§ 1. Mr. CarttissTo ask the Secretary of State for Health how prescribing costs under the proposed National Health Service changes will be monitored.
§ The Secretary of State for Health (Mr. Kenneth Clarke)Under the indicative drug budget scheme, practices will be able to monitor their own expenditure on drugs by means of a simple monthly statement from the Prescription Pricing Authority.
§ Mr. CarttissI thank my right hon. and learned Friend for his reply. Has he seen the circular letter sent to local medical committees by the hon. Member for Peckham (Ms. Harman), repeating the Opposition claim that drug budgets will be cash limited? As the hon. Lady declines to recognise the repeated assurances that that is not so, will my right hon. and learned Friend take this opportunity to reiterate that drug budgets will not be cash limited, and that no patient will go without necessary drugs?
§ Mr. ClarkeWe demonstrate repeatedly to the British Medical Association and to the hon. Member for Peckham (Ms. Harman) that indicative drug budgets will not be cash limited and that every doctor will be free to prescribe whatever drugs a patient needs for his or her condition. The hon. Lady continues not to produce any evidence for her contrary assertion, but she keeps making it. Therefore, I intend to write to all local medical committees yet again, refuting her suggestion and giving reasons, if I can persuade the British Medical Association to give me the addresses of the local medical committees to which she wrote.
§ Ms. HarmanWill the Secretary of State please investigate the case of David Whitton, a former chairman of the Royal Free hospital kidney patients association, who had to change his general practitioner because his GP would not prescribe for him cyclosporin, an expensive drug which he needs to keep his transplant in place? Will the Secretary of State acknowledge that cash-starved hospitals are passing on to GPs expensive drug costs? How will patients get the drugs that they need when GPs' drugs budgets are capped under the National Health Service and Community Care Bill?
§ Mr. ClarkeI shall look into that case, as I look into all the cases that the hon. Lady refers to me. So far, not one 994 of the cases that I have looked into has justified the particular assertion that she made on the Floor of the House. Certainly, I disapprove of the attempt by some hospitals to shift the prescription of drugs for which their consultants are responsible on to GPs. A GP has no budgetary reason for refusing to dispense a drug, but some of them are quite correct in insisting that they will riot prescribe drugs when a consultant continues to be responsible for the patient. I shall look into that case and see whether it gives rise to some cause to intervene.
§ Mr. Brandon-BravoDoes my right hon. and learned Friend agree that no practice or doctor objects to the monitoring that is suggested? Does not he deplore the conduct of Opposition politicians and, sadly, unprofessionally, some doctors who are still frightening the life out of elderly and disabled people by telling them that the drug budget will stop them having the drugs that they need? Will he nail that lie once and for all?
§ Mr. ClarkeI agree with my hon. Friend. Most doctors already prescribe responsibly. The vast majority welcome the introduction of the information system known as PACT—prescribing analyses and cost—which tells them what they are spending now, and most will welcome the opportunity to monitor their own drug spending. I have already refuted the ridiculous allegation that patients might not get the drugs that they need, on grounds of expense. I continue to insist that in a minority of practices there is a sensible case for tackling avoidable and unnecessary costs in prescribing—perhaps they are dispensing drugs that are not needed by the patient, or expensive drugs when cheaper ones are available. The savings made by extending good prescribing practice will be ploughed back into the National Health Service to help improve services.