§ 2.44 p.m.
§ Lord Williamson of Horton asked Her Majesty's Government:
§ Whether, since some of the new and effective medicines for the treatment of schizophrenia, the atypical anti-psychotic drugs, are not being made available by some health authorities due to funding difficulties, they will seek to ensure that this situation is corrected as soon as possible.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)My Lords, we have commissioned guidance to enable mental health professionals to provide the most effective treatment for people with schizophrenia. As part of the new money that we are making available for mental health in 1999–2000, we have allocated an extra £2.5 million for the new anti-psychotic medications.
§ Lord Williamson of HortonMy Lords, I thank the Minister for that reply and action. A recent survey shows that rationing of these medicines is widespread. Does the Minister agree that greater account should now be taken of the long-term savings through fewer hospital admissions because of these drugs?
§ Baroness HaymanMy Lords, I certainly agree with the noble Lord that the cost-effectiveness of treatment should be looked at in the round rather than simply comparing the cost of one drug as against another. That is why we have commissioned the British Psychological Society and the Royal College of Psychiatrists to produce guidelines, which will be published later this year, on effective treatment for schizophrenia that cover both drug and non-drug treatment. I hope that that will be one of the driving forces to challenge unacceptable variations in access to care.
§ Lord Clement-JonesMy Lords, the Department of Health's recent paper Safer Services on homicides and suicides by those with mental illness made clear how important was the availability of so-called atypical drugs to ensure compliance. Can the Minister say specifically what action the department is taking in that respect?
§ Baroness HaymanMy Lords, the major new report on suicide and homicide by psychiatric patients is very important and highlights changes that could improve the safety of mental health care. There is often a perception that suicide and homicide by people with mental illness cannot be either predicted or prevented. I believe that the report of Professor Appleby in particular shows that there are lessons to learn and steps to be taken to help reduce those tragic incidents. I hope that the national 5 service framework for mental health will allow us to ensure that everyone is working on accredited guidelines and understands the effective treatments in this area.
§ Lord SkelmersdaleMy Lords, that leads me very nicely to my question. Will the late lamented CHIMP, now re-christened CHIM (the Commission for Health Improvement)—because "CHIMP" sounded a bit silly—be studying schizophrenia treatments of this kind, and will the Government encourage them?
§ Baroness HaymanMy Lords, the role of the commission will be to monitor the performance of health service providers in providing high quality care. One of the matters that it will look at is the guidelines that are being implemented and the adherence to accredited advice. One role for the commission is to look at the national service framework and to monitor, through clinical governance and inspections, how that is being implemented. There is also a role for the National Institute for Clinical Excellence in looking in particular at the cost-effectiveness and clinical effectiveness of the new treatments as they come on stream.
§ Lord ThurlowMy Lords, while I warmly welcome what the Minister has said about the prospect of a new national framework for guidance, which I believe can make an enormous difference, is she aware that 91 per cent of psychiatrists would like to prescribe the new atypical drugs but are virtually rationed, and that to treat all new patients with them would increase the total bill for mental health medication by only 1 per cent?
§ Baroness HaymanMy Lords, I am aware of considerable support among the mental health professional community, although we should not regard this as a panacea. The new anti-psychotics are very effective in some patients but not necessarily more effective than standard treatment nor are they necessarily without side effects compared with present treatments. I return to the evidence base on which funding decisions should be taken. That is why we believe that the guidelines, which we hope will be published later this year, will be very important in ensuring that we all work from a common set of data.
§ Lord McNairMy Lords, is not one of the lessons to be learned that the side effects of the drugs prescribed are a major cause of the problem to which the report refers? Does the Minister accept that there is a growing interest among users of mental health services in alternative and complementary methods of treating mental illness symptoms, in particular as regards nutrition? Does she agree that that may provide the opportunity for the cost savings which the questioner seeks?
Perhaps I may recommend that the Minister reads the article, Complementary therapies, in the 10th June issue of Mental Health Care, Volume 2.
§ Baroness HaymanMy Lords, I thank the noble Lord for that suggestion; I shall look at the article.
6 The noble Lord is right to highlight that we cannot consider individual issues in totally self-contained compartments. The noble Lord, Lord Williamson, made that point. A range of treatments may be effective. That is why we specifically asked for the guidelines to consider non-drug as well as drug treatments
Earl HoweMy Lords, can the Minister assure the House that when the range of anti-psychotic treatments is examined by the national institute for clinical excellence the issue of affordability of newer types of drugs, as distinct from their clinical or cost effectiveness, will play no part whatever in its deliberations?
§ Baroness HaymanMy Lords, we have not yet announced the programme of work for the national institute for clinical excellence. I should not like to pre-empt that. We have stated clearly that that organisation will look to provide advice based on the issues of cost effectiveness and clinical effectiveness.