HC Deb 12 February 1985 vol 73 cc150-3
2. Mr. Fisher

asked the Secretary of State for Social Services what recent representations he has received on his proposals to limit the prescription of certain drugs.

6. Mr. Yeo

asked the Secretary of State for Social Services what further representations he has received regarding the Government's proposals to limit the list of drugs available on National Health Service prescriptions.

The Secretary of State for Social Services (Mr. Norman Fowler)

I am now considering the results of the consultation, following my announcement in the House in November, together with the advice of the group of independent experts consulted by my Chief Medical Officer. I hope to make a statement on the final list shortly.

Mr. Fisher

Do not all those representations, including those by the experts, tell the Secretary of State that he is creating two National Health Services, one for those who can pay and one for those who cannot? Is he not saying to people who have confidence in the drugs that they are using and who find that those drugs suit them and work for them that he knows best and that he will prescribe different drugs for those who cannot afford to pay? Will he now take away his prescription for those people and reconsider his proposals?

Mr. Fowler

No, I will not do that. Nor have we any intention of introducing a two-tier system. I have a responsibility to provide proper and sufficient drugs, and that responsibility I shall fulfil. That is why if we find a branded drug that cannot be replaced it will remain, but I ask the House to await my statement on the subject.

Mr. Yeo

Will my right hon. Friend condemn the tactics that appear to have been used by certain sections of the medical profession in attempting to frighten some of their patients — especially elderly patients — into believing that certain essential preparations will no longer be available under the NHS?

Mr. Fowler

The tactics employed in that campaign both by the profession and at times by the association that purports to represent the industry reflect no credit on either body. My frank advice to both would be to cool it and to await the statement. They will then find that many of the fears that they have raised are groundless.

Mr. Willie W. Hamilton

Is the Secretary of State not aware that there is much genuine concern, especially among older patients, that they will be denied the drugs to which they have hitherto had access? Does he not realise that he could have avoided all this trouble if he had gone through the normal processes of adequate consultation before announcing the change?

Mr. Fowler

With great respect, we have been consulting since November—

Mr. Fisher

Nonsense. Not with the BMA.

Mr. Fowler

The hon. Member for Stoke-on-Trent, Central (Mr. Fisher) says "Not with the BMA". That is because the BMA has decided that it does not wish to consult. That is therefore a somewhat ridiculous statement, even from the hon. Gentleman's point of view.

I put it to the hon. Member for Fife, Central (Mr. Hamilton) that the Labour party has a policy of indiscriminate generic substitution.

Mr. Fisher


Mr. Fowler

That was certainly the policy until a few weeks ago. If there has been another change, I am sure that the House would be pleased to hear what the policy is now. On this whole subject the Opposition have no credibility whatsoever.

Mrs. Jill Knight

Will my right hon. Friend note that many hon. Members join the Royal College of Surgeons, the Royal College of Physicians and the pharmacists in their full support for producing a limited list and putting an end to the enormous waste of drugs in the NHS? Will my right hon. Friend assure the House that the money saved will be spent elsewhere in the NHS?

Mr. Fowler

Yes, I can give that assurance. Until now, I had always assumed that it was common ground between both sides of the House that we wanted to reduce the NHS drugs bill. Opposition Members talk about it, but they do not come forward with any proposals.

Mr. Donald Stewart

The agreement with the BMA that generic drugs should be used in place of the same drugs bearing expensive branded names is regarded as sensible. At the same time, however, will the Secretary of State adhere to the principle that doctors must be free to prescribe what they think is best for the patient?

Mr. Fowler

In my statement, I shall consider such points. The Government stand firmly by the principle and the approach that I have already set out, but, clearly, I do not want to close the door on any reasonable suggestions —and suggestions have been made, both by doctors and by hon. Members, that we will wish to consider.

Sir John Wells

Homoeopathic medicine provides, at one-tenth or one-thousandth of the cost, remedies that are for the most part wholly satisfactory to the patients. Will my right hon. Friend take that on board, and also the fact that the BMA thoroughly dislikes it?

