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NHS Patients (Access to Medicines)

I thank the Secretary of State for early sight of the statement and join hon. Members in thanking Professor Mike Richards for his work in producing the report. The statement—albeit it a remarkable U-turn, albeit that it comes after pressure of a threatened judicial review and albeit that the Government seem to be fudging or drawing a distinction between what is proposed and the principle of top-ups—is none the less a welcome step. It is a complex area. There are understandable anxieties about the implications of moving in the direction outlined, but the bottom line is that we cannot justify a cruel and pernicious system that threatens to withdraw NHS care if a patient chooses to follow a clinician's advice in paying for a drug that is not available under the NHS. However, allowing top-ups must go hand in hand with reforms to ensure that access under the NHS is available to drugs that are routinely accessible in Europe but are not currently available in this country. On proposals to extend access, the Secretary of State's ambition is to achieve draft or final guidance within six months, but he will only achieve that for all drugs by 2010. Surely if it is only draft guidance within six months, there could be a further long delay in producing the final guidance. Why will it take so long to get to the six-month point, given that there is already a much faster system in Scotland? I know that the process there is different, but it usually ends up achieving the same verdict as we do in England only it does so much quicker. That the system is taking so long results in a great sense of unfairness in England. The Secretary of State said nothing about the need to reform the requirement of ministerial referral. Surely we should scrap that and allow NICE to make its own decisions. Surely, also, we should ensure that there is complete transparency of the modelling that NICE undertakes in reaching its decisions. The Secretary of State referred to the need for more flexibility in the evaluation of high-cost drugs. Will he consider widening the factors that NICE takes into account—the impact on carers and the potential to get an individual back to work—in assessing whether a drug is cost-effective? There is a key question for him: under the reforms, which drugs that have been rejected does he expect will become available? What analysis has he undertaken of that? He must have done some. Will appraisals be reopened on drugs that have recently been rejected by NICE? He said that the current rules would come to an end with immediate effect, but at the same time he announced a consultation on how those new rules will apply. What will happen in the meantime? The right hon. Gentleman said that treatment must be in a separate facility, but is that not inconsistent with good quality patient care and patient safety? Will he address that specific concern? With regard to the importance of local transparency in the decision-making process by primary care trusts, when will the Secretary of State announce those core principles, and will they take into account social factors—family circumstances—in determining whether a drug should be available? The statement contained nothing about the absolute importance of independent advice to patients on whether it is right to pay for an additional drug. It also said nothing about the potential need to regulate any market that might develop in dealing with very vulnerable people at a critical stage in their life. Finally, the right hon. Gentleman said nothing about addressing the potential conflict of interest for clinicians and the NHS in making these difficult judgments. Will he address those concerns as well in his response?