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NHS Patients (Access to Medicines)

With permission, Mr. Speaker, I should like to make a statement about Professor Mike Richards's review of current policy concerning NHS patients who wish to pay for additional private drugs. I start by paying tribute to Professor Richards and his review team for the diligence with which they have conducted this review. The report is informed by evidence from thousands of patients, carers and clinicians across the country, and it was completed with necessary urgency but without in any way compromising its thoroughness. The time scales that I set were deliberately challenging, because this issue is causing great concern and distress to a number of patients and their families. The review's terms of reference were to examine current policy relating to patients who choose to pay privately for drugs that are recommended by their clinician but not funded by the NHS and who, as a result, are required to pay for the NHS care that they would otherwise have received free of charge. I also asked Professor Richards to make recommendations on whether policy or guidance could be clarified or improved. Professor Richards quickly identified the underlying causes of the problem. His review starts from the fundamental principle that the NHS provides a universal and comprehensive service to all its patients, free at the point of need. During the Second Reading of the NHS Bill in 1946, Nye Bevan described the financial anxiety endured by people seeking medical help as the ““first evil”” that the NHS must vanquish. Yet Professor Richards's report shows that access to certain treatments on the NHS, particularly drugs for the terminally ill, is inconsistent, and as a result a very small number of patients feel that they have to pay for additional treatment and are worried that in doing so they will jeopardise their entitlement to NHS care. His report makes recommendations not only to revise the guidance for those exceptional and rare circumstances, but to improve access to certain drugs on the NHS, reducing the need for such patients to resort to private care. His recommendations are accompanied by proposals put forward by Professor Sir Michael Rawlins, chair of the National Institute for Health and Clinical Excellence, to employ greater flexibility in the appraisal of certain treatments, specifically those relating to drugs for the terminally ill. I accept Professor Richards's recommendations in full and today I can announce two immediate developments to make drugs more available on the NHS to those who could benefit from them. Since it was established in 1999, NICE has ensured not only that many thousands of patients benefit from access to the latest treatments, but that the taxpayer gets value for money. NICE provides wholly independent and scientifically rigorous assessments of the latest medicines and treatments and is widely admired across the world for its work. Its guidance on drugs and treatments is internationally respected, and many other countries are adopting similar models. The price of the drugs that NICE assesses is a matter for the manufacturers, but I can confirm that I am working closely with the pharmaceutical industry on new and more flexible pricing arrangements that will increase patients' access to new drugs. Those arrangements will include enabling drug companies to supply drugs to the NHS at lower initial prices, with the option of higher prices if value is proven at a later date. The new arrangements will also build on patient access schemes already developed for particular drugs. That will help to ensure that patients can access medicines that would not otherwise have been deemed cost-effective by NICE. I expect to be able to say more about that soon. In addition, NICE has for some time been concerned about its ability to take into account the premium that society places on helping those with terminal illnesses. Professor Sir Michael Rawlins has written to me to outline a new, more flexible approach to the appraisal process in order to address those concerns. NICE proposes to introduce more flexibility in the evaluation of higher-cost drugs, which have been shown to extend the lives of terminally ill patients, and where the less common nature of a particular condition may mean that the more flexible pricing arrangements we are discussing with the industry are not in themselves sufficient. The proposal will be implemented immediately while NICE holds a full consultation Those two measures will ensure that more treatments, which in the past patients may only have been able to access privately, will be available free on the NHS. The work of NICE is necessarily complex, but as we highlighted in the cancer reform strategy, it sometimes takes too long. Its appraisal guidance has often not been available for two years or more after a drug has been licensed. Steps have already been taken to address that, with, for example, fast-track procedures to appraise automatically significant new cancer drugs, but the time it takes NICE to publish guidance can lead to significant local variation. In response to Professor Richards's report, I am today setting out a new timetable to speed up the appraisal process for all drugs evaluated by NICE. In 2009, draft or final guidance will be available within six months of licensing for about half of the drugs that are being appraised through the fast-track single technology appraisal programme. In 2010, draft or final guidance for all new cancer drugs will be available within six months, on average, of a drug being licensed. We will work with NICE to explore further ways of speeding up the appraisal process with the intention of announcing the outcome of our work early in the new year. All of those measures will dramatically reduce the instances where a drug is available on the market but primary care trusts have no guidance from NICE on which to base their decisions about funding. However, we cannot totally eliminate instances of primary care trusts having to make decisions in the absence of NICE guidance. Professor Richards has found that patients and professionals are often unclear about who takes such decisions or how they make them. Patients and their families are often left bewildered about why a particular treatment has been denied, despite what they see as a clear clinical need. As we highlighted in the NHS constitution, we need to do more to improve the quality and consistency of the decisions, especially in any interim period before NICE's guidance is released. We will therefore publish a set of core principles to inform the way in which primary care trusts make decisions about funding new drugs. It is essential that the process, as well as the decisions, is clear and accessible to patients and the public so that, if a patient is denied access to a particular treatment, the reasoning behind the decision is transparent and consistent. We will publish detailed good practice guidance for primary care trusts about the processes that they should have in place to make decisions about funding new drugs and handling exceptional cases. Better local decision making, a faster appraisal process, fairer pricing and greater flexibility in evaluating certain treatments will address the main issues that have fuelled the demand from some patients for additional private treatment. However, it would be unreasonable to expect the NHS to fund every single new treatment, and we cannot guarantee that we will completely eradicate the circumstances in which a small minority of patients wish to pay for a drug that the NHS does not provide. The vast majority of people to whom Professor Richards spoke during his review thought that, in such circumstances, it would be wrong to take away a patient's entitlement to NHS care because they had purchased additional treatment privately. Professor Richards recommends that that practice should end and I agree. It will end with immediate effect. However, Professor Richards is also clear that there must be tight controls to prevent the NHS from becoming a two-tier system. Today, we will publish draft revised guidance, to take immediate effect, to ensure that the NHS is clear about how to deal with the rare occasions—which, with the implementation of the proposals already mentioned will be even rarer—when patients opt to fund additional drugs privately. The guidance will make it clear that NHS care should never be withdrawn and that administering private care should take place separately from NHS care to ensure that NHS funds are never used to subsidise private care. In short, there is no question of patients who can pay more being able to access a different and higher level of NHS treatment, but neither should any patient who has at some point paid for private treatment lose their entitlement to NHS care. Today's draft guidance sets out that, in such circumstances, private treatment should be provided in a private facility so that it is always clear whether a particular treatment is NHS or private. That removes any confusion about what constitutes a single visit or single episode of care. It will also remove any question of a two-tier system, whereby those who pay for additional care have their private care subsidised by the NHS. The NHS must, by definition, continually evolve and improve to fulfil rising expectations and offer the latest advances in medical care to all our citizens, irrespective of wealth, class, ethnicity or disability. The debate has been critically important to the NHS and the values that underpin it. I believe that the measures that I outlined today will, in enabling the NHS to exercise its natural compassion, help secure those values for the future. We are fortunate in Britain to have a health system that provides a comprehensive service for all patients, based on clinical need, with public funds for health care devoted solely to the benefit of the people it serves. The report by Professor Richards enhances those principles and I commend the statement to the House.