NHS: Drug Prescribing (Hansard, 15 January 1985)

§ Lord Kilmarnock
My Lords I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)
No, my Lords. The Government are committed to the introduction of a limited list of less important drugs for the National Health Service. A limited list will result in substantial savings to the National Health Service for better patient services which generic substitution would not, and avoids the problems of divided professional responsibilities for patient care which generic substitution can entail.

§ Lord Kilmarnock
My Lords, that is a disappointing reply. Would the noble Lord not agree that the course which has been chosen by the Government goes completely contrary to recommendation 25 of their own Greenfield Committee which included six representatives of the department in its 14-man membership? Is it not the case that this list has been widely criticised as being both clinically and pharmacologically inept and liable to cause widespread suffering if it is implemented on 1st April? Perhaps more important, is it not the case that there are now indications that most of the interested parties will be prepared to settle for the Greenfield proposals, and in the circumstances will the noble Lord's department not seize the opportunity to get an agreed system of generic substitution which all parties can subscribe to in the interest of patients?

§ Lord Glenarthur
My Lords, so far as recommendation 25 of the Greenfield Report is concerned, times have moved on since then, as the noble Lord will be aware. Our present proposals are the result of a study 868 of the whole subject which has been undertaken in great depth since 1981 in the light of experience not only here, but also in other countries. As a result we have evolved a scheme which not only provides value for money for the taxpayer, but also ensures that effective medicines remain available for doctors to prescribe for their patients under the National Health Service.

§ Lord Ennals
My Lords, may I put two questions to the Minister? First, bearing in mind the strong condemnation of the Government's proposals by the British Medical Association, the pharmaceutical industry, the pharmacists and those who speak on behalf of the elderly and infirm, what support do the Government have for the proposals that are now before the country and before Parliament?
Secondly, can the Minister say how he squares this? He referred to studies since 1981. In 1981 the Secretary of State for Social Services said that the Government would resist any system of limiting the freedom of doctors to prescribe. He said that there would be no limited lists, no black lists and no compulsory substitution of generics. How does the Minister manage to justify the statement then made by the Secretary of State with the action which is now being discussed?

§ Lord Glenarthur
My Lords, so far as the second part of the noble Lord's supplementary question is concerned, I think that was made clear in what I said earlier—that times change and move on, and we have been conducting a thorough survey of what happens in this country and what happens abroad. Those facts must be taken into account. Concerning support for our proposals, the noble Lord will be aware that the list put out was a consultative one. There have been many representations made about that list. The Chief Medical Officer in my department has written to all doctors and has received over 650 letters which go into some detail on the sorts of medicines which ought to be included. I should have thought that that was a perfectly sound way to approach the question.

§ Lord Hunter of Newington
My Lords, will the Minister please tell us whether in future all drugs prescribed in the National Health Service will have to be approved by Ministers, or is it the intention that a final list be arrived at by consultation with the professional people?

§ Lord Glenarthur
My Lords, Ministers are not themselves experts on drugs, and the noble Lord will be aware that the members of the committee on the safety of medicines are the people who approve drugs—the doctors, the pharmacists and others—and that will be the method which is held to in future.

Lord Chelwood
My Lords, have not some of the criticisms of Her Majesty's Government been premature and greatly exaggerated? Do not the two letters in The Times—one yesterday from the Chief Medical Officer of the Department of Health and Social Security, and one today from the President of the Royal College of Physicians—put this question into a much more sensible perspective?

§ Lord Glenarthur
Yes, my Lords, I am grateful to my noble friend. There has been much wild exaggeration which has preyed on the minds of many people who have no need to worry. I am grateful to my noble friend for his supplementary question.

The Lord Bishop of Norwich
My Lords, I thank the noble Lord for the assurance he has given. But is the Minister aware that the initial restricted list sent to doctors by the Department of Health and Social Security may adversely affect the quality of life of the aged who are on pensions because at present they receive, as an example, bulking and stool softening medicines, and they get them free? They will probably be most at risk because they can least afford to pay. So under the new arrangements they will be the most disadvantaged if this restricted list is brought in. I assure the Minister before he replies that I have no personal interest in the matter. I eat bran, and what is good enough for rabbits is good enough for prelates.

§ Lord Glenarthur
My Lords, I am delighted to hear that the right reverend Prelate is so well, and I can assure him that the points he makes are exactly the kind that will be borne in mind by those people such as the Chief Medical Officer who will be drawing up this list.

§ Lord Molloy
My Lords, does the Minister not agree that the valid points raised by my noble friend Lord Ennals deserve examination in that the BMA and the Royal College of Physicians are appalled and extremely anxious, so much so that the general opinion is that any Government who thought up such a scheme must be ill and sick? Does he not agree that these great organisations should be consulted before anything is passed into legislation?

§ Lord Glenarthur
My Lords, we have asked the BMA to comment. It has refused to do so. The ball is in its court.

§ Baroness Masham of Ilton
My Lords, are the Government aware that there is great concern among the severely disabled about limited prescribing? Will the Government look sympathetically at the specialised needs of these people? Is the Minister aware that I have had many letters from doctors and disabled people throughout the country?

§ Lord Glenarthur
My Lords, I am grateful to the noble Baroness for that. That, again, is the sort of point to be borne in mind by the experts who are looking at it at the moment.

§ Lord Ennals
My Lords, does not the Minister recognise that the reason why the BMA have not cared to comment is that they are totally opposed to the whole principle on which the Government are now basing a limited list? Does he not understand that?

§ Lord Glenarthur
My Lords, I understand it: but then I draw the attention of the noble Lord to the remarks of my noble friend behind me who pointed out the letters that had been written in support of our proposals, one of which is from the Royal College of Physicians.

§ Lord Kilmarnock
My Lords, in relation to the intervention of the noble Lord, Lord Chelwood, is the noble Lord aware that the President of the Royal College of Physicians—and I have the letter here in front of me—specified that one of the important points is that, Drugs should be available to meet the full range of desired therapeutic activities"? That is a quotation from his letter in today's The Times. Is that condition being met by the removal of the whole of the intermediate range of analgesics, so that doctors will have nothing to prescribe for conditions between mild pain and exquisite agony? Is he also aware of the concern that has been expressed about laxatives, particularly so in the case of cancer patients, and would he not agree that he will have to extend his limited list so that, rather than coming out at £100 million, it may come out at something much nearer £50 million? In those circumstances, would it not have been much better to go for Greenfield which would secure the co-operation of all the parties concerned?

§ Lord Glenarthur
My Lords, the Greenfield Report was published in February 1983. We accepted its recommendation that a limited list should not then be introduced because there was not enough convincing evidence that the potential financial benefits would outweigh the administrative problems in drawing up and maintaining one. Since then, as I have said, we have done more work on the subject and we have learned from our experience, and from the experience of others, that savings are worthwhile. A lot of what the noble Lord has asked concerns matters which will be fully taken into account as the list is discussed—and it is being discussed at the moment—and I dare say that the list that was first issued will not be the same when it comes into effect on 1st April.

§ Baroness Lane-Fox
My Lords, will my noble friend the Minister bear very sympathetically in mind the repeated needs of paraplegics, polio and cancer sufferers for certain medication drugs to deal with that very unpopular problem of constipation? Intense worry has been expressed to me in letters about the exclusion of Dorbanex from the official list.

§ Lord Glenarthur
My Lords, I shall certainly draw my noble friend's remarks to the attention of my right honourable friend and I am sure that the Chief Medical Officer is also very well aware of the views which she expresses.