HC Deb 28 July 1998 vol 317 cc157-9
5. Dr. Evan Harris (Oxford, West and Abingdon)

How he intends to involve the public in discussions about limits on the provision of drugs and treatments in the NHS. [50980]

The Minister of State, Department of Health (Mr. Alan Milburn)

The public will be involved in setting national standards for the NHS through the new National Institute of Clinical Excellence, and in developing national service frameworks. We have also made it clear that local commissioners of services should consult the public to ensure that services reflect local needs and wishes.

Dr. Harris

The Minister will recall that at his last Question Time we dragged from him the admission that postcode rationing exists, particularly for new drugs. It is also recognised that 3.7 per cent. growth across a Parliament will not provide for growth in drug expenditure. Does the Minister accept that the question is not whether rationing exists for treatment for multiple sclerosis, varicose veins, fertility and impotence, but when the Government will admit that that is happening and either fund the health service to avoid it, or engage the public and the taxpayer on how to meet demand for existing resources?

Mr. Milburn

As usual, I am not sure what is the policy of Liberal Democrat Members. There is no question of information being dragged out of this Government. We have acknowledged that treatments and the drugs available vary unacceptably throughout the country. Equally, we have made it clear that we are determined to bear down on those unacceptable variations. We want greater national consistency, based on more informed clinical judgments. The hon. Gentleman argued a few days ago from the Liberal Benches that the NHS needed 3 per cent. real-terms growth in expenditure. We have gone above 3 per cent. and 4 per cent. and for the next three years it will be 4.7 per cent. What does the hon. Gentleman want? Is 4.7 per cent. good enough or not?

Mr. Neil Gerrard (Walthamstow)

Will my hon. Friend ensure that debates about the availability of drug treatments focus not merely on the cost of the drugs but on the benefits? I am thinking, for example, of the new drugs for HIV, where there has been much focus on the cost but not as much on the long-term benefits, including the economic benefits of people being able to get back to work. In the argument about whether drugs should be available for a particular treatment, we want to avoid setting one group of patients against another, as has happened in the past.

Mr. Milburn

My hon. Friend makes two good points. On the first point, like previous Health Ministers, we get lots of advice from economists and others who say that we need to bear down on the NHS drugs bill, as though drugs were a bad thing, which is a naive assumption. If drugs mean easier, better and quicker treatment for the patient instead of going to hospital, that is a good thing and if it means growth in the NHS drugs bill, we should welcome it. On the second point, we want a more rigorous assessment of what is cost effective and clinically effective, particularly when drugs come on to the market.

To return to the question by the hon. Member for Oxford, West and Abingdon (Dr. Harris), at the moment assessment of drugs when they are first introduced into the NHS is inconsistent. That is why we are introducing the National Institute for Clinical Excellence to ensure greater consistency throughout the health service. After all, it is supposed to be a national health service, not a series of competing local health services.

Mr. Peter Bottomley (Worthing, West)

Hon. Members will agree with what the Minister has said, together with what the Secretary of State said about innovation and making general what has been shown to work. On the limiting of treatments, may I ask the hon. Gentleman, in a non-partisan way, whether he recognises that delays in non-emergency treatment for cataracts and hip operations, for example, affect the elderly in particular? Will he consider publishing for each health authority the instructions to hospitals in their areas on necessary delays for waiting lists? West Sussex has the highest proportion of elderly people and the waiting time is 17 months.

Mr. Milburn

First, on the general point, the hon. Gentleman will be aware—I hope that he and his party now accept this—that as we bring down waiting lists, which we are doing, waiting times for individual patients will also come down and I hope that he welcomes that. I will look into the situation in his area. I am aware of the problems there because he has seen me about them, in particular the increased demand that can arise from a higher than average elderly population. I will be pleased to look into the specific concerns that he expresses.