§ The Minister of Health (Mr. Enoch Powell)
With your permission, Mr. Speaker, I wish to make a statement.
The Secretary of State for Scotland and I recently asked the Standing Joint Committee on the Classification of Proprietary Preparations, of which Lord Cohen of Birkenhead is Chairman, to consider if it could help doctors in prescribing by giving more guidance on proprietary preparations. The Committee has now reported and the House will wish to know its principal conclusion.
The Committee advises that, while there should continue to be no absolute restriction on the prescribing of any drug which the doctor considers necessary for the treatment of his patient, he need not normally go outside the drugs and preparations described from time to time in the British Pharmacopoeia, the British Pharmaceutical Codex and the British National Formulary, together with the drugs that the Committee classify as N (new drugs of proved value not yet standard), and P (drugs for which there is prima facie evidence of therapeutic value, but where the Committee wants further evidence before firm classification).
The Report goes on to advise that a doctor who prescribes other preparations may be liable to be called on to justify his action if the cost of his prescribing is being formally investigated.
The Report will be published and, in consultation with the medical profession, will be brought to the attention of all doctors.
My right hon. Friend and I are aware that the pharmaceutical industry may be apprehensive of the effect of this advice on its future progress and development, but we are sure that any such apprehension would be ill-founded. Many standard preparations are, and will no doubt continue to be, available only in proprietary form, or cost little more or no more in proprietary than in unbranded form. This, together with categories N and P, and the individual doctor's professional discretion, will continue to provide full scope for the products of the industry's research and development to find their reward.
§ Mr. K. Robinson
Does the Minister not think that he might have acknowledged that the course recommended by the Cohen Committee is the one consistently advocated over a long period from this side of the House, particularly by Lady Summerskill and other of my hon. Friends?
Does he not agree that substantial savings can be effected in the drug bill by this decision, and might well reach a sum considerably more than that which he will receive by the increased prescription charges? In the light of this, will he not, even at this stage, consider revoking the prescription Regulations?
May I ask one or two questions arising out of the statement? Is any further guidance to be given to doctors to assist them in prescribing British Pharmacopoeia equivalents? Will he say what savings he estimates there will be on the drug bill, provided doctors do, as I am sure they will, conscientiously follow the advice of the Cohen Committee?
Will he also say what further steps he is to take to reduce the cost of these proprietary drugs not covered by the statement, particularly those in the N and P categories? Finally, will he say when the Report will be published?
§ Mr. Powell
The Report will be published as soon as it can be made available for sale, which, I am advised, is likely to be in the early days of April. I cannot, obviously, at this stage, in any way anticipate what will be the effect on the total cost of the pharmaceutical service of the advice which the Cohen Committee has tendered to my right hon. Friend and myself, and I certainly would assume that the Cohen Committee, in arriving at this advice, has been guided solely by its own knowledge and professional judgment.
The questions which the hon. Gentleman asked about other matters and other steps appear to me to lie outside the scope of this advice and of this Report, but I will gladly deal with them in the debate which we are to have later tonight
§ Mr. Robinson
In his statement the Minister says that this Report will be published and be brought to the attention of the executive councils and doctors. The Minister has not said that he accepts the Report. Will he make 1416 it quite clear that he accepts the Report, that he welcomes its conclusion, and that his Department will do all it can to see that it is implemented?
§ Mr. Powell
The Report does not require acceptance. This is advice which is tendered to my right how Friend and myself, and, through us, to the whole of the medical profession, by the Cohen Committee. It is our duty, which we will carry out with the minimum of delay, to bring it to the attention of every member of the medical profession in the National Health Service.
§ Vice-Admiral Hughes Hallett
Is my right hon. Friend aware that many of us on this side of the House also think that this is a great step forward and should result in substantial economies? Does he think that it will also have the effect of reducing the high-pressure advertising which has been such an objectionable feature of this matter in the past?
§ Mr. Powell
I am sure that this recommendation of the Cohen Committee is a most important one to the profession. I have little doubt that it will be of assistance to doctors and will be welcomed by them in exercising their judgment upon the claims which are put before them.
