| National Institute for Clinical Excellence (Establishment and and Constitution) Order 1999
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The Minister of State, Department of Health (Mr. John Denham): I am grateful to the hon. Member for Oxford, West and Abingdon for giving half a cheer for our proposals. He is slightly less enthusiastic than the royal colleges, the other 52 professional bodies that supported our approach to the National Institute for Clinical Excellence, 37 community health councils and other patient groups. The response of those in the front line is somewhat warmer than anything I have heard this afternoon. I congratulate the hon. Member for Runnymede and Weybridge on his perceptiveness: the Act should be dated 1977, not 1997. The remainder of his speech was less acutely focused, but on that point he was absolutely correct. A correction slip may be required if the regulation has to be amended. I hope that that will not prevent us discussing the important issues raised today. The hon. Member for Runnymede and Weybridge was right about the Government's commitment to modernise public services. It is important that we leave behind the many years of neglect; we want to ensure that public services are equipped for the 21st century. That commitment extends to modernising the national health service, and ensuring that high quality services are available to all patients, wherever they live. Our commitment is to tackling problems head on, and to improving the standards of quality of NHS care for all patients, throughout the country. I do not accept that our saying that we need to make the best use of resources immediately justifies the claim that we are talking about rationing. It is self-evident that part of the process of modernising the NHS will be to make the most effective use of our resources. Many have commented on the fact that some treatments are available in one area but not another—so-called postcode prescribing. If we wish the NHS to make the best use of the resources provided for health care, it is important that every part of the service should have clear guidance about the clinical effectiveness and the cost-effectiveness of treatment. We are establishing NICE because we want to ensure that the NHS provides the best possible care with the available resources. Mr. Hammond: The Minister referred to the present geographical inequalities in the availability of various treatments. Will he assure the Committee that the process will be one of levelling up, and that we shall not discover that the imposition of uniformity will result in treatments that are currently available in some areas and not in others becoming unavailable in any area? Mr. Denham: We shall be ensuring that a consistent body of advice and guidance is available throughout the NHS. At the moment, individual bodies, often health authorities, are making decisions and drawing on advice from a disparate set of sources that do not necessarily hang together, and which have not necessarily been assessed on the same basis. Providing a consistent body of guidance will give those working in the NHS a consistent set of tools with which to make judgments. We believe that patients have the right to expect the NHS to take full account of best practice, based on advances in medical research, and we want to support health professionals by enabling them to know which treatments are most clinically effective and cost-effective. The institute will play a central role in the achievement of three core components of the plan to modernise the NHS. First, NICE will promote innovation and quality in the NHS—a fact that has not yet been mentioned. It will identify those developments that have the greatest potential to improve patient care, and it will help spread those new treatments across the NHS much more quickly than before. New treatments for common diseases have been developed—for example, clot-busting drugs or curing ulcers without surgery—yet, all too often, it has taken months, years or even decades for those treatments to be used throughout the NHS. If NICE can bring that sort of knowledge to our front-line NHS staff more quickly, it would be a great step forward. Secondly, NICE is essential for our plans for fair and equal treatment of patients within a health service that is truly national. Internal markets and postcodes were never an acceptable way to run a health service. NICE guidelines will provide a common effectiveness foundation for the NHS. It will inform and assist those making decisions about care—nationally and locally. Mr. Hammond: I shall try once more, as the Minister has raised the subject again. Is it possible, as a result of that process, that treatments that are currently available in some areas will no longer be available? Mr. Denham: A thorough scientific appraisal of the best available evidence should be undertaken. For instance, it may be found that a treatment simply did not work, or that a pharmaceutical, although not positively dangerous, should be available and licensed. Clinical judgment clearly has to be exercised by individual clinicians about individual patients, but if the solid body of evidence was overwhelmingly clear that a pharmaceutical simply did not work, we would expect to see that reflected in the pattern of treatment offered by the NHS. Except in special cases, I am sure that the hon. Gentleman would not expect the NHS or individual clinicians to carry on with a treatment or procedure that did not work and brought no benefit to patients. Mr. Hammond: The point is that NICE will have to consider whether a treatment is clinically effective and cost-effective. Obviously, I concur with the Minister that it would be appropriate to withdraw treatments that were found to be clinically ineffective. Is the Minister ruling out the possibility that a treatment that was currently available in one area would cease to be available in that area if it was found not to be cost-effective? Mr. Denham: Although we are talking about individual cases, health authorities will need to consider and reflect, and decide how to act upon guidance that is issued by NICE. Beyond that, it makes no sense to hypothesise. The hon. Gentleman asked me earlier about the impact of NICE guidance, and I think that I answered him fully—but perhaps not as he expected. Mr. Geoffrey Clifton-Brown (Cotswold): The Minister said that if a drug clearly did not work, he would expect the guidelines to rule it out. Would he expect the guidelines to rule it out on cost? For instance, taxol is an extremely expensive treatment for ovarian cancer that is currently available in some areas but not others. It is a beneficial treatment for a few patients, and it could give them an extra lease of life. Could we expect NICE to rule it out? Mr. Denham: I think that taxol is a good example. The NHS would welcome a consistent body of advice on such drugs. At the moment, differing decisions are being taken in different places. Although we can never ensure absolute uniformity, one of the great advantages of NICE for the NHS will be a consistent body of advice against which decisions can be made. It would be wrong for me to anticipate the outcome of any named procedure, although many advocate the benefits of taxol. Sir David Madel (South-West Bedfordshire): Following on from that, can we therefore expect a more even distribution of beta interferon? Mr. Denham: It is probably unhelpful to speculate about any specific procedure; I do not have the scientific information to do so. Beta interferon has been approved for various conditions. Without the brief in front of me, it would be inappropriate to go into detail, but the hon. Gentleman will be aware that a recent approval has been given for a new set of conditions, including multiple sclerosis. At present, health authorities find themselves pretty much left to their own devices to make their own assessments and appraisals, possibly with support from regional level. NICE has not yet determined its programme, but the Committee should recognise that the ability to appraise such new procedures and to give consistent advice will improve the quality of decision making in the NHS. That is precisely what NICE has set out to do. It would not be sensible for me to attempt to speculate about the likely outcome for those or any of the other new pharmaceuticals of which we have read but which have not yet come on to the market. Dr. Harris: I agree with the Minister that referring to individual cases does not take the debate forward. However, I hope that he will accept the point that I made earlier. If NICE decides that it is not cost-effective to use taxol for certain groups of patients, the Minister should be associated with that decision. People could then understand that such decisions are taken because the NHS has only a certain amount of funding. If levelling up takes place—we hope it will, because that is where the problems lie—it will mean that resources must be taken from other treatments, because health authorities have only a fixed amount of money. It is worrying that no funds will be left for the last treatments that are appraised because the money will be used to level up all the other treatments. That problem must be recognised. The Chairman: Order. Hon. Members should keep their interventions short. They will have the opportunity to say what they want during their speeches. No one wants to curtail debate, but interventions should be short. Mr. Denham: The resources that are available to the NHS remain the responsibility of the Government. We are not franchising to NICE decisions about the level of resources in NHS. That has always been a matter for ministerial decision and of political accountability in elections. Mr. Clifton-Brown: Before the Minister moves on, I want to raise an important issue that is debated in my constituency. How do the proposals square with a GP's Hippocratic oath of having the freedom to prescribe? If he deems that a drug should be prescribed in certain case but protocols and NICE prevent him from doing so, how does the patient stand?
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| ©Parliamentary copyright 1999 | Prepared 11 March 1999 |
