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10.44 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate my hon. Friend the Member for South Thanet (Dr. Ladyman) on his success in securing the debate. I understand the importance of the topic to his constituents, many of whom are employed by Pfizer, which is of course the manufacturer of Viagra, among many other important products. That drug has produced more comment and opinion than perhaps any new drug in living memory. I shall return to it in a moment.
As a Government, we do fully accept the importance of the United Kingdom pharmaceutical industry to this country. Only last week, at the Association of the British Pharmaceutical Industry annual dinner, my right hon. Friend the Secretary of State described the industry as "quite brilliant". The Government unequivocally support the industry.
The Department of Health is responsible within Government for policy in relation to NHS purchase and the use of pharmaceuticals, and for policies designed to create the right competitive environment in which the UK pharmaceutical industry can continue to flourish and compete in the global market. Those two aims are not at odds. We recognise that the industry's present success was hard won. In the face of globalisation and increased competition, the industry must be at the forefront of innovation and competitiveness if that success is to be sustained. Nothing that we are doing threatens that success--rather the opposite.
The principal objective of recent developments, such as the National Institute for Clinical Excellence, is to enable faster and more equitable access to innovation, and to ensure that resources are used cost-effectively. Clinicians encounter more and more new products--the pace of change is quickening. The setting up of NICE recognises the need for machinery to provide authoritative guidance, and the industry has expressed support for the broad objectives of NICE. The Association of British Pharmaceutical Industry and the Association of the British Health Care Industry will be represented on the partners' council, which will oversee NICE's work programme and ensure fair play in its working methods.
We have made it clear that if medicines are shown to be more clinically and cost effective than other treatments, that is how the money should be spent. Unified budgets will facilitate that. There is no cap on the drugs budget. The introduction of unified budgets creates a single
funding stream for three components of expenditure--hospital and community health services, prescribing, and GP practice infrastructure--which were previously managed separately, under differing rules, by different parts of the NHS.
Mr. Philip Hammond (Runnymede and Weybridge):
Will the Minister give way?
Mr. Denham:
In fairness to my hon. Friend the Member for South Thanet, I think I should try to answer as many of his points as possible.
Those three components have been combined into a single pot at health authority and primary care group level. That level will depend on the clinical priorities that health authorities and primary care groups set themselves. Unified budgets will create a flexible environment, which will help to ensure that patients get the most appropriate treatment for their condition.
It is not true to say that the Government are unwilling to allow for the full cost of treatment when assessing the price of medicines. Under the NICE appraisal system, companies will be free to submit any relevant data, with the core of NICE's appraisal focusing on the health benefits achievable from NHS budgets--including hospital beds and staff, not just the cost of drugs.
We continue to work closely with industry. For example, the industry strategy group, which includes senior industry representatives and Department of Health, Department of Trade and Industry and Treasury officials, meets every quarter to discuss a range of issues. The industry has praised Government for their handling of the debate on the development of the single market in pharmaceuticals during our presidency last year, and subsequently the ISG and other bilateral contacts provide forums for discussion of NHS policies as they affect the pharmaceutical industry and other relevant Government policies. One of these is the parallel import of pharmaceuticals into the UK. Government has an on-going and constructive dialogue with the industry on that issue. Internationally, the ISG is seen as a unique forum for Government-industry debate.
As a discerning home customer, the Government are determined to secure value for money for the national health service. The clinically and cost effective use of pharmaceuticals helps to stimulate UK industrial competitiveness; it does not undermine it.
We do want to reach a voluntary agreement on the pharmaceutical price regulation scheme, but the Health Bill will enable us to back it by statute if necessary. Above all, the PPRS--voluntary or backed by statute--has, and will continue to have, the joint aims of fair prices for the NHS which represent good value for money, and fair prices or profits on NHS sales for the industry which represent a reasonable return on the enormous investment that goes into pharmaceutical research and development and of course helps to fund future R and D.
This remains a very good country in which to invest in pharmaceuticals: it has lower costs, labour flexibility, good industrial relations, a strong science and skills base, a strong cluster of existing industry, low corporation tax, political and social stability and an excellent regulatory regime.
I said that I would return to the topic of Viagra. Impotence is in itself not life-threatening and does not cause physical pain. It can, in exceptional circumstances,
cause psychological distress. Until the advent of Viagra, NHS expenditure on this condition has been limited because of the nature of the treatments available. Now that treatment is available in tablet form, the cost of treating impotence could escalate. To limit that impact, we propose controls that reflect the priority given to treatment for impotence and reflect current expenditure on it.
