NHS Hospitals: Apheresis

Question

15:07:00

Asked by

To ask His Majesty’s Government what steps they are taking to support increasing apheresis capacity in NHS hospitals in England.

The Government are aware of the issues around apheresis capacity within the National Health Service impacting patient services, including stem cell donations. A departmentally led working group met for the first time last month to examine existing apheresis capacity and to develop solutions, and it will report in the spring. This working group includes members of the UK stem cell register, health professionals and service providers, and it aims to develop an evidence base by which strategic decisions around capacity can be established.

My Lords, I thank my noble friend Lady Merron for her very helpful reply. Only last month I chaired a round table in your Lordships’ House on apheresis capacity. Therefore, given the rapid developments in cell and gene therapies and related international regulation over the last few years, what plans do the Government have to update legislation governing the use of substance of human origin and the development of advanced therapeutical medicinal products to better utilise modern technologies such as apheresis platforms?

I am grateful to my noble friend for her work in this regard. I certainly share the view that there have been very rapid developments in cell and gene therapies over the past few years, and there is tremendous potential for these therapies to address the root cause of diseases and to offer life-changing outcomes for patients. So, we are working with devolved Governments and with key stakeholders to review the EU standards and requirements, and to consider our approach in light of the changes introduced by the EU SoHO regulations, which will take account of innovation within the sector.

My Lords, can the Minister say what the waiting times are for patients and clinicians who wish to use the eight therapeutic centres we have in England? Are the Government committed to providing investment in addition to the £1.5 million that NHS England announced back in February?

NHS Blood and Transplant provides the biggest apheresis service in Europe. It has been growing by 10% to 20% year on year, and that includes the workforce and increasing provision to patients. I will be pleased to write to the noble Baroness with the most up-to-date waiting list figures. However, in addition to the existing units, satellite services have been set up in Plymouth, Cardiff, Birmingham and London. I am glad to say that, over the next six months, NHS Blood and Transplant will also open new services in East Anglia and the south-west, and it is aiming to provide over 2,000 additional collection slots per year within the next 12 months. I hope the noble Baroness will welcome that development, which we want to continue to really harness the benefits of life sciences.

My Lords, does the government review that the Minster mentioned encompass sickle cell patients? As a member of the All-Party Group on Sickle Cell and Thalassaemia, I am aware that apheresis is one of the few treatment options for sickle cell patients. It is crucial in reducing the chances of sickle cell patients suffering a sickle crisis whereby oxygen is prevented from travelling around the body, resulting in intense pain and potentially life-threatening complications. However, the lack of adequate apheresis capacity means that many sickle cell patients are unable to access this essential care. A number of APPG reports have shown that they often get under-prioritised and bounced out by other patients. Is the department factoring in sickle cell patients?

I assure the noble Baroness that we are more than factoring it in. We are totally committed to working to support those with sickle cell, and thalassaemia. There is ongoing work to provide the very best possible care, including boosting the number of blood donors, which is vital in improving clinical pathways and delivering treatments. There is a treatment, as I am sure the noble Baroness is aware, called Casgevy, which requires apheresis as part of the process. It is being evaluated by NICE for the treatment of thalassaemia and it is also being evaluated for sickle cell. I hope all those things will bring great benefits.

My Lords, I am grateful to the Minister for highlighting that we are a leader across Europe with our services, but only 50% of the country is covered. Can she assure us that in all reviews of the NHS, consideration will be given to centrally commissioned, highly specialised services such as this, rather than relying on local commissioning, that the workforce plan will recognise that highly skilled nurses are needed to undertake this treatment, and that that needs to be factored in? The numbers are small but the skills are enormous.

What the noble Baroness says is very true and I certainly can give the assurances she seeks.

My Lords, I have scanned the literature because I looked at this Question on the Order Paper, and I noticed that there seem to be very few completed trials showing clear efficacy of stem cell transplantation, except in the case of blood dyscrasias such as cystic fibrosis. Would the Minister be kind enough to let me know how many trials are being conducted in this country? If she does not know, maybe she could tell me in due course.

I thank my noble friend for raising that important point. I will be very pleased to look into this further, so I can answer him in full.

My Lords, I pay tribute to the noble Baroness, Lady Ritchie, for her work in this area. In England, leukapheresis can be performed only by the NHS Manchester apheresis unit, and the Birmingham unit can carry out only three of the apheresis services. Are His Majesty’s Government committed to expanding the range of apheresis services available at each unit?

Further to my answer to the noble Baroness, NHS Blood and Transplant is seeking to expand capacity in the way I outlined. It is probably worth going back to the point about the apheresis working group. It met for the first time last month to determine the extent of the capacity issues which we know exist. It will also be looking at who delivers what, how and for what uses. It will identify the issues in respect of workforce, machinery, finance and efficiency, and seek to come up with a recommendation. It will report in spring of next year, so we have a route forward.

Have the NHS and the Department of Health and Social Care had any discussions with independent health providers to see whether they have any free capacity that therapeutic apheresis could perhaps utilise?

I thank the noble Baroness for raising that issue. I am sure it will be part of the working group’s investigations as it seeks to expand capacity to meet existing demand.

I draw noble Lords’ attention to my registered interests. The Minister has identified the importance of having a framework for the adoption and standard incorporation of innovative technologies into routine care. In this regard, the long-term plan for the NHS that His Majesty’s Government are preparing is a vital element of what will happen over the next five years. Can the Minister confirm that that plan will look specifically at commissioning these innovations in such a way that life sciences innovation in our country is protected, and they get to patients quickly?

Yes, I can confirm that we will be drawing on the parts of the report of the noble Lord, Lord Darzi, that refer to that. He refers to the need for innovation, to expand the use we make of life sciences and to develop that still further. That will very much form part of not just our thinking, but our doing.

Given the welcome switch of the National Health Service from being just restorative to preventive, might the Minister consider discussing the World Health Organization system of women health volunteers and visitors? Then, these discussions can start at a much lower level and people will be much less fearful of the treatment they may eventually have to have in hospital.

Certainly, we want to look at all the ways we can support patients to get the services they need, and that includes providing reassurance and the information they need. I will look at the Baroness’s suggestion.