§ Lord KilmarnockMy Lords, I beg leave to ask the first Question standing in my name on the Order Paper.
The Question was as follows: To ask Her Majesty's Government why they decided to raise NHS prescription charges rather than save a comparable amount of money through generic substitution by pharmacists as proposed in paragraph 24 of the Greenfield Report on Effective Prescribing.
§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)My Lords, the two issues raised are quite separate. The increase in prescription charges from 1st April reflects the Government's view that increases in the costs of services—in this case the pharmaceutical service—should be reflected in charges. This year's increase also makes a small contribution to the extra cost of providing the family practitioner services. The Government's decision not to introduce generic substitution was taken because both doctors and pharmacists foresaw it leading to problems of divided responsibilities for the treatment of patients. We are however encouraging doctors themselves to prescribe drugs by generic name.
§ Lord KilmarnockMy Lords, while thanking the noble Lord for that reply, may I say that I am not sure that the two issues are as separate as he makes out. Is it not the case that if the Government wanted to save some £30 to £40 million, a ready means was at hand without raising prescription charges? Is it not also the case that many hospitals, which are cash limited, are trying to achieve savings by limiting prescriptions to outpatients and patients on discharge to one to two weeks, with a recommendation to GPs to continue the treatment? Is this not a further reason for encouraging generic substitution to limit the open ended drug bill in the family practitioner sector?
§ Lord GlenarthurMy Lords, when the Greenfield Report was published, the Government said that we were anxious to avoid continuing uncertainty; but it soon became quite clear that generic substitution could not be separated from more general steps that we were considering, and have now taken, to make savings on the drugs bill. All the potential saving came out of the same pharmaceutical company profits and there is a limit to how much we can take without endangering the industry. We had to wait until it was clear how much we could save through changes in the PPRS before coming to a final decision on generic substitution.
§ Lord SainsburyMy Lords, is the Minister aware that I was chairman of the committee of inquiry into the relationship of the pharmaceutical industry and the National Health Service, and one of its recommendations was that brand names should not be used in any new pharmaceutical product? Has the ministry considered that recommendation?
§ Lord GlenarthurMy Lords, I am sure that that recommendation has been considered; but, as the noble Lord, Lord Sainsbury, will know, it is very much a matter for individual drug companies. Their views, too, have to be taken into account.
§ Lord SomersMy Lords, would it not be possible for those who are forced to have a repeat prescription— say once a month or thereabouts—not to have to pay the same prescription charge each time?
§ Lord GlenarthurMy Lords, there is a method by which those that need repeat prescriptions can pay a block rate. I am afraid I cannot remember the actual term for it; but I will certainly let the noble Lord know.
§ Lord EnnalsMy Lords, on prescription charges, how can the Minister justify what is in fact an 800 per cent. increase since 1979? Is he not aware that there are many needy people, particularly the unemployed, who actually cannot afford the medication which they have been prescribed? On the Greenfield Report, is he aware that many people will feel that his answer is not a satisfactory one? If he looks very carefully at recommendation 24, to which the noble Lord, Lord Kilmarnock, referred, in no way is the doctor's clinical freedom interfered with at all.
§ Lord GlenarthurMy Lords, on the last point which the noble Lord raises, there were I think 14 recommendations of Greenfield, all but one of which were accepted by the Government. On the one to which the noble Lord attributed the figure No. 24, I am afraid the noble Lord is not correct. There is a strong view among doctors that it would be an infringement of their freedom to prescribe drugs of their choice. So far as the prescription charge is concerned, the noble Lord will remember that 72 per cent. of all prescriptions are free, anyway.
§ Lord EnnalsMy Lords, the noble Lord says that it restricts the clinical freedom of doctors. May I challenge him on that, because according to recommendation 24 every doctor is entitled to say that he wishes a particular prescription to be for a particu-lar brand. How can that be restricting his clinical freedom?
