In my previous blog I mentioned that this week the States
was to debate 3 cannabis related propositions. The outcome was predicable but
it was the quality of the debate that was disappointing.
States Members have the ability of lodging propositions seeking
States approval on a variety of issues. There are many Members who never do but
fortunately there are a handful like Deputy Monty Tadier who do and he is to be
complimented for lodging the 3 propositions which sought to improve the lives
of those who through no fault of their own suffer pain and discomfort.
One of the propositions (P127) which can also be read below
requested the Health Minister to take steps to make Sativex Spray available
without cost to MS patients. The other 2 propositions were much more contentious
because Deputy Tadier was seeking support to allow for cannabis to be
prescribed for medicinal purposes.
Deputy Tadier decided to debate the Sativex Spray proposition
first as it was relatively straight forward and I shall devote this blog to that
matter. I will declare an interest because my wife has MS and when asked if she
would be the petitioner to represent other MS sufferers she readily agreed.
Before Backbencher’s propositions are debated the relevant
Minister normally lodges “Comments” indicating whether the proposition is
supported, if it is not, reasons are given. Deputy Tadier lodged his
proposition on 16th July. The Comments which are below were
published on 8th September however the debate was deferred due to
the impending elections. It should be noted that after the elections there was
a change of Minister. However the new Minister Senator Green did not lodge his Comments until the 8th of December which was the day before the debate but his comments differed from the previous Ministers.
Both Ministers opposed the proposition but it worth noting
their reasons. The previous Minister Deputy Anne Pryke’s Comments could be
summarised as follows.
Sativex can
be supplied by any pharmacy, in accordance with the doctor’s prescription. It
is, however, only available as a private prescription and costs have to be met
by the patient.
Previous
application from a consultant to make Sativex available via the Hospital pharmacy
– in that case specifically for patients suffering with MS (Multiple Sclerosis)
– has been rejected by the Hospital Drugs and Therapeutics Committee, based on
assessment of clinical evidence and cost-effectiveness.
This
decision has recently been corroborated by NICE in its
draft revised guidance which does not recommend the use of Sativex for MS
patients.
Current
Health and Social Services Policy directs that the Department will not provide
treatments at public expense where NICE has
rejected that treatment. Final NICE guidance on
recommended treatments is expected later this year and, should the advice on
the use of Sativex for MS patients be amended, this position will be reviewed.
The issue
within this proposition, therefore, is whether funding for a NICE non -recommended
treatment should be met by taxpayers, at the expense of other treatments that are
approved by professional, clinical expertise. The cost to the taxpayer of
providing Sativex to any one individual patient would be in the region of
£4–£5,000 per year.
There is no
way to predict how many patients may subsequently be prescribed this treatment and,
therefore, the potential overall impact on the Department’s already stretched
annual drugs budget.
While it is
available for prescription, Sativex remains a non-NICE approved
treatment, and I cannot support a proposition for its supply to be funded by
the taxpayer.
It is evident that the previous Minister could not
support the proposition, because Sativex is not recommended by NICE , it is expensive even though Health does know how many people might need
it but the Hospital Drugs and Therapeutics Committee, has already rejected the
one application from a consultant based on assessment of clinical evidence and
cost-effectiveness.
One is left to wonder whether the officer briefing
Senator Green was the same who briefed the former Minister because it was not
the information conveyed by Senator Green to States Members on Tuesday and
confirmed by email to me.
Three weeks before the debate I wrote to Senator Green with
a number of queries, unfortunately his answer below which was the information
he gave to States Members was not sent to me until a couple of minutes after
the vote had been taken. The following is an extract.
I am mindful that,
ordinarily, Sativex is only available on private prescription. However, there
is an existing mechanism in place for a
recognised Consultant in an appropriate specialism, to make a request for
public funding of such a treatment on behalf of a specific individual.
The treatment of
patients must always be based on clinical assessment and professional
expertise. But where clinical
judgement can demonstrate that there are exceptional circumstances in an
individual case, which would support the prescribing of this licensed product,
a special request can be made for the cost of treatment to be met through
public funding. To date, no application has been for exceptional consideration
in such circumstances has been received. For these reasons, Monty’s petition
is, to all intents and purposes, redundant and that’s why I do not intend support
it.
Although the former Minister said there had been an unsuccessful
application Senator Green says there have been none. If there have been none it
would not be surprising because I doubt whether GP’s or their patients are
aware of what appears to be a policy change introduced by Senator Green. I can
confirm that my wife and her MS circle of friends are not aware of the policy
change but know full well that if recommendations have to go via a consultant the
whole process could take many frustrating months.
I mentioned above that the quality of the debate was
disappointing and that was because apart from Deputy Tadier who proposed the
proposition and the Minister responding the only other Member to speak was the
newly elected Senator Dr Zoe Cameron who had
made it known that she had been elected to try to get the health service fit
for the future.
She had featured in the
Jersey Evening Post that day in which she had expressed her dissatisfaction
with politics mainly because she had not been given the Health Minister or even
the Assistant Minister’s post. However on Tuesday she had the ideal platform to
speak about the plight of MS patients, the merits of Sativex and informing
Members whether she was aware that it was available albeit via the Consultant
route. Also had she contacted Chemists she could have informed Members that the
cost of Sativex in Jersey would be around £3000 and not the 4/5k as quoted in
the Comments.
It is estimated that possibly
one person in a thousand may have Multiple Sclerosis (MS). As there are around 100,000
residents in Jersey there could be around 100 people with MS who have
various stages of the disease. Sativex is primarily to relieve spasticity which
can be a problem for some people with MS. Although the number of people who
would benefit from Sativex is unknown it is likely to be only a small
percentage of 100. The reason why not exact figure can be given is because
Sativex has only been available to those who can afford to purchase it.
Sadly it is evident that
Senator Cameron did not pick up on the contradictions in the former Ministers
Comments and the current Ministers speech. She had an opportunity of informing
Members of how the current system is not working but failed to do so. Her short
uninspiring speech added nothing to the debate, it was hardly the stuff of a
potential Minister and she was one of the 29 Members who voted against the
proposition.
The debate lasted less than
20 minutes and Deputy Tadier’s proposition received 16 votes which were around
the same number he received for his other propositions. He might not have won
the vote but he shook some branches in relation to the issue of Sativex because
not withstanding the previous Minister’s Comments the current Minister says
that Sativex can be freely prescribed if supported by a GP and Consultant.
I have written to Senator
Green asking what steps he is taking to ensure that MS patients and their GP’s
are informed of his policy.
Readers might find this blog posted by Tony the Prof to be of interest---Please click here
Readers might find this blog posted by Tony the Prof to be of interest---Please click here
