NHS: Anti-obesity Medication

Question

Asked by

To ask His Majesty’s Government what steps they are taking to ensure that the prescription of new anti-obesity medication by the NHS is cost effective.

I recognise my noble friend’s interest in this issue. The National Institute for Health and Care Excellence—NICE—makes recommendations on whether new medicines, including obesity medicines, should be routinely funded by the NHS in England, based on an assessment of their costs and benefits. The NICE process ensures that new medicines do not displace funding for other, more effective treatments and services. The NHS in England is required to fund NICE-recommended treatments, usually within three months of the final guidance.

My Lords, I welcome my noble friend to the Front Bench and wish him well—especially if he is going to give some good replies to my questions too. My concern is the potential cost of the new drugs to the NHS, which could be crippling. Secondly, my concern is about youngsters who have type 2 diabetes. I foresee the possibility that these drugs could be prescribed to children and teenagers. That is a great worry for all of us—to see people self-administering in that way.

There are alternatives and there are cheaper alternatives. It behoves us to explore all of those before we start embarking on massive expenditure programmes. Could I get an assurance from my Minister that we are doing everything that we can with the private sector—the producers of food and drink—to ensure that we reduce the amount of sugar, particularly, and that we seek reformulation of food and drink, which will be much cheaper than spending a lot of money on an alternative new drug?

I am very grateful to the noble Lord. Of course, I will always give him the answers that he seeks. He touches on a lot of issues there—his question alone is probably worth a QSD. However, touching on one or two, the whole reason for the existence of NICE is to examine value for money for the taxpayer and effectiveness. Drugs are not approved and licensed simply for the sake of it, and certainly are not doled out by the NHS for the same reason. There is a range of measures in place. The weight-management services, which are available across the country, extend from the most basic end, using an NHS app, through a range of services and across a range of agencies through to surgery and the use of drugs. When he touches on the use of drugs by children, I think what he is talking about is not so much the drugs that are prescribed but children getting access potentially to the online world and getting online drugs that are not prescribed—which is a whole different issue.

Is the Minister aware of the reported deaths from semaglutide in the UK, according to the Yellow Card advisory service, and is he further aware that there are very many complications from these anti-obesity drugs, including nausea, vomiting, constipation and many other unpleasant symptoms. Is it not time to be rather more cautious before we prescribe these drugs?

I recognise the noble Lord’s distinguished history, and again he touches on a range of issues. I will say just a couple of things. The idea that the drugs are licensed and prescribed in a trivial way is wide of the mark. The process that is overseen by NICE and the MHRA is very rigorous; it is one of the most rigorous processes in the world and it is internationally recognised as such. As for prescribing, of course that is up to the individual physician, GP or hospital service, and I do not believe that, in the vast majority of cases, GPs or other medics would prescribe drugs on the basis of a sort of trivial view of these things. As to the deaths, they are obviously deeply regrettable. I think the noble Lord is touching on a particular recent death that has been in the news, and we all regard that as deeply regrettable, but I do not feel, because it is very recent, that I can comment on it.

My Lords, I am on the side of the Minister. All drugs have complications and, not surprisingly, these new drugs are also a source of complications. It is for that reason that a proper monitoring of longer-term prescribing of weight-loss drugs is carried out properly, as is the prescribing itself. When it comes to cost, £11.9 billion every year is the cost of dealing with overweight and obesity, and the current plans that are being consulted on, on the use of weight-reduction drugs, are, in my mind, appropriate and properly controlled. I hope the Minister will agree that properly controlled trials, which it is intended that NICE and NHS England will carry out, are appropriate, especially when monitored by general practitioners and secondary care doctors.

I am grateful to the noble Lord, who makes a number of good points. He is mainly talking about the MHRA and NICE. The MHRA continuously works with national and international partners and agencies to monitor drugs and make sure that they are prescribed properly. He also touched on the problem of obesity, which I probably should have mentioned before. A majority of people in this country, certainly adults, are overweight, and 30% of adults live with obesity, leading to illnesses such as diabetes, heart disease, kidney disease and bladder problems—a whole range of problems that are perfectly preventable. But trying to persuade people to eat more healthily has not worked in the past, which is why we are going down the path that we are at the moment, with weight-management services and, in certain cases only, the prescription of drugs that are very closely monitored. The process that the drugs go through before they are available to the public is extremely rigorous.

My Lords, Henry Dimbleby’s National Food Strategy independent review details the factors that impact on our ability to eat healthily. They include having the facilities at home to be able to prepare fresh food and having the time to do so; it is also about where you live. About 3.3 million people cannot reach any food store selling raw ingredients by public transport. When it comes to combating obesity, what steps are the Government taking to assist low-income families, in particular, with accessing healthy and nutritious meals?

I am grateful for the question. What the right reverend Prelate is really talking about is conditions rather than medicine, which touches on an important part of the 10-year plan for health that was introduced recently by the incoming Government. That is about moving towards a system of prevention rather than cure. Prevention is always more sensible than cure and, in the longer term, it is actually a great deal cheaper as well. The right reverend Prelate talked about social and economic conditions that will take a long time to address, with the best will in the world.

My Lords, I have recently become a user of a weight-loss injection, on medical advice and in order to improve my diabetic control. Does the Minister not think that we need to move on from the current short-term system of assessing the value of drugs to a much longer-term consideration of cost-benefit analysis measured over some decades, taking into account the benefits of things such as improving health and emotional well-being, reducing the costs of other NHS treatments, including for depression and anxiety, and considering in the long run the benefits of more people paying HMRC and fewer needing support from the DWP?

I appreciate what the noble Lord says but, again, the processes that lead to drugs becoming available on the NHS are extremely rigorous. The noble Lord seemed to imply, or he said, that the processes that lead to drugs becoming available on the NHS were somehow curtailed or somehow short. They are not. They go on for a very long time. The latest obesity drug has been going through those processes for many months and is still not available. It might be available in the very near future, but it is not available at the moment because it is going through such a rigorous process.