HC Deb 17 March 1958 vol 584 cc1039-44

9.20 p.m.

The Joint Under-Secretary of State for Scotland (Mr. J. Nixon Browne)

In asking the House to approve this additional sum of £1½ million for the Scottish National Health Service, I should like to give a brief account of how it arises. The net sum is £1½million after the saving of approximately £250,000 in appropriations-in-aid. The sum consists of wages awards and prices, which account for nearly £700,000, and £750,000 on account of pharmaceutical services. I should like to speak briefly about the heavy increase in the pharmaceutical expenditure in Scotland.

In the revised Estimate which we had in July, we estimated for 21.5 million prescriptions at an average cost of 69.9d., or 5s. 9¾d. per prescription. In the event, we shall have 21 million prescriptions—half-a-million fewer than the Estimate—at—an average cost of 81d., or 6s. 9d. per prescription.

There are two main reasons for the increased cost per prescription. The first is undoubtedly the increasing use of such expensive drugs as cortisone, which has increased the drug bill by some £400,000. We can weigh against this increase the value of these drugs to the patient. I will not deal at length with the cost of drugs themselves, about which my hon. Friend the Parliamentary Secretary to the Ministry of Health has already spoken. It may interest the House to know that the Association of British Pharmaceutical Industry is to give evidence soon to the Scottish Committee for Prescribing Costs, and we await with interest the views of the Committee on this difficult question.

I think I should give the House the interesting interim suggestions made by the Scottish Committee for Prescribing Costs, which sits under the Chairmanship of Sir James Douglas. My right hon. Friend asked for interim suggestions. The Committee recommends that the Deans of Medical Schools be approached about the need for all those engaged in training students in prescribing to stress the importance of economy in the use of drugs. It recommends that the issue to general practitioners of general practitioner prescribing statistics be speeded up as far as possible. It recommends authority for hospital pharmacists, with the approval of doctors in charge of the wards, to supply identical standard equivalents for proprietary drugs prescribed unless a special need for a proprietary brand is indicated. Another important recommendation is that there should be consultation between doctors and pharmacists at hospital level to reduce as far as is possible the number of drugs of similar therapeutic effect requiring to be stocked.

The House knows that the hon. Lady the Member for Lanarkshire, North (Miss Herbison) wishes to speak for a few moments, otherwise I should have dealt at greater length with this Supplementary Estimate. I assure the House that we are by no means complacent and that we intend to press on with this process. We have great hopes of the results which the Scottish Committee on Prescribing Costs will give us. I have pleasure in commending the Estimate.

9.24 p.m.

Miss Margaret Herbison (Lanarkshire, North)

In the few minutes which are left there are one or two questions which I should like to put, although I am afraid that I shall have to wait for the answers, as the axe falls at 9.30 p.m. I do not know whether I have the figure right—perhaps the Joint Under-Secretary of State will indicate assent or dissent—but I understand that the expectation of the cost of prescriptions was 5s. 9¾d. and the actual cost is 6s. 9d.

Mr. J. N. Browne indicated assent—

Miss Herbison

That seems a very big increase indeed. The equivalent figure given by the Minister of Health was 6s. 1d.

Mr. Browne

There are half-a-million prescriptions fewer, and there would have been 1½ million but for the influenza epidemic.

Miss Herbison

Yes, but that still means that our prescriptions are costing 8d. more than prescriptions in England and Wales.

I realise that this is a very unsatisfactory procedure and we may, when it comes to our general Estimates, have a better debate, but there is one question I should like to put to the Minister now. He knows, as I very well know from my time in the office he now holds, that there has been great criticism by the Public Accounts Committee of the payment made for prescriptions to Scottish chemists. I would have liked tonight to have had time to find out whether the payment now made suits the views of the Public Accounts Committee better than it did.

In replying to the debate on the National Health Service for England and Wales, the Parliamentary Secretary spoke about the agreement made with the Association of British Pharmaceutical Industry, and he pointed out that, in over 200 cases, there had been reductions. Of course, that was in over 200 cases out of 4,000. Again, from my reading and inquiries into this matter, I was of opinion that neither the Ministry of Health nor the Secretary of State for Scotland, nor, indeed, the Treasury, was at all satisfied with the agreement come to. Perhaps the Ministry can tell us.

