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HEALTH BILL [LORDS] [MONEY]
Queen's recommendation having been signified--
Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a),
Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a),
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Hill.]
Dr. Stephen Ladyman (South Thanet):
I do not know whether it is a good or a bad thing that the Adjournment immediately follows the Second Reading of the Health Bill. My hon. Friend the Minister has had to work doubly hard tonight, but at least he has not had to break up two evenings. As I was in Committee this evening, I was unable to listen to the Second Reading; I hope not to cover the same ground but if I do so, I apologise to the House.
The national health service drugs bill is rising; in my opinion, it is rising inexorably, but, also in my opinion, that is not a bad thing. Drugs can be extremely cost effective. A drug that keeps someone out of hospital can make a saving for the NHS. A medicine that gets someone back to work quickly can have a beneficial effect on the economy. New drugs are becoming more efficient all the time and are starting to deal with conditions that we were previously unable to treat. The pharmaceutical industry is a big contributor to the national economy and is an industry that we should be trying to support. My purpose tonight is try to convince my hon. Friend--if he needed to be convinced--of those matters and to suggest some ways in which we could try to think about meeting the rising drugs bill that we shall face in coming years.
The Government have already made a huge start: an extra £19 billion will be available for the NHS in the next three years. That money will help to modernise the service. It will make more services available, and some of it will go towards meeting the cost of the rising drugs budget. However, in my view, it will be insufficient.
In recent weeks we have engaged in debates on this subject; we have increasingly heard the Conservatives start to answer some of the questions that perhaps they did not fully address during their 18 years in government. Unfortunately, the answers that they have given to those questions tend to be right-wing ones that advocate more private practice and more private medicine. I do not believe that those answers are in line with the principles of the NHS. The Liberal Democrats have also acknowledged the rising drugs bill, but yet again they seem to think that their magic penny on income tax will address all the problems.
I am loth to suggest that what I offer tonight is a third way, because the boss--my right hon. Friend the Prime Minister--has already copyrighted that particular phrase. I will, however, offer a basis for debate that is in line with the principles of the NHS and that will help us to address the issues.
My constituency includes Pfizer, a large and successful pharmaceutical company that employs 3,500 people there. When its current building programme is complete, it will employ 1,000 more. My right hon. Friend the Secretary of State for Trade and Industry and I are working hard to encourage the company to make further investments, and we are hopeful that it will do so. However, the company, like other pharmaceutical firms, is beginning to feel underappreciated.
Some reasons for that have been inherited by the Labour Government, including the limited prescribing list and the problems of parallel importing that still have not
been fully dealt with. Equally, however, Pfizer feels underappreciated because it is difficult to see effects such as the outcome generated by a medicine taken into consideration when pricing is considered. The company also fears that the National Institute for Clinical Excellence will focus on driving down the drugs bill rather than on outcomes and cost effectiveness.
The industry is also worried about changes in the pharmaceutical price regulation scheme, although it has been reassured by recent statements that the new agreement would be introduced after full discussion and, as far as possible, on a voluntary basis.
I reject some of the fears that have been expressed, but I must recognise that those fears exist, and, as a constituency Member, I must reflect them fairly. Of even more concern, however, are the needs of individual constituents such as Mrs. Noreen Heffer of Ramsgate and Ms Lesley Jordan of Sandwich, who have been diagnosed as suffering from multiple sclerosis and who would benefit from beta interferon treatment, which they currently cannot receive.
The reason for that is complex. As best as I can piece the story together, there was an accord in east Kent on who could appropriately receive the drug and who could not. The accord broke down, and too many people were put on the treatment, for some of whom it was not suitable. Once the health authority recognised that there was a problem, consultants got together to agree new prescribing guidelines and to start to review the cases of people on beta interferon. While the list is being reviewed, and while people for whom the treatment is not appropriate are weaned off it, Mrs. Heffer and Ms Jordan have to wait.
The health authority has increased its budget to £325,000, which is large for an authority of its size. Although I can give my two constituents a good explanation for what has happened, all they want to hear is that beta interferon is available so that they can begin their treatment. How can we make such treatments available?
We must remember that if expensive drugs are made available, there will be an impact on drugs budgets.
Another constituent's wife was diagnosed as suitable for Aricept treatment at a time when it was not available in my constituency. By the time it became available, her condition had deteriorated to the point at which the treatment was no longer appropriate. An opportunity was missed for that patient.
Many constituents have also come to me because they have erectile dysfunction and wish to receive Viagra, which they cannot receive under current guidelines. They are concerned that they will not receive it either if the preliminary guidelines on which the Government are consulting remain unchanged.
Dr. Evan Harris (Oxford, West and Abingdon):
I thank the hon. Gentleman for letting me intervene on his thoughtful and remarkably independent-minded speech. Does he agree that the Government's proposal on Viagra, which has just been out to consultation, is a rather irrational way to go about rationing a drug? The proposal would restrict the drug's prescription on the basis of the causes of dysfunction rather than the likely benefit, meaning that many people, particularly older people, simply will not have access to it because the Government
Dr. Ladyman:
I largely agree with the hon. Gentleman; I have concerns about the rationality of the drug's availability being limited by the cause of the underlying condition. But even on that basis the principle behind the guidelines appears to be that erectile dysfunction has an underlying psychological cause, whereas it is now clear that there is usually an organic condition behind it--for example, diabetes, hypertension, post myocardial infarction, arteriosclerosis, stroke, renal disease, multiple sclerosis, spinal cord injury, pelvic injury, prostate resection, radical prostatectomy and pelvic radiotherapy are all major causes of erectile dysfunction.
