§ Sir Dudley Smithasked the Secretary of State for Social Services what were the specific criteria used to include products on his limited list with particular reference to the section on benzodiazepines.
§ Mr. Kenneth ClarkeThe overall objective given to the group of independent experts who advised the Chief Medical Officer on which drugs should be prescribable was to meet all real clinical needs at the minimum cost to the National Health Service. The criteria they used when considering individual medicinal products were the same in each therapeutic group covered by the limited list. First, was the product required to satisfy a real clinical or therapeutic need not met as effectively by any other product available? If so, it was put on the list regardless of cost. Secondly, did it meet a real clinical or therapeutic need at least as effectively and at the same price as or more cheaply than any other available product? If so, it too was put on the list. Any products that were more expensive but not more effective were excluded.
In considering clinical needs the group took into account not only the specific therapeutic action of the products under consideration but also the practical problems of general medical practice. They therefore considered such problems as the acceptability and palatability of the products—especially for children, old people and the dying—and the need to have a choice of effective remedies wherever practical.
It follows that the criterion for including drugs in the schedule of medicinal products and other substances not to be available on NHS prescription from 1 April 1985 was that, on expert advice, they had no clinical or therapeutic advantage over other, cheaper, drugs in the categories of antacids, laxatives, analgesics for mild to moderate pain, cough and cold remedies, bitters and tonics, vitamins and benzodiazepine sedatives and tranquillisers. Drugs prescribable only for specified conditions—at present only one, Clobazam for epilepsy—are those which have more than one distinct therapeutic use and which meet this criterion for at least one of those uses but do not meet it for all of them.
In addition, the main schedule includes substances which the Advisory Committee on Borderline Substances has advised are never drugs or medicines in the circumstances of general practice. The independent experts advising us on the contents of the limited list also made a general recommendation, which we accepted. This was that to achieve maximum economy drugs to be retained should wherever possible be specified and prescribed by a non-proprietary name.