COSTING OF HEALTH SERVICE DRUGS (Hansard, 5 February 1963)

§ LORD TAYLOR
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ THE PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH (LORD NEWTON)
My Lords, 1,440 staff, at an annual salary cost of about £800,000, are engaged in England and Wales in pricing prescriptions for the purpose of calculating payments to chemists. In addition, 109 staff, at an annual salary cost of about £64,000, calculate periodically the cost of each general practitioner's prescribing.

§ LORD TAYLOR
My Lords, I thank the noble Lord for that Answer. Is he satisfied that this money is well spent, and that there might not be better ways—for example, by eliminating unnecessary prescribing—of reducing the cost of drugs than by this detailed scrunity by a very large clerical staff of these prescriptions?

§ LORD NEWTON
My Lords, the 1,440 staff are people whose work is essential for the payment of retail chemists. Their salary cost represents about 1 per cent. of the total cost of the prescriptions dis 488 pensed. The 109 other staff are those who work in the Prescribing Investigation Bureaux, and their job is, about once a year, to analyse each doctor's prescribing over a period of a month. It is from their analyses that prima facie cases of excessive prescribing are shown up, and then followed up. Although I cannot give an estimate of how much money the Prescribing Investigation Bureaux save, there is no doubt in my mind that, so far as the national drug bill is concerned, they pay for themselves many times over. Perhaps I might also say that nobody in my Department is in the least complacent about the drug bill. We are constantly trying to seek new ways of persuading doctors not to be extravagant, and any ideas from any quarter of how we can do it better would be most welcome.

§ LORD TAYLOR
My Lords, I am very pleased to hear that: but one is a little worried. The noble Lord says that the salary cost involved here is 1 per cent. of the cost of the drugs. But the number of people engaged represents, I think, nearly, if not quite, 5 per cent., of the number of general practitioners engaged in prescribing these drugs. Could there not be some sampling procedure instead of this very large growth of an administrative overhead on the National Health Service?

§ LORD NEWTON
My Lords, one must always look to see whether one is employing too many people in any branch of the Government service, but I suppose the important thing is the cost of it all; and 1 per cent. is not a very large proportion.

§ BARONESS SUMMERSK1LL
My Lords, when are the noble Lord and the Government going to stop fiddling with this really scandalous increase in the price of drugs in this country? The noble Lord says that he will be glad to have some advice on the subject, but has he not read the latest Report of the Public Accounts Committee? Does he not know that it is possible to prescribe a drug on the National Formulary equal to the proprietary drugs, and at much lower cost? Why do not the Government insist that the doctors should do it? At the moment it is a public scandal.

§ LORD NEWTON
My Lords, as I have said, there is no complacency about this matter. The noble Lady knows as 489 well as I do that in this country doctors are free to prescribe what they think is necessary for the wellbeing of their patients, and there is machinery, which I have just mentioned to the noble Lord, Lord Taylor, which checks up on whether or not they are being extravagant. I do not want, by my answers to this Question, to widen this into a debate about prescribing methods of doctors and so on, but it may be of interest to the noble Lady to know that in. England and Wales, for instance, in the calendar year 1957 207 million prescriptions were prescribed, and in the year 1961, 205 million.

§ BARONESS SUMMERSKILL
My Lords, if, as the noble Lord knows, the price went up, all that happens is that doctors prescribe in larger amounts and it becomes one prescription, so that the two prescriptions prescribed the year before become one. These figures, when analysed, mean absolutely nothing.

§ LORD NEWTON
My Lords, as I say, there is no complacency about this, but it is a difficult problem.

§ EARL ALEXANDER OF HILLSBOROUGH
My Lords, I think Parliament would be inclined to ask this of the Minister. I am sure he has read the Report of the Public Accounts Committee. Have the Government referred this Report of the Public Accounts Committee to the machinery the noble Lord says advises them on it, and have they advised the Government that there is nothing that can be done to reduce the cost?

§ LORD NEWTON
My Lords, I think that is a much wider question, and I should not like to give a snap answer to the noble Earl.

LORD HAWKE
My Lords, if the figures given by the noble Lord, Lord Taylor, are correct, and there is one man costing prescriptions per every twenty prescribing them, does that not seem a very high proportion? Would not my noble friend have some investigation to see whether these people are really doing their job properly, because the proportion seems very high, when one considers that the doctor is prescribing for only a very small proportion of his time, if it requires one man to check every twenty doctors' prescriptions?

§ LORD TAYLOR
My Lords, I thank the noble Lord, Lord Hawke, for that supplementary. That, indeed, was the thought that was in my mind. There really is an extraordinary number of persons engaged in checking these prescriptions. I was asking whether there could not be some simpler and cheaper mechanism for the nation to achieve exactly the same result so far as the retail chemists are concerned.

§ LORD NEWTON
There are only 109 people who are engaged in checking doctors' prescriptions. The 1,440 are calculating how much chemists have to be paid.

§ LORD TAYLOR
That is precisely it.

§ LORD NEWTON
I have certainly listened to what has been said. In reply to my noble friend Lord Hawke, I should not like to give a definite answer, because I do not at the moment know whether the figures given by the noble Lord, Lord Taylor, are correct.

§ EARL ALEXANDER OF HILLSBOROUGH
My Lords, before the matter is quite closed, may I say that I cannot regard the question I raised as having made the issue wider? All I want to know from the Ministry—and perhaps the Minister could write to us—is whether the consultations I spoke about have taken place.

§ LORD NEWTON
My Lords, I will certainly see that the noble Earl receives the explanation he wants. If he would like to me to write to him, I should be happy to do so. I would say that if he would be good enough to look at the original Question, he would see that it asks Her Majesty's Government how many person are employed in the costing of drugs prescribed by general practitioners, and at what approximate cost. That is a fairly narrow question.