HL Deb 16 March 1993 vol 543 cc1330-2

2.45 p.m.

Lord Dormand of Easington asked Her Majesty's Government:

What estimate they have made of the outcome of their proposal to include the contraceptive pill in the additional categories being considered for inclusion in the extended limited list of drugs which cannot be prescribed on the National Health Service.

Baroness Cumberlege

My Lords, decisions on which oral contraceptives may no longer be available on NHS prescription will be based on advice from an independent advisory committee whose remit is to ensure that drugs to meet all real clinical needs can be provided as economically as possible under the NHS.

Lord Dormand of Easington

My Lords, in spite of that Answer, is the Minister aware that the medical profession as a whole believes that the proposed changes to the limited list will lead to an increase in unwanted pregnancies and that this view is also held by the Birth Control Trust and the Family Planning Association? Is it not true that the NHS uses the cheapest oral contraceptive pill in the European Community? Finally, do not these factors make nonsense of this cost cutting exercise, particularly when a change of pill or method can and very often does lead to ill health on the part of the individuals concerned?

Baroness Cumberlege

My Lords, we are very anxious to involve the medical profession in the decisions that are made. It is represented on the committee that is advising the Government on which brands of medicine—which oral contraceptives in this case—should be used. When the selected list was first introduced in 1985 there were great cries that there would be disastrous repercussions. Those have failed to materialise, and I suspect that this time too these fears are groundless.

Lord Renton

My Lords, is my noble friend aware that it is now 20 years since Parliament placed on the Government an obligation to give family planning advice under the National Health Service and the opportunity to provide services? Bearing in mind the large proportion of unmarried mothers, is it not essential that those opportunities should be fully used?

Baroness Cumberlege

My Lords, there will still be opportunities for family planning services both in clinics and at GPs' surgeries. I very much endorse the views expressed by my noble friend. It is important that we try to prevent unplanned pregnancies. That is why oral contraceptives are one of the very few medicines that are free to all regardless of ability to pay.

Lord Ennals

My Lords, is the Minister aware that while I fully support the proposal of a limited list, I believe that in this case it would be very unwise indeed? Does she not agree that it would be a false economy and entirely unjustified? Is she aware that the money cost of an abortion is probably nearly £300, quite apart from all the other moral aspects of the matter? Does she not agree that there is a danger that if the Government pursue this proposal there will be more unwanted pregnancies and therefore more abortions at a cost in both social and financial terms?

Baroness Cumberlege

My Lords, I do not accept that premise at all. I should like to point out to your Lordships that the purpose of the scheme that is being introduced or indeed expanded is to restrain the rate of growth in the drugs bill. The drugs bill is at its highest level ever and is expected to rise by 14 per cent. again this year. Continued growth at this rate can only be at the expense of other health care. There is no question of oral contraceptives not being available. It is simply that there will be a selected list from which GPs and women can choose.

Lord Bruce of Donington

My Lords, is the noble Baroness aware that any endeavours by the Government, their quangos or at management levels in the NHS to interfere with the clinical judgment of the doctors themselves will be widely resented in the country as a whole?

Baroness Cumberlege

My Lords, we already have a selected list and those allegations are not made. The expert committee, which is independent of government, will involve the medical profession to ensure that there is a range of medications—oral contraceptives in this case—from which a choice can be made.

Lord Desai

My Lords, can the noble Baroness tell us whether, after this change, the Government expect to meet the target set in The Health of the Nation that unwanted pregnancies among under 16 year-olds will be reduced by 50 per cent.? Is she aware that choice will be restricted? Can the noble Baroness tell us the extra saving that will be made, or is expected to be made, by this change?

Baroness Cumberlege

My Lords, it is impossible to estimate what savings are going to be made until the committee has met and decided which medications and oral contraceptives will be on the list. But we do know that the saving which was made when the original list was introduced in 1985 was £75 million, which is a considerable sum of money.

Earl Russell

My Lords, I heard with pleasure the Minister's answer to her noble friend Lord Renton. I am of course aware of the need to control costs. But in considering them, will the Minister undertake to compare the cost of oral contraceptives with that of single parenthood, even though that cost does not fall on the Minister's own department?

Baroness Cumberlege

My Lords, it is not solely contraceptives, or the lack of them, which contribute towards single parenthood.

Lord Monkswell

My Lords, is the Minister aware that at the time when the limited list was introduced there were two other mechanisms which were being discussed which would have improved the health service and also reduced costs? I am referring in particular to the concept of medical audit and of generic prescribing. Is she aware of those two aspects? Does the Minister also understand that it is not just the contraceptive element which is important with the contraceptive pill, but that different women require different formulations of the contraceptive pill to prevent damage to their health? Instead of—

Noble Lords

Order!

Lord Monkswell

—including contraceptive pills in the limited list, will she undertake an exercise of medical audit and generic prescribing to ensure the better provision of health care at reduced costs?

Baroness Cumberlege

My Lords, the principles both of generic prescribing and medical audit are well established in the health service. The Government have made great investment in medical audit and we are beginning to see the fruits of that work coming to the fore now.

Baroness Robson of Kiddington

My Lords, will the Minister assure me that clinical judgment will not be completely removed from the doctor, but that if in his opinion a patient requires an oral contraceptive which is not on the list, he will still be entitled to prescribe it?

Baroness Cumberlege

My Lords, no. There will be an element of clinical judgment —that is essential—as indeed takes place now with the seven categories of drugs which are already on the selected list. Drugs on the selected list will not be prescribable under the NHS but other drugs will be.