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Mr. Bercow: That was a nice try, but I am afraid that it will not suffice. The Minister has provided an excellent answer to a question that I did not ask, but, unfortunately, he has not provided an answer to the question I asked. If he does not mind, I will choose the questions and I should be very grateful if he would provide the answers. The situation to which I am referring is one in which NICE concludes that it believes that a treatment should be provided, but the Government decide otherwise. If the Government insist on getting their own way, will NICE be at liberty publicly to declare its disagreement with the Government's decision? That is my question.

Mr. Denham: It is absolutely our intention that the appraisals carried out by NICE will be public appraisals. If the national institute produces an appraisal suggesting that a particular drug should be used in particular circumstances and the Government of the day decide that that drug should not be used, that decision will be there for people to see. They will be able to compare the published appraisal of the national institute with the decision taken by Ministers. I hope that I can make some progress, because some other important issues were raised. I turn to new clauses 16 and 17.

Dr. Evan Harris (Oxford, West and Abingdon): I thank the Minister for giving way and, to save time on my reply, may I press him on the nub of new clause 4? I should like to hear from him the following words:

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NICE will not be asked to take into account overall cost or affordability in its calculations and appraisals and will stick strictly--as the hon. Gentleman has already said, although he has not yet limited it to this--to clinical effectiveness and relative cost-effectiveness.

Mr. Denham: I risk repeating what I said several times over in Committee. Some months ago, we published a document on the appraisal techniques to be used by the national institute. We received a wide range of responses, some of which said that NICE must take into account almost every penny of NHS resources and apply a particular procedure to that. Others took the position that NICE should take no account even of cost-effectiveness, let alone wider NHS resources. I said in Committee that we were considering the responses to the consultation and we will decide in due course what factors we will ask NICE to take into account. I have made an important promise this evening, and have repeated what I said in Committee. The key point is that the framework that we establish for NICE and any guidance that is issued to it will be open and transparent. I am repeating a commitment made in Committee.

Mr. Hammond rose--

Mr. Denham: I am somewhat in the hands of the hon. Gentleman, but I had assumed that the House would want to discuss more than one issue this evening. I shall give way to him once more and then perhaps I can make progress.

Mr. Hammond: I thank the Minister for giving way. Will he acknowledge that the question that he has ducked is extremely important? We cannot consider how NICE will operate in practice until we know the answer to it. If NICE will simply consider on a comparative basis the cost of providing a given outcome in a given situation, that will be beneficial--no one would disagree with that--but if it is to be asked to look at different outcomes to different situations and weigh them against each other, that will clearly be a rationing mechanism, which is what Conservative Members have suspected all along. We must know the answer.

Mr. Denham: The hon. Gentleman persists in missing the fundamental point, which is that NICE will provide the guidance sought by clinicians and others in the health service about how they take decisions. They will wish to know, and they will know, on what basis the national institute has reached those decisions and they will be able to take that into account in responding to the guidance. I shall move on--

Mr. Simon Hughes: Will the Minister give way on that point?

Mr. Denham: No, I will resist the hon. Gentleman. The hon. Member for Oxford, West and Abingdon (Dr. Harris) spoke for over an hour last night. [Interruption.] I may have been present for part of that discussion, and I think that it would be fairer to respond to the points that the hon. Member for Oxford, West and Abingdon has already made and with which I have not yet had a chance to deal.

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I turn to new clauses 16 and 17, which would restrict the Secretary of State's freedom to take decisions about which medicines should be prescribable by general practitioners under the NHS. The Liberal Democrats are in a somewhat confusing situation: they are seeking to establish a patients forum to determine what drugs should be available on the NHS and, at the same time, they are tabling new clauses which would remove from any Government the ability to take decisions about which medicines should be prescribable.

Schedule 11 to the National Health Service (General Medical Services) Regulations 1992 lists drugs that can be prescribed under the NHS only in certain circumstances. For example, clobazam can be prescribed only for the treatment of epilepsy, not as a sedative or tranquilliser, but there are good reasons for that. Clobazam offers clinical benefit in treating epilepsy, yet it is a far more expensive sedative or tranquilliser than similar drugs which have the same properties. At current prices, a packet of 30 clobazam tablets costs about £10, but a similar-sized packet of diazepam costs no more than a few pence. It would be ridiculous, I suggest, to countenance the use of clobazam as a sedative when other, equally effective treatments are available much more cheaply. The new clause would make it impossible for a Government to continue to use that provision.

That schedule, subject to parliamentary acceptance of the necessary regulations, will be used to restrict the prescribing of treatments for impotence from 1 July. In this instance, it is proposed that treatment will be available to categories of men with specified underlying organic causes of impotence.

New clause 17 strikes at the heart of the Government's ability to influence or control the costs of prescribing and would constrain even the Secretary of State's ability to issue guidance. He could not say to doctors, for example, "Think about the cost of this medicine when you are considering prescribing it." He could not even point out that an equally effective medicine was available at lower cost. That would be plainly absurd. It would also constrain his ability to make regulations that would either prevent GPs from prescribing things on the NHS or restrict the circumstances in which they should do so. New clause 17 would undermine the purposes of schedules 10 and 11 to the GMS regulations. The majority of the products in those schedules appear as a result of advice from two committees: the Advisory Committee on NHS Drugs and the Advisory Committee on Borderline Substances.

I hope that I have covered the core issues if not the detailed issues that have been raised. We were invited yesterday to agree that the NHS rations; I do not agree with that. We were also invited to agree that rationing is defined as sharing out in fixed quantities; that is precisely what the NHS does not do. We do not each have a fixed quantity of NHS resources. What we use and what we gain from the NHS varies according to our own life histories and ill-health. That is precisely the reason why we reject language that is used only by those who seek to undermine the NHS and put a private health service in its place.

Dr. Harris: I am afraid that that reply varied from disappointing to very disappointing. The Minister is usually correct in his facts, but during a debate, mainly on Liberal Democrat new clauses and amendments, lasting nearly six hours, I spoke for 45 minutes and took

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eight interventions--a greater number than he was able to take in his reply. I regret that he would not take the intervention of my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes), our Front-Bench spokesman, which he has been good enough to do in the past.

On new clause 4, it is clear that the Government are hiding their answer behind a consultation process. I believe that primary legislation--this may be our only opportunity to discuss this issue on that basis during the current Parliament--should take precedence over consultation. It will not do for the Government to try to hide their position behind a consultation process in which, according to the Minister himself--I think that he understood this point--there would be extremes of view. People, certainly including clinicians and patients' organisations, are desperate to know whether the Government are minded to allow guidance to come from a professional body on the basis of affordability or of overall costs. As the Government have not allowed us a separate debate, this is our best opportunity to find that out.

The Government say that it is for them to regulate on the basis of guidance from the institute--guidance which will bind neither them nor individual clinicians. We fear, however, that this Government or other Governments may say, "We must look at the guidance from the professionals. We would be foolish to ignore it." We are keen to ensure that a professional body--or, at least, a body that is informed by experts and by professional advice--is not forced by the Government to consider matters that should be solely the Government's remit, and that the Government are not allowed to hide behind such arrangements.

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