Examination of Witnesses (Questions 560
WEDNESDAY 6 MARCH 2002
HEATH OBE AND
560. I have one question, it is probably totally
unrelated to anything, it is something that has been niggling
away, really, frequently we see statements, I quote one here,
it says, "we estimate that NICE'S work on drugs to treat
breast and ovarian cancer is already benefiting about 9,000 women
at a cost to the NHS of 30 million", that was dated February
this year. When you say 9,000 women are already benefiting, it
is not clear how that figure has been arrived at. How is that
figure arrived at? Does that figure include the 4,000 patients
who were, perhaps, already benefiting before the guidelines were
produced and does that mean, in effect, only 5,000 extra are benefiting?
To produce these figures and come up with these sums you have
to have an idea of what was going on before. What is not clear
to me is what work is done to assess drug usage before NICE and
after NICE and, again, how transparent that process is? It would
be interesting in the future if that information could be available
and broken down on a geographic basis so that we can more accurately
monitor whether, in fact, the post code prescribing, which everyone
is so keen to get rid of, has been achieved?
(Lord Hunt of Kings Heath) I will ask Mr McKeon to
answer the details of that.
(Mr McKeon) The 9,000 women would be the total expected
number who would be treated by that particular drug, it would,
therefore, include some who had been already been treated. We
try to make estimates of overall usage, particularly if there
is the drug has been on the market for some time, as, in fact,
Herceptin had been on the market for some time. It was included
in NICE's own appraisal document, and what the total of the additional
cost would be for the NHS. Clearly where it is a new drug, perhaps
a new drug near to launch, where there would not be any current
use, I think we had an earlier discussion about the information
that we have available and the way in which we seek to monitor
the implementation of the NICE recommendations particularly in
this area and in other drugs. Our information on hospitals prescribing
is relatively important, which we are seeking to rectify. Having
done that we will be able to give a better geographic breakdown
(Lord Hunt of Kings Heath) The other thing I would
add is, we have asked the Commission for Health Improvement when
they undertake their regular review to pick up the issue to make
sure guidance is implemented.
561. What are the Government's plans for the
Council for Quality in Health Care?
(Lord Hunt of Kings Heath) As you know, we have got
a number of national agencies concerned with quality. It is going
to have a co-ordinating role to make sure people talk to each
other, that there is consistency of approach, that there is no
562. How will we know you are talking to each
other? How will that come out into the public domain that you
are talking to each other?
(Lord Hunt of Kings Heath) You will see it in the
quality of the work that these various national organisations
563. How will it be, most importantly, accountable
(Lord Hunt of Kings Heath) The Council will obviously
be responsible for meeting with these different organisations.
I have no doubt it will publish reports from time to time and
it may well report. That is way it will come out into the public
564. That does not sound as if it is going to
be accountable to Parliament, does it, Lord Hunt?
(Lord Hunt of Kings Heath) It is accountable to Ministers
and Ministers are accountable to Parliament.
Chairman: Who are accountable to you, Mr Amess.
565. Do you accept that the National Institute
for Clinical Excellence has to refer to a de facto threshold
(Lord Hunt of Kings Heath) We have discussed that.
I think it has been made clear that it is a guideline and if you
go above a certain QALY figure then that is a question for serious
consideration but it is not a de facto absolute limit.
Chairman: Are there any further questions? If
not, Minister, Mr McKeon, thank you very much for your attendance.
We are very grateful for your co-operation.