Mr. Fowler

I have no proposals for a limited list in homoeopathic medicine. I know that my hon. Friend intends to give me a teach-in on the subject, to which I look forward with eagerness.

Mr. Madden

In the light of recent events, was it wise for the advisers on this issue to be requested to sign the Official Secrets Act? Will the right hon. Gentleman undertake to publish the advice and representations that he receives? If the overwhelming message that he has received by the end of the consultation process is that this is an undesirable attempt to introduce a two-tier NHS, will he undertake to withdraw the proposals altogether?

Mr. Fowler

No. We shall act on the advice that we are given. That is the whole purpose of setting up a team of independent outside experts to advise me. I must ask the hon. Gentleman to await my statement.

Sir Dudley Smith

Is my right hon. Friend aware that, because of the confusion and anxiety that has been caused, there is a strong feeling that the limited list ought to be for consultation? Will he introduce it as a list for consultation before bringing forward a statutory instrument?

Mr. Fowler

I am aware that my hon. Friend has a close knowledge of these matters. I made an announcement to the House in November on how we were proceeding and I invited consultations and representations then. At some stage the House must reach a decision. The history of limiting the cost of drugs in the NHS during the past 10 or 20 years has been one of Governments evading action and simply using words. The Government intend to take action. I hope that that action will be reasonable and carry the support of my hon. Friend. The time has come for decisions.

Mr. Kennedy

Why does the Secretary of State not adopt the approach laid down in the Greenfield report, which would allow generic substitution with medical consent? Will he consider extending membership of the Acheson committee, which is advising him inter-departmentally, to take on board people in the medical profession who have shown a willingness to try to improve or move towards the generic system which both sides of the House want?

Mr. Fowler

I am not sure that both sides of the House want the type of indiscriminate generic substitution that the Greenfield committee suggested. The industry would regard such a proposal as damaging to its interests, as it would affect research-based jobs. The hon. Gentleman and his party must take that on board. With regard to the independent committee, the hon. Gentleman is under a misapprehension. Members of the committee are not what he regards as an inter-departmental committee of civil servants but doctors, pharmacists and people from universities. They are from outside government. Their examination has finished and I do not intend to extend it.

Mr. Galley

Although much of the debate has rightly concentrated on the unscrupulous activities of a minority of doctors, does my right hon. Friend share my anxiety about the effect on pharmacists? Is he able to give us some assurances about compensation for stock losses?

Mr. Fowler

I am aware of my hon. Friend's interest in this matter. Pharmacists and their stocks will be considered in the statement. I understand, however, that many pharmacists broadly support the Government's action.

Mr. Meacher

As the Secretary of State's bungling of the issue has been so ham-fisted as to turn off the British Medical Association and the Government's standing medical advisory committee, will he now at least have the grace to recognise that a limited list is acceptable only if doctors agree that it covers the full range of clinical needs—

Mr. John Patten

What is Labour's policy?

Mr. Meacher

This is our policy. Does the right hon. Gentleman agree that the limited list is acceptable only if it includes generic substitutes whenever possible, if it applies in the private sector as well as in the NHS, if it is not implemented over-rigidly and if it is subject to regular review by a qualified, representative and independent body that represents all of the relevant interests? Does he or does he not accept those criteria?

Mr. Fowler

No, I do not accept those criteria. First, because the Labour party's policy — [HON. MEMBERS: "What about the Government's policy?"] With respect, the hon. Member for Oldham, West (Mr. Meacher) asked me to comment on the policy that he has just put forward. That policy would do immense damage to the industry and would be opposed by the research-based industry. No Government want that. Secondly, if the hon. Gentleman believes so firmly in this policy why, when in government, did his party do absolutely nothing about the drugs bill? Thirdly, the hon. Gentleman is utterly inaccurate about the advisory committee. Three of the royal colleges support our policy. The Government are acting, and all the Opposition are good for is words and hot air.