Briefly, it is proposed that Viagra and other drug treatments for impotence would be available on prescription from GPs for the following groups of men: those who have had radical pelvic surgery or their prostate removed; those suffering from spinal cord injury; diabetics; multiple sclerosis sufferers and those who have single gene neurological disease. Treatment would also be available for other men adjudged by a hospital specialist to be suffering from severe distress. General practitioners would be able to prescribe privately to impotent men not suffering from one of the named conditions.
The period of consultation ended on 25 March and work is now under way to collate the responses. That is likely to be a considerable task as there are about 850 of them. Even at this initial stage, it is clear that the widest possible range of views has been expressed to us. I should make it clear that no final decisions will be taken until we have had the opportunity to consider the range of responses sent in. We will carefully consider all comments that have been received during the consultation period before reaching a final decision. We shall also keep the issue under review once final policies are in place. We have to find a sensible balance between treating men with a distressing condition and protecting the resources of the NHS to deal with other patients with, for example, cancer, heart disease and mental health problems.
All health authorities were issued in 1995 with guidance that covered the use of beta interferon for the treatment of multiple sclerosis. It recommended that prescribing should be initiated by hospital specialists where clinically appropriate. The costs of prescribing are expected to be met within health authority allocations, taking account of local priorities.
However, we should be clear that there are continuing questions about the clinical effectiveness and cost-effectiveness of beta interferon, the benefits achieved, which patients will benefit and for how long, and how the benefits compare with those of supporting patients through, for example, specialist nursing care. Health authorities and clinicians rightly take these and other factors into account when they set local priorities.
We must ensure that clinical and cost-effective treatments are spread through the NHS as quickly as possible, and that is one of the roles of the National Institute for Clinical Excellence, which will provide clear and authoritative advice on key treatments and procedures. Subject to the outcome of consultation on the discussion document and appraisal by NICE, we are minded to refer beta interferon to the institute.
I should like to take the opportunity to address some of the other specific issues and suggestions that have been
raised and made by my hon. Friend. My hon. Friend suggests that we should switch as many drugs from prescription only to over-the-counter status as can be accommodated safely. The Government encourage wider availability of medicines as soon as there is adequate evidence of safety in use. We have tried and effective mechanisms for processing such switches; indeed, they have formed the model for European-wide switching.
My hon. Friend suggests that greater emphasis should be given to the benefits of home health care. The Government are already doing a great deal to promote self-care. Most significantly, we have set up NHS Direct, the 24-hour nurse-led helpline, which has been a big success, with the first three pilot projects achieving a97 per cent. satisfaction rating. NHS Direct is helping patients to make better use of the NHS. Many of the callers change their course of behaviour as a result of their calls.
Drawing on the experience of NHS Direct, my right hon. Friend the Prime Minister announced today plans for extending its role in a number of new areas of activity. Among these is the development of NHS Direct as a health promotional tool, and NHS Direct nurses in west Yorkshire are planning to phone people to remind them of their hospital appointments.
We will also be piloting arrangements under which nurses will be able to call older people who come out of hospital to check that they are all right, or work will be done with family health service teams to help to improve the management of chronic diseases such as asthma and diabetes. NHS Direct will go on the internet as NHS Direct On-Line, so that the public can consult an interactive guide covering common minor ailments to help them decide when they can look after themselves and when they need to seek professional advice.
National health service direct information points may be placed in surgeries, libraries, pharmacies, post offices, supermarkets, accident and emergency departments and healthy living centres. They will be able to provide internet access to NHS Direct On-Line and phone access to a NHS Direct nurse and information on local health services. We shall publish a NHS Direct health guide to help people care for themselves. These are important developments.
My hon. Friend was right to refer to the role that pharmacists can play in encouraging the effective use of medicines. We are working on a strategy for community pharmacy that will take into account the expertise that pharmacists can bring to the use of medicines.
My hon. Friend made some radical suggestions about prescription charges, including the proposal that they should bring in about three times as much revenue as they do at present. In opposition, we promised to review prescription charges, and that we have done. The current prescription charge exemption arrangements were examined as part of the comprehensive spending review, which reported last year. We looked at a range of options for this Parliament, but concluded that the present charging arrangements should continue: all current prescription charge exemptions would be protected for the rest of this Parliament and existing patient charges would rise by no more than the rate of inflation over the next three years.
I am afraid that nothing my hon. Friend has said tonight has persuaded me that that conclusion was wrong.
There are systems such as my hon. Friend proposes in other parts of Europe. I should say that, where they apply, it is almost always the case that Viagra has been placed not in the intermediate category, as he proposes, but in the category of medicines for which patients have to meet the full cost themselves.
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