Limited List Prescribing (Hansard, 13 February 1985)

§ 3. Mr. Ewing
asked the Secretary of State for Scotland if he will make a statement following his meeting with the British Medical Association, Scotland, to discuss the restricted list of medicines that will be available for prescription on the National Health Service.

§ 10. Mr. Hugh Brown
asked the Secretary of State for Scotland if he will list the number of organisations in Scotland which have made representations on the proposals for limited list prescribing; how many he has met; and if he will make a statement.

§ The Parliamentary Under-Secretary of State for Scotland (Mr. John MacKay)
I have met representatives of the Scottish Council of the British Medical Association and the Pharmaceutical General Council (Scotland). In addition, by the end of the consultation period we had received representations from some 60 organisations, and I shall list those in the Official Report. 324 Our proposals cover only some 10 per cent. of the drugs bill. The drugs that will remain available for prescription on the NHS will be sufficient to meet all clinical needs in the areas in question.

§ Mr. Ewing
How does the Minister know that the drugs that will remain available on the restricted list will be sufficient to meet the needs of NHS patients? How many of the 60 representations that he has received were in favour of his proposals, and how many were against? Does he understand the anxiety that is now being expressed throughout the medical profession and by patients in Scotland about the Government's proposals? Will he give an assurance that when the final list is published it will be more extensive than the rather restricted list with which we originally started?

§ Mr. MacKay
We received a considerable range of representations, and most conceded the need for and our ability to make savings on the drugs bill. Many were in favour of a limited list, but representations were made on drugs that should be on that list. As the hon. Gentleman knows, my right hon. Friend the Secretary of State for Social Services has a committee of experts advising him on the list. When the House hears his statement on the final list, it will appreciate that the clinical needs of patients have been met.

§ Mr. Brown
Everyone in the House will agree with the need to keep down costs of prescriptions in the Health Service and to get value for money, so that is just a cliché. If the Government say that essential drugs will be made available under the NHS, who will decide—the general practitioner or somebody in St. Andrew's House?

§ Mr. MacKay
If the hon. Gentleman looks at the people whom my right hon. Friend the Secretary of State for Social Services has as his advisers, he will see that we are taking the advice of some very senior medical people. It is not just civil servants in St. Andrew's House or the Elephant and Castle who are advising my right hon. Friend. We are considering one of the suggestions that has come to us. If a doctor decides, for clinical reasons, to prescribe a drug that is on the banned list, we are considering ways in which that might be done. However, I advise the hon. Gentleman to await my right hon. Friend's announcement.

§ Mrs. McCurley
Will my hon. Friend utterly condemn the scare tactics of the BMA over the limited list, but bear in mind some of its manifestly sound judgments on the limited list in relation to chronic arthritic and elderly patients?

§ Mr. MacKay
My hon. Friend has made a valid point. I have read with great interest the sensible suggestions that have been made by doctors, even doctors who are implacably opposed to the scheme. However, many doctors have been absolutely unfair to their elderly patients in scaring them into thinking that they will not get suitable drugs after 1 April. To make matters worse, some doctors have made that suggestion about drugs that are not even in the therapeutic groups under consideration.

§ Sir Hector Monro
Will my hon. Friend clear up the misunderstanding between prescribing and dispensing doctors, bearing in mind that dispensing practitioners have a particular role to fill in rural Scotland, where chemists' shops are not readily available?

§ Mr. MacKay
I think that my hon. Friend is referring to a misunderstanding of a reply by my right hon. and learned Friend the Minister for Health the other day, when he said that prescribing general medical practitioners would not be permitted to sell drugs to their National Health Service patients. We are considering the representations that have been made to us on behalf of dispensing doctors in Scotland and the rest of the United Kingdom on whether they should be able to sell to their patients drugs that are on the banned list.

§ Mr. Home Robertson
Is the Under-Secretary of State aware of the overwhelming opposition to the whole scheme on the ground that it undermines one of the basic principles of the NHS? Will he now reply to the point raised by his hon. Friend the Member for Dumfries (Sir H. Monro) and turn his mind to the problem of rural doctors who not only prescribe but dispense drugs? How can it be right that they may be required to charge patients for certain drugs?