§ Lord GlenarthurMy Lords, our belief is that it is better to educate rather than coerce doctors in this particular way and that is why we propose to encourage generic prescribing and not substitution.
§ Lord BlytonMy Lords, is the Minister aware that when he came to power in 1979, prescription charges were 20 pence per item? They have now risen to £ 1.60 per item, Does he not think that it is disgraceful and disgusting bearing in mind that people are paying more for their health stamp than they paid in 1979?
§ Lord GlenarthurMy Lords, the figures for prescription charges are what the noble Lord describes, but there is no change in the categories of people who are entitled to free prescriptions. Along with the 20p increase in the prescription charge, the income level at which people may be exempted from prescription charges will be raised by the same amount. This ensures that no one currently on low income exemption—which refers to the point that the noble Lord, Lord Ennals, made—will lose out due to the increase in prescription charges.
§ Lord ReaMy Lords, is the noble Lord aware that generic substitution has been practised in hospitals for some years without the objection of any hospital doctors? Can he give an explanation as to why the same system should not be applied to general practice, where the bulk of prescribing takes place?
§ Lord GlenarthurYes, my Lords; I am aware of what the noble Lord says. So far as the second part of his question is concerned, when we consulted we found that there was no general support for what he suggests. The recommendation could not be implemented without the agreement of the medical profession and—and this, too, relates to the point raised by the noble Lord, Lord Ennals—they objected to the element of compulsion involved.
§ Lord DiamondMy Lords, will the noble Lord be good enough to reconsider the answer that he gave to my noble friend Lord Sainsbury when he indicated that brand names could not be kept off new products because it was a matter for the drug manufacturers? Is it not the case that the drug manufacturers lend a very careful ear to what the Government have to say to them, having regard to the fact that the Government are their main customer? Therefore, so far as new products are concerned, would it not be reasonable to expect that progress could be made in this difficult matter by paying attention to what my noble friend, as chairman of the committee, reported?
§ Lord GlenarthurMy Lords, I am certainly grateful to the noble Lord, Lord Sainsbury, for his contribution. But the fact remains that some drugs have extremely complex names, and I do not think that it would necessarily be right, nor convenient to the patients who have these drugs, to use these sometimes extremely long and complex terms.
Lord WinstanleyMy Lords, is it not rather odd that the noble Lord should tell the House that it is the Government's view that prescription charges should rise in relation to the increase in pharmaceutical costs, if one bears in mind that the prescription charge is £1.60 per item, whether the item happens to be a bottle of tablets, with each tablet costing £10, or whether the tablets cost only a few pence a bucketful?
§ Lord GlenarthurMy Lords, I shall certainly study the noble Lord's remarks.
§ Lord KilmarnockMy Lords, does not the noble Lord agree that there is no mention at all of coercion in paragraph 24 of the Greenfield Report—that was the word that he used—and would he not undertake 706 through his department to encourage a pilot scheme involving the very simple procedure which is recommended in that paragraph?
§ Lord GlenarthurMy Lords, the matter of generic substitution has been raised and so it will not be ruled out forever, but whether or not there is a possibility of further savings in the way that the noble Lord suggests remains to be seen.
§ Baroness Ewart-BiggsMy Lords, can the Minister give the sum which he estimates would be saved in the financial year 1984–85 by the genuine substitution of generic names for brand names in National Health Service prescriptions?
§ Lord GlenarthurMy Lords, I am afraid that I could not give that figure without notice.
§ The Countess of MarMy Lords, is the noble Lord aware that there are a great many people who appreciate the value of the National Health Service and the drugs that are prescribed for them? For example, I am on drugs which cost £1 for each tablet. My doctor made me aware of the cost, I asked him whether there was any alternative, and he said, "No". I need these tablets, and I very much appreciate the help that is given to me by the National Health Service.
§ Lord GlenarthurMy Lords. I am very grateful to the noble Countess for her remarks. I am well aware of that kind of situation; I have also come across it myself.