Mr. Browne

No. I think that it is early days yet to express satisfaction or dissatisfaction.

Miss Herbison

It may be so, but a spokesman who appeared before the Public Accounts Committee said that the Treasury, at any rate, was not at all satisfied with the arrangement which had been made. Will the Hinchliffe Committee examine this matter? It is of very great importance.

We want, wherever we possibly can, within reason, to cut down the cost, particularly of the pharmaceutical service, and, at the same time, not interfere with the real effectiveness of our National Health Service. The Joint Under-Secretary of State and the Scottish Department of Health would, I think, be in full agreement with that purpose. It seems to me that, wherever we possibly can, we ought to be carrying out reviews and examinations to ensure that, where savings can be made, those savings will quite definitely be made. For that reason, I am worried at the very great increase of the price of prescriptions in Scotland. Even the intervention of the Joint Under-Secretary has not given us the whole picture, I feel, or all the reasons that we should have had this very great increase.

I have looked at the Report for 1956–57 on the cost of the drugs which were bought in bulk by hospitals, and here again I find that dissatisfaction was expressed in the examination of that matter. This was the Report published on 18th December, 1957. We are told that this agreement made with the Association of British Pharmaceutical Industry has been operating since June, 1957, yet, in paragraph 62 of the Report, it is said that, where tenders have been given for the 1956–57 contracts for five other drugs, with an estimated——

It being half-past Nine o'clock, Mr. SPEAKER proceeded, pursuant to Standing Order No. 16 (Business of Supply), to put forthwith the Question necessary to dispose of the Resolution under consideration.

Question, That this House doth agree with the Committee in the said Resolution, put and agreed.

Mr. SPEAKER then proceeded to put forthwith, with respect to each of the remaining Resolutions reported from the Committee of Supply but not yet agreed to by the House, the Question, That this House doth agree with the Committee in that Resolution:—

Question, That this House doth agree with the Committee in their Fifth Resolution,

put and agreed to.

Question, That this House doth agree with the Committee in their Sixth Resolution,

put and agreed to.

Question, That this House doth agree with the Committee in their Seventh Resolution,

put and agreed to.

Question, That this House doth agree with the Committee in their Eighth Resolution,

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Question, That this House cloth agree with the Committee in their Ninth Resolution,

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Question, That this House doth agree with the Committee in their Tenth Resolution,

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Question, That this House doth agree with the Committee in their Eleventh Resolution,

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Question, That this House doth agree with the Committee in their Twelfth Resolution,

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Question, That this House doth agree with the Committee in their Thirteenth Resolution,

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Question, That this House doth agree with the Committee in their Fourteenth Resolution,

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Question, That this House doth agree with the Committee in their Fifteenth Resolution,

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Question, That this House doth agree with the Committee in their Sixteenth Resolution,

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Question, That this House doth agree with the Committee in their Seventeenth Resolution,

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Question, That this House doth agree with the Committee in their Eighteenth Resolution,

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Question, That this House doth agree with the Committee in their Nineteenth Resolution,

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Question, That this House doth agree with the Committee in their Twentieth Resolution,

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Question, That this House doth agree with the Committee in their Twenty-first Resolution,

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Question, That this House doth agree with the Committee in their Twenty-second Resolution,

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Question, That this House doth agree with the Committee in their Twenty-third Resolution,

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Question, That this House doth agree with the Committee in their Twenty-fourth Resolution,

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Question, That this House doth agree with the Committee in their Twenty-fifth Resolution,

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Question, That this House doth agree with the Committee in their Twenty-sixth Resolution,

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Question, That this House doth agree with the Committee in their Twenty-seventh Resolution,

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Question, That this House doth agree with the Committee in their Twenty-eighth Resolution,

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Mr. SPEAKER then proceeded to put forthwith, with respect to each Resolution come to by the Committee of Supply and not yet agreed to by the House, the Question, That this House doth agree with the Committee in that Resolution:—