§ Mr. MacKay
I thought that I had already answered that point, but obviously the hon. Gentleman was not listening, as usual. I said that we were considering the matter of dispensing doctors, and that will be part of the statement that will be made by my right hon. Friend the Secretary of State for Social Services. Many hospitals in Scotland already operate a limited list over the whole range of drugs.

§ Mr. Michael Forsyth
Is my hon. Friend aware that in Stirling the local health council, using funds provided by his Department, is putting leaflets through letter boxes and organising public meetings telling elderly people that they will not be able to get their drugs because they will have to pay for them in future, when the health council does not even know what the list will contain and when the position has been clearly explained? Will my hon. Friend look into the matter and take it up with the health council, which is supposed to be there to serve the community, not to indulge in political propaganda?

§ Mr. MacKay
My hon. Friend makes a valid point. It is irresponsible of the health council to do that sort of thing. We have made it clear all along that the drugs that will remain prescribable under the NHS will meet all the clinical needs of patients.

§ Mr. Johnston
Will the Minister explain to me and the many doctors and constituents who have written to me — not necessarily those who are opposed to generic prescribing—why, in drawing up the original list, he apparently took no medical advice? Was this not both insensitive and possibly arrogant?

§ Mr. MacKay
The process of consultation lasted from the middle of November to the end of January. As I have explained my right hon. Friend the Secretary of State for Social Services set up a committee of very experienced medical people. I have been taking the advice of my medical officials, and we have been taking into consideration the representations of doctors. I thought that that was the proper way to consult.

§ Mr. Fairbairn
Will my hon. Friend note the hyprocisy of the Opposition, who are anxious that the drug companies should not cream off huge profits and that doctors should dispense properly for their patients?

§ Mr. MacKay
The Opposition's hyprocisy extends even further than that. As I understand it, they approve of generic prescribing, which is opposed by the drugs industry and the BMA.

Mr. O' Neill
Is the Minister aware that the Greenfield report, which inspired the so-called banned list, to use the hon. Gentleman's expression, has been around for some considerable time? The Government's ham-fisted approach caused an inadequate list to be produced in the first instance, and they are now having to scurry back and forth between doctors and pharmaceutical companies to secure their agreement before the list can be implemented. That is the scandal and that is what is causing great anxiety among our constituents.

§ Mr. MacKay
When the hon. Gentleman sees the final list he will recognise — I have said this three or four times — that it will meet clinical needs. The hon. Gentleman makes a valid point about the Greenfield report. We have been discussing ways to reduce the drugs bill for some time. The Government decided that it was time to stop the discussions and to make concrete suggestions.

§ Mr. McQuarrie
I wish to press my hon. Friend on his meeting with the BMA. Did he discuss with the BMA the serious situation that will arise in rural areas where general practitioners prescribe and dispense? Will he bear in mind that those doctors should be entitled to consider brand names rather than to implement the Government's proposals for generic medicines?

§ Mr. Speaker
Briefly.

§ Mr. McQuarrie
Will my hon. Friend ensure that our right hon. Friend the Secretary of State for Social Services bears in mind the problems that will be faced in rural areas of Scotland, which are inhabited mainly by the elderly?

§ Mr. MacKay
I think that I have already replied to my hon. Friend's question in answer to a previous question. I can confirm that I discussed the matter with the BMA. A fair number of doctors have made their position clear to me in the course of making their representations. The role of dispensing doctors is one of the matters that is now under consideration.

§ Dr. M. S. Miller
The Minister should not get too excited about trying to defend the indefensible. Does he realise that this is another step on the slippery slope down which the Government are leading the Health Service? Will he give a guarantee that the elderly and the poorer people who will be affected by the list which he has published will not suffer when the final list is put forward by the Government?

§ Mr. MacKay
I have already given that guarantee, and I am happy to give it again. We are taking the best advice possible to ensure that the list as it emerges, when my right hon. Friend the Secretary of State for Social Services makes his statement, will be sufficient to meet all the clinical needs of patients.

§ Mr. Willie W. Hamilton
On a point of order, Mr. Speaker. I shall raise my point of order at the end of Question time.

