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Mr. Fabricant: I am sure that my hon. Friend would not want the House to think that it is only beta interferon that the Government claim has clinical deficiencies. Is my hon. Friend aware that the Government also claim that Taxol, an excellent drug used in the treatment of certain cancers and in the reduction of certain malignant tumours, should be restricted not because of its cost but because of its efficacy? However, clinical oncologists argue that Taxol is an effective means of treating certain forms of cancer.
Mr. Bercow: I am grateful to my hon. Friend. I was not aware of that point. My hon. Friend has now enlightened me and, in so doing, he underlines the fact testified to by my hon. Friend the Member for Runnymede and Weybridge that this problem applies across the board.
Mr. Fabricant: Would my hon. Friend care to speculate that the Government would earn respect not only among parliamentarians but among those in the medical profession if they came clean and said, "Yes, there is rationing. That is not surprising. There ought to be rationing because, whether we like it or not, there are limited resources. Given that there is rationing, let us approach the problem logistically, logically and systematically and try to find a solution"? The fact that they deny that rationing takes place and that they try to deceive the electorate and patients means that they earn the disrespect of this House and those who know that the NHS is not safe in Labour's hands.
Mr. Bercow: I agree entirely with my hon. Friend. That lack of candour applies across the board. I appeal to the Minister to abandon his nescience and to admit that the Government are trying to present the issue in a way that
clouds the facts instead of clarifying them. [Interruption.] I am sorry if the Minister is uncertain about the word "nescience". The late parliamentarian of 37 years' standing, the right hon. Member for Down, South--and, before that, the Member for Wolverhampton, South-West--once said to the Member for Harrow, East, who was so unwise as to claim that Mr. Powell had used a word that did not exist, that if, during the drier parts of his speech, the hon. Gentleman would like to avail himself of a copy of the Oxford English Dictionary in the Members' Library, he might look up the word "transfretation", and he would find it all right. I say to the Minister that if he looks up "nescience" in the dictionary, he will certainly find it. I shall not help him because he should learn by discovery and the effort required to consult the dictionary. He will benefit from that.
The Minister acknowledges that there is a patchwork of provision of beta interferon throughout the country. That point is common ground between us. In the debate on 14 May, he reiterated what he had said at health questions some 10 days earlier. He said that there are great disparities between what health authorities in different parts of the country provide. We agree on that.
Dr. Dennis Briley, consultant neurologist at Stoke Mandeville hospital, which serves many thousands of my constituents, has described that situation as treatment by postcode. He disapproves of that, I disapprove of it and the Opposition disapprove of it. The Minister of State implies that he disapproves of it and contends that the Government's proposals for the National Institute for Clinical Excellence will lead to increasing provision and greater equality of provision throughout the country. I am not sure that their proposals will deliver anything of the sort because I subscribe to the view of my hon. Friend the Member for Runnymede and Weybridge that NICE is being set up in a way that will give the Government an excuse to ration while avoiding the blame for its effects. They intend NICE to carry the can.
I am concerned, and my concern is reinforced because the Minister of State has on several occasions given a bogus reason for the disparities in treatment. I will not accuse him of bad faith.
By the standards of a Labour Minister, and at the risk of causing grave embarrassment and damage to his future, I shall go so far as to say that I have always thought the hon. Gentleman the closest approximation to a normal human being on the Government Benches whom I have encountered since 1 May 1997. I do not think that he is advancing such a reason deliberately. I think that he genuinely believes that difference of opinion among consultant neurologists is the reason for the disparity in provision of beta interferon across the country.
On 4 May, in answer to a question from me, the Minister suggested that differences of opinion among consultant neurologists explained the variations in the amount of treatment provided by different health authorities.
Mr. Denham:
I am grateful for the hon. Gentleman giving way on this very important point. I believe that the record will show that I indicated that it was one of the factors that influenced the differences in prescribing.
Mr. Bercow:
I am grateful for that assurance. The Minister is edging his way towards a more satisfactory position. He will forgive me for saying so, but when he made that point before, he did so with some emphasis. The impression which many of us gained, including my constituents who suffer from the relapsing, remitting form of multiple sclerosis, was that he was taking refuge behind clinical differences of opinion. I do not say that unkindly to the Minister, but my constituents, Caroline Cripps, who is 28 years old and from Westcott, and 31-year-old Mr. Marc Smith from Buckingham, both believed that the Minister was trying to use that point as an excuse for the variations in provision. If he is assuring me now that it is but one of the factors and that it is by no means the major factor, I am very grateful. The debate has already advanced if he is prepared to make that admission.
I should like to take the debate a stage further. If the Minister is to advance difference of opinion among consultant neurologists as an explanation--not necessarily a justification--for the disparities in treatment, he is duty bound to consider the position when no such disagreement exists, but, rather unanimity of view.
I cannot expect the Minister, much as I would like him to do so, to recall word for word the exchanges between us during an Adjournment debate on 14 May. He may recall that I reminded him of the position in the south-west of England, where all 18 consultant neurologists had decided that the provision of beta interferon for particular multiple sclerosis sufferers would be clinically effective. Despite that unanimity of view, such treatment was for long periods not made available. Therefore, it is simply not good enough for the Minister to talk about differences of opinion as an explanation for the provision of treatment.
When there is unanimity of view among the people whom we all accept are the experts, and still the funding is not made available, we must conclude that other factors are at work. Either a political decision has been made or financial factors explain the unwillingness to fund.
Mr. Swayne:
Is not the very purpose of new clause 4 to ensure that the national institute takes a considered view on the basis of positive science as to the efficacy of a treatment such as beta interferon? The danger, as evidenced by the statements of the chairman of the national institute, is that NICE may well decide that such treatment should not be available simply on the ground of cost.
Mr. Bercow:
That possibility does exist. I am sure that my hon. Friend will agree that it emphasises the importance of having the maximum discussion in public of what the priorities should be, the criteria upon which judgments are made, and the mechanisms to review those judgments.
There is no shame, even for a commission, in making an honest mistake. There is only shame in failing to acknowledge the possibility of having done so. It is precisely because we can get it wrong from time to time, and clinicians can make mistakes, that there must be review mechanisms. The magnifying glass of publicity,
which the hon. Member for Oxford, West and Abingdon mentioned in different terms, is important in that process. The more private discussion and confidentiality there is, the less confidence there will be. The more public discussion and openness there is, the greater confidence there will be in the propriety of the decision-making process.
Mr. Brady:
Does my hon. Friend agree that it is a matter of concern that, in the pursuit of cost saving through the activities of the National Institute for Clinical Excellence, there may be a reduction in communities' ability to have an input into the priorities for health care, and that, in pursuing uniformity, NICE may be the enemy of good provision because, at the moment, some communities may set different priorities from others?
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