Erectile dysfunction is an extremely distressing condition, and I think that men who suffer from it are entitled to have the entirety of their condition treated. If one is treating renal disease, surely one should also treat the conditions that renal disease causes, which might include impotence. The prescribing guidelines should reflect that.
In fairness, I should state that Viagra is a Pfizer drug, so that is another constituency concern. I should also point out to the Minister that Pfizer has estimated that Viagra would cost only about £50 million if it were freely available on the NHS. That is far less than some of the figures that were put about a year ago when the debate first took off. Viagra is actually quite a cost-effective treatment. It would cost only about £19 a month under the current pricing guidelines, which is far less than the monthly cost of an antacid treatment.
If the Minister feels that he needs to limit the availability of Viagra in case the bill gets out of control, I suggest that he challenges Pfizer to cap the cost of Viagra at £50 million; if more than £50 million worth is required, he should suggest that Pfizer should provide it for free. I think that Pfizer might enter negotiations on that basis. The Minister might be pleasantly surprised--he should at least have a go. If he does not think that he has the power to do so, today's Second Reading of the Health Bill revealed that clauses 30 and 31 give him the power, even if he does not have it at the moment.
Finally on behalf of my constituents, I have a further concern that men's health issues are generally downgraded and not given the consideration that they should be. With Lord Jopling, I recently helped to host a meeting in the Houses of Parliament with Senator Bob Dole. I do not share Senator Dole's political philosophy, but he has been campaigning in America for increased prostate cancer treatment and screening. We should be taking up that issue in this country, but I accept that if we did, it would also greatly increase the drugs budget.
I am asking the Minister for fair treatment for pharmaceutical companies, for novel treatments such as Viagra and Aricept to become freely available, and for expensive drugs like beta interferon to become freely available. All these will increase the pressure on thedrugs bill. Although the National Institute for Clinical Excellence is a very good start and will clearly consider cost-effectiveness, it alone will not hold back the flood waters of increased drug prices.
Therefore the Minister might care to give some thought to my following suggestions. He could switch as many drugs as possible to over-the-counter availability. If he then changed the way in which pharmacists were remunerated to encourage them to have private rooms where they could advise customers on over-the-counter drugs, and if the Government and pharmacists together raised awareness of the benefits of home health care, many of the treatments that currently have to be prescribed by GPs could be sold over the counter. That would also keep people out of GPs' surgeries, thus reducing another burden on the NHS.
The Minister should change the way in which drugs are priced to reflect outcomes, and do so in such a way that the saving made by a medicine keeping somebody out of a hospital bed is reflected in the drugs budget. The drugs budget can then be allocated the resources needed to exploit to the full the potential of medicines.
Even those things would not be sufficient for the increase in the drugs bill for which we must gear ourselves up. So, I shall make one further slightly more radical suggestion for the Minister to consider. Currently, the NHS prescription bill--based on an answer that his predecessor, my hon Friend the Member for Brent, South (Mr. Boateng), gave me in April last year--is £4.5 billion a year, of which we raise only £300 million through prescription charges. We can either fund the increased drugs budget through the money made available under the comprehensive spending review or in some way increase prescription charges--the money which comes directly from the patients. That is where the Minister should be looking.
The Government have said in the debate on Viagra that the principle behind the NHS is that it should make freely available treatments for life-threatening, painful or disabling conditions. I agree; drugs for such treatment should be freely available to everybody irrespective of income. But, those represent only half of the current drugs budget. The other half need not necessarily be freely available to everybody. Drugs that deal with trivial conditions and conditions which get better on their own should be charged at the market rate to everybody, also irrespective of income.
In the middle, there is a group of drugs which deal with serious conditions--I would include Viagra in that category--and should be freely available only to people who are on low incomes. Others should pay for them at the market rate. By doing that, we would create a market in such drugs; competition might force the price down. We would also generate private medical insurance schemes to help people who want to take such an option. Such an approach would be true to the principle of the NHS that life-threatening and disabling illnesses would be freely treated and that pain relief would be freely available to all.
In case the Minister doubts whether there is room in the budget for such an approach, I shall give him a few examples of drugs in the middle category. Dermatological products cost £246 million, non-serious use of anti- ulcerants costs £300 million, anti-diarrhoeals cost £67 million, laxatives £71 million, tropical non-steroidal anti-inflammatory drugs £35 million, drugs for hayfever £34 million, contraceptive pills--slightly more controversial in such a category--£58 million, hormone
replacement therapy £138 million, oral nutrition drugs £85 million, food for special diets £29 million and vitamins £12 million.
That, for the purposes of any Act resulting from the Health Bill [Lords], it is expedient to authorise--
Question agreed to.
(a) the payment out of money provided by Parliament of--
(i) any expenditure incurred by a Minister of the Crown under the Act,
(ii) any increase attributable to the Act in the sums payable out of money so provided under any other enactment,
(b) the conversion into public dividend capital of any amount outstanding by way of initial loan forming part of an NHS trust's originating capital debt.--[Mr. Hill.]
That, for the purposes of any Act resulting from the Health Bill [Lords], it is expedient to authorise the imposition of charges in respect of expenditure incurred by the Commission for Health Improvement.--[Mr. Hill.]
Question agreed to.
10.26 pm
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