Mr. Hamilton
On a point of order, Mr. Speaker. On earlier occasions you have explained to me how you group 327 oral questions for the purpose of calling hon. Members to ask supplementary questions. I am sure that you will have noticed that today there were five questions—all asked by Opposition Members — on the proposals of the Government in relation to prescription charges, mine being one of them. The other four hon. Members were called to ask their supplementary questions; you called at least four hon. Members from the Government Benches, none of whom had a question down on the subject; and you called two hon. Members from the Opposition Benches to ask supplementary questions, although neither of them had a question down on the subject. I was the only one in that list who was not called. [HoN. MEMBERS: "Shame."] I want to know whether this is a new principle of victimisation of poor souls such as me.

Several Hon. Members
rose—

§ Mr. Speaker
Order. I assure the hon. Member for Fife, Central (Mr. Hamilton) absolutely that there was no question of victimisation. I had regard to the fact that I called him on exactly the same question yesterday, when questions were down to the Secretary of State for Social Services, and I thought it only fair to give other hon. Members a chance today.

Hon. Members
Hear, hear.

§ Mr. Hamilton
Further to your original ruling, Mr. Speaker. You said that you did not call me because I had asked a question on this matter yesterday, presumably the Secretary of State for Social Services. You will understand, Mr. Speaker, that the Health Service in Scotland is separate from the Health Service in England. It is well known that, at the moment, the Scottish Minister is in violent conflict on this very matter with the Secretary of State for Social Services. You should not have presumed, as you did, Mr. Speaker, that the question I asked yesterday was the same question I was going to put to the Scottish Minister today.

§ Mr. Speaker
I try to be as fair as possible. I hope that when the hon. Member studies the Order Paper tomorrow he will note that, of those hon. Members who tabled questions that were not reached, no fewer than 12 were called today. I am sorry that the hon. Member was not among those hon. Members who were called. If he had risen on another question, I would have tried to get him in.
Following is the information: Limited list of drugs organisations which made representations up to 31 January 1985

The British Medical Association

The British Medical Association, Scottish Council

Pharmaceutical Society of Great Britain (Scottish Department)

Pharmaceutical General Council (Scotland)

The British Dental Association

Royal College of Physicians, Edinburgh

Royal College of Physicians and Surgeons, Glasgow

Borders Health Board

Highland Health Board

British Medical Association (Wigtown Division)

British Medical Association (Ayrshire and Arran Division)

Local Dental Committee of Greater Glasgow Health Board

Grampian Local Medical Committee

Borders Local Medical Committee
328
Fife Local Medical Committee

Shetland Local Medical Committee

Highland Area Local Medical Committee

Hospital Paediatric Services Advisory Group

Glasgow Terminal Care Group

Keith Patient Participation Group

Scottish Spina Bifida Association

Association of Scottish Health Councils

City of Aberdeen Local Health Council

Argyll and Bute Local Health Council

Edinburgh Local Health Council

North East Fife Local Health Council

South Ayrshire Local Health Council

Kincardine and Deeside Local Health Council

West Fife Local Health Council

Greater Glasgow East Local Health Council

Orkney Local Health Council

City of Edinburgh District Council

Aithsting and Standsting Community Council

Whalsay and Skerries Community Council

Pollock Community Council

Tingwall, Whiteness and Weisdale Community Council

Burra and Trondra Community Council

Lerwick Community Council

Kilmeny Community Council

Iona Community Council

Rannoch and Tummel Community Council

Mull Community Council

Baillieston Community Council

Stepps and District Community Council

Northmavine Community Council

Torridon and Kinlochewe Community Council

East Sutherland Council of Social Service

Harris Council of Social Service

Guild of Hospital Pharmacists

Association of Scientific, Technical and Managerial Staff

National and Local Government Officers Association (Kyle and Carrick District Branch)

Paisley and District Trades Council

Orkney Labour Party Executive

Ayr Constituency Labour Party

Old Pollock Tenants Association

Age Concern Scotland

National Federation of Old Age Pensioners' Association

Pennyghael Community Association

Wester Hailes Good Neighbourhood Scheme for Information and Social Help

Hanover (Scotland) Housing Association Ltd.

Total 60 organisations.