§ Mr. Holt
Does the Minister agree that this advice to the medical profession will become really effective and achieve the maximum economy in the Health Service if he follows the suggestion I made in the first of our recent debates on Health Service charges, namely, that any drugs obtained from the lists in these publications should be free and charges retained merely for proprietary brands?
§ Mr. Hirst
Is my right hon. Friend aware that after thirty years' experience of the pharmaceutical industry I can unhesitatingly assure him that many of the equivalents in the British Pharmacopoeia and the British Pharmaceutical Codex are absolutely therapeutically excellent and good, and could replace many extravagant and much-advertised articles?
§ Mr. G. Brown
Will the Minister think again about his reluctance to say whether he accepts the Report, welcomes it, or urges it on the profession? if, as I gather, he wants it to be effective, presumably he is ready to say so, which must mean that he is ready to endorse it. I ask him to be firm about this.
May I also ask the right hon. Gentleman whether the irony of the comparison between the miserable economies he has made for widows and the sick, and the proposal contained in this announcement, has yet occurred to him?
§ Mr. Powell
I do not know what will be the financial effects of this advice. It certainly does not alter any of the arguments which I have put before the House in the last six weeks.
I want to clear up what may be a point of misunderstanding about the question of endorsing the Report. It would be quite inappropriate and an impertinence on the Government's part to endorse or accept a professional report and professional advice to the medical profession. The duty of my right hon. Friend and myself is to ensure that, the advice having been formulated—as professional advice, we have no reason to endorse it or otherwise; that is not within our field—it is brought fully and effectively to the notice of the medical profession.
§ Mr. Brown
On a point of order. Mr. Speaker, in what sense does the proposal come before us? The opening words of the Minister's statement are:The Secretary of State for Scotland and I recently asked the Standing Joint Committee on the Classification of Proprietary Preparations …to do a job, and that job has been done.
The Minister has conceived it as his duty to bring the Report to the House, but he has declined to tell the House whether he approves or disapproves of it. If it is improper and impertinent, as he says, for him to indicate whether he approves or disapproves of it, on what basis is the House being asked to take cognisance of it?
§ Mr. Speaker
The basis on which it arises is that the Minister asks my leave to make a statement. He does not require, in the context, my approval of 1418 the terms of the statement. I do not think any other point of order, as distinct from other matters, arises.
§ Mr. Brown
I understand that, Mr. Speaker, but a Government statement must involve some recommendation of policy. It must involve some Ministerial responsibility, as it is called. The Minister says that in this case there is no Ministerial responsibility and that it would be impertinent and improper for him to accept any responsibility. No matter what the Minister said to you, Mr. Speaker, is it not an abuse of the order of the House to take our time up with something which he says it would be improper for him to take any responsibility for?
§ Mr. Powell
Ministerial responsibility here is to ensure that attention is drawn to this advice and the Report generally and, in particular, is brought to the attention of the medical profession. That is the duty of my right hon. Friend and myself, which we will carry out. I think that both sides of the House have recognised the importance of the advice which it is our duty in this way to bring to the notice of the profession. The job which my right hon. Friend and I asked the Committee to perform was to consider if it could help doctors in prescribing by giving them more guidance on proprietary preparations.
§ Sir H. Linstead
It is clear that the advice which my right hon. Friend has received will command very wide support professionally. However, I ask my right hon. Friend to underline one point of professional principle which has always been carefully cherished, namely, the continual right of a prescriber to prescribe for his patient whatever medicament the prescriber thinks the patient requires. I understand that, subject to justification if necessary, that right still remains with the prescriber. Am I right?
§ Mr. Powell
Yes, Sir. That is entirely correct and is re-emphasised in terms in the words of the Committee's Report which I paraphrased to the House.
§ Mr. K. Robinson
May I ask the Minister this one simple question? Does he hope that the recommendation of the Committee will succeed in its objective?
§ Mr. Powell
Naturally. My right hon. Friend and I asked the Committee if it could help doctors in prescribing. I hope and believe that the advice which we are transmitting from the Committee to doctors will have that effect.