Merton and Sutton PCT (Prescribing Policy): 1st March 2013

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate and on rightly bringing this matter to the House’s attention. I hope that I can offer her, if not the answer to her question, a number of points and perhaps arrange some sort of meeting between her, the local PCT and all those involved in Mr Aziz’s care to establish why he is not receiving the treatment that he and Professor Madden believe he should have. The PCT should be held to account for why it has not provided that treatment. That really is where the problem, if it is a problem, and certainly where the responsibility lies.

The hon. Lady will know that PCTs have been around for some time. One of the reasons why the Government were so keen to introduce the Health and Social Care Act 2012 was to abolish PCTs and have exactly these sorts of commissioning decisions, which have frustrated so many Members on both sides of the Chamber, made by those best placed to make them: clinicians, effectively through GP-led clinical commissioning groups. As a result of the Act, those people will make such decisions in future.

The hon. Lady started her speech with a political point, so I will make a political point as well. We wanted to get rid of PCTs because too often they are overly bureaucratic and they are certainly not accountable. It was our desire to change that by taking the decisions away from bureaucrats and putting them back in the hands of clinicians. That was one of the fundamental underlying reasons why we were so keen to get the Act through this place and on to the statute book. Far from damaging the NHS, and far from denying patients medications and, perhaps most importantly, explanations, the Act will ensure that these types of problems no longer exist.

It is not for me, as Minister for Public Health, or through any other role that falls within my brief in the Department of Health, to make a case for or against the PCT’s decision. Its members will certainly receive a copy of the Hansard report of this debate so that they can read the hon. Lady’s remarks and mine. I understand that there is a chance that they may be watching this debate. If so, no doubt many of them will be hanging their heads in shame. If they are not, then frankly they should be, if the hon. Lady is accurate in her description. I think that she must be, because I too have a copy of the letter from the Sutton and Merton borough teams that she quoted. It seems that they have a profound problem somewhere in their system, because they clearly did not answer her letters or e-mails or respond to her telephone calls. She is the Member of Parliament. This is about her constituents and her local PCT, and if there is anybody they should respond to, it is the Member of Parliament. MPs are the people who come to this place to represent the people in their wards and absolutely to do what she has done, which is to advance the case of Mr Aziz.

For all I know, there may be a very good reason, not just financial but clinical, as to why this particular gentleman should not receive this particular drug—I know not. I know it sounds awful to say it, and I hate saying it, but it is not my job to know. It is not the job of a Minister to say that somebody should or should not receive a treatment. However, it is my job to make it ​absolutely clear that whoever someone is in the NHS, they should treat that person with care and compassion. That means that they should sit down with somebody like Mr Aziz and explain to him, or perhaps to his elected representative or his general practitioner, the good, solid reasons as to why or why not a particular decision has been made. It is absolutely vital for them to have the courtesy, never mind the care that we would hope for, to do that.

I admit that it might have been late in the day, but I specifically asked my officials to contact NHS South West London to obtain some sort of statement that I could present, because I do not want to do anybody any injustice—Mr Aziz or, indeed, the PCT. Unfortunately, the statement that I have is handwritten and I am having difficulty reading it, so I will not read it out. In fact, it does not tell me anything that I have not already been told.

It is important to explain that the National Institute for Health and Clinical Excellence provides the NHS with evidence-based guidance on the clinical effectiveness and cost-effectiveness of drugs and other technologies. NICE, as an independent body, makes the decisions on whether a particular drug has a clinical or cost-effectiveness basis on which it should be prescribed. Where treatments have been positively appraised by NICE, PCTs are legally obliged to provide funding for them. However, NICE has not issued any guidance to the NHS on the use of sildenafil nitrate for the treatment of pulmonary arterial hypertension. That is the problem. It is because NICE has not given that advice to the NHS that the treatment is at the discretion of the PCT and we are in difficult times. There were difficult times under the previous Administration. There always are, because we do not have a bottomless pot of money, and treatments—often brilliant treatments—increasingly cost huge amounts of money.

Siobhain McDonagh
On that precise point, Mr Aziz, who is here listening to this debate, said to me on the way in, “Siobhain, I have paid my taxes for 35 years. I do not want a drug that makes me look better—I want a drug that is going to save my life.”

Anna Soubry
I was coming to that in due course.

Apart from making these comments at the Dispatch Box, I cannot advance Mr Aziz’s case, because I do not know his case. I know what the hon. Lady has said, and I know that he has been through, to use these awful words, due process. His application has been considered. Having looked at what the PCT says in its letter, I can see that his case has been through all the sorts of processes that one would expect. I hope and pray that in the course of all that and through the various appeals that he has made, everything has been properly considered by the PCT.

It strikes me, however, that the most obvious thing that should have been done has not been done. Nobody seems to have sat Mr Aziz down—this is not the hon. Lady’s job, because she knows no more than I do—and explained things to him. If there is a good reason, he should be told. If it is about the money, we need to know exactly what the problem is. I suggest that those who may be listening, whether they be in this building or watching on television, should sit down with this man and discuss the way forward for his treatment. ​They should provide him with an explanation, because he is not just a human being—and it does not matter whether he is a good or a bad man—but one who is extremely ill with a life-threatening disease. Somebody needs to sit down and do a proper job on this, just like the hon. Lady has done in bringing the case to the House.

I despair—we should not have to be here, but we are. The emergence of the clinical commissioning groups will lead, I hope, to a far better system. They will make decisions based on their own knowledge and understanding as clinicians. They will also, in many ways, be far more accountable than primary care trusts have been. Every CCG will have a representative on the upper-tier local authority’s health and wellbeing board. The theory that generated the highly controversial legislation that went through this place is that it would be much better for decisions to be made at a more local and accountable level by those best placed to make them, namely health professionals.​

I fear that I have not been able to answer the question asked by the hon. Lady and Mr Aziz, whom I wish well, as we all do. I hope that, as a result of this debate, which the hon. Lady quite rightly called for, people will sit down and not only perhaps have a rethink, but certainly give a human being an explanation, if for no other reason than because, at the end of the day, he pays their wages. On those somewhat positive remarks, I hope that this matter might be concluded to everybody’s advantage.