existing innovative drugs policies across the whole United Kingdom. I draw particular attention to the advances being made at Queen’s University Belfast, which we should combine with progress in the rest of the United Kingdom.

The contributions from each and every Member were valuable, detailed, informative and compassionate. It is important that we put on the record our thanks to the charities and other contributors. We are all moved by the e-petitions, which show that there is clearly a deep interest in the best way to fund cancer drugs. We have tried to ensure that patients at their weakest are the focus of the debate. I thank the Minister for his comprehensive reply. We look forward to helping our constituents across the whole United Kingdom of Great Britain and Northern Ireland.

[Lady Hermon]

rose—

[Mr Philip Hollobone (in the Chair)]

Order. I encourage Lady Hermon to grab the Minister and the hon. Member for Strangford (Jim Shannon) on the way out.

Question put and agreed to.

Resolved,

That this House has considered the availability of cancer drugs.