HL Deb 15 March 2000 vol 610 cc1537-40

Baroness Gardner of Parkes asked Her Majesty's Government:

How they intend to ensure that those patients currently receiving beneficial National Health Service treatments or drug therapies will not be disadvantaged when discriminatory postcode prescribing is abolished.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, the National Institute for Clinical Excellence will help to end the current inequities of access by advising which treatments are clinically and cost effective. Where the institute advises against the use of a treatment, it will give guidance about patients currently receiving it. In some cases it may be possible to switch patients to more effective therapy.

Baroness Gardner of Parkes

My Lords, I thank the Minister for the Answer, which, of course, I do not find satisfactory. We were told that the National Institute for Clinical Excellence (NICE) would constitute a levelling up, not a levelling down. Will the Minister assure me that in cases where treatments are considered costly but where research has shown that they are definitely effective—such as Beta Interferon for multiple sclerosis and the taxanes for ovarian and breast cancer—those patients receiving such treatments will be allowed to continue to receive them? It is bad enough for people not to be able to receive a treatment, but to receive effective, though costly, treatment and then have it taken away is rather like an employee whose firm is taken over and finds that his or her wages are cut. Will the Minister assure me that that will not happen?

Lord Hunt of Kings Heath

My Lords, I can best reiterate the point that I made in my initial Answer; namely, we must take into account the advice that NICE gives in relation to each individual drug or therapy. That is the Government's position. We shall, of course, consider that advice carefully as and when we receive it. As regards the point about levelling up, this process is about levelling up. The history of the NHS has shown considerable inconsistency in the availability of, for example, new treatments and new drugs. Having made a judgment about whether a particular treatment is clinically and cost effective, the aim of NICE is to ensure that it is introduced in a consistent way throughout the whole of the National Health Service.

Lord Clement-Jones

My Lords, would the Minister care to give advice to a doctor faced with postcode prescribing affecting the treatment that he thinks would benefit a patient? Should be not tell him or her about the existence of a treatment; or lie, as some cancer specialists admit that they have to do? Or would he tell the patient about a treatment but say that the health authority cannot afford it?

Lord Hunt of Kings Heath

My Lords, it is not for me to advise clinicians in the exercise of their clinical judgment. Our concern is to ensure that the situation which has existed for many years of woefully inconsistent availability of treatments is ended. We believe that the processes we have set in train in the National Institute for Clinical Excellence and the advice that it can give on whether treatments are cost effective and clinically effective, the introduction of clinical governance at local level and the involvement of the Commission for Health Improvement will enable us to ensure that the public receive high quality, consistent care across the country.

Baroness Knight of Collingtree

My Lords, will the Minister answer one simple question? Can he assure the House that when the changes in the arrangements are introduced no patients will be worse off than they are now?

Lord Hunt of Kings Heath

My Lords, I refer to the matter of a current treatment which is being evaluated by NICE where the institute advises against the use of that treatment. We have asked NICE to give us its best advice on what should happen in those circumstances. Over the years the National Institute for Clinical Excellence will have referred to it many treatments and many medicines. I do not believe that one can state a simple principle in relation to all the potential future treatments and drugs. However, as I say—this is important—we shall ask NICE to give us advice in relation to each treatment or medicine.

Lord Whaddon

My Lords, my noble friend refers to cost effectiveness. Who judges that; the patient suffering the pain, or the Minister?

Lord Hunt of Kings Heath

My Lords, there are various considerations which the National Institute for Clinical Excellence will have to take into account. First, it must ensure that the best possible evidence is available as to the clinical effectiveness of a treatment. The institute then has to take into account the effectiveness of the treatment alongside issues of resources. NICE develops evaluation reports which are considered by appraisal committees. Draft guidelines are circulated for comment and careful note is taken of all those considerations. At the end of the day, of course, a judgment has to be made as to whether a particular treatment or medicine is cost effective. I believe that we have set in place a mechanism to ensure that we get the best possible advice and a pattern of consistency across the country.

Lord Skelmersdale

My Lords, does the Minister recognise the growing practice among general practitioners of issuing post-dated prescriptions for drugs? Does he approve of this practice?

Lord Hunt of Kings Heath

No, my Lords. I have not come across such an instance. If the noble Lord cares to write to me about this matter, I shall be happy to look into it.

The Countess of Mar

My Lords, does the Minister recall that I have written to him on a number of occasions about people who require treatment through environmental medicine because nothing else has succeeded? Is he aware that, in order to get such treatment validated, I have had meetings with representatives of NICE? I have found them extremely co-operative, helpful and very understanding of the situation. They have given me and the doctor practitioner a large amount of advice on how to get the treatment validated. Will the Minister pass my thanks on to them?

Lord Hunt of Kings Heath

My Lords, that is the kind of supplementary question I am always happy to agree to. The House can have confidence in the process. We have brought together some extremely high calibre people to assist the NHS in ensuring that the best possible treatments are available throughout the whole of the health service. Careful appraisals and an ability for organisations to submit their views to the commission give us a great deal of confidence in the impact that this will have in the future.

Earl Howe

My Lords, does the Minister agree that, apart from clinical and cost effectiveness, the other part of NICE's remit is to assess the effective use of available resources? Does not that mean that NICE will be the judge and jury on the affordability of treatments in a national context? How will that not prevent a situation in which doctors find themselves obliged to withdraw established effective treatments from patients who have been receiving them?

Lord Hunt of Kings Heath

My Lords, I do not follow the noble Earl's argument. As I have said, traditionally, new treatments in the NHS have been introduced in a very patchy way, as has the phasing out of old treatments which have proven to be not very effective, and the process has taken longer than it should. The whole impact of NICE is to enable us to speed up the process of phasing out ineffective treatments and to speed up the introduction of new, effective treatments. Yes, NICE will advise on clinical and cost effectiveness, but it is for Ministers to decide the overall resources of the NHS.

As to the issue of absolute affordability, it is worth making the point that, in relation to some of the medicines we have referred to NICE for appraisal, some health authorities have been funding them and others have not. That is a reflection of the inconsistency of the current decision-making process. It is the very reason why we need the mechanisms of NICE to ensure greater consistency in the NHS.

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