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Drugs (Funding)
10. Dr. Ian Gibson (Norwich, North): What plans he has to provide resources for drugs recommended by the National Institute for Clinical Excellence. [106247]
The Minister of State, Department of Health (Mr. John Denham): New drugs and treatments are constantly being introduced to the NHS. The cost of those treatments--whether or not they have been referred to the National Institute for Clinical Excellence--is met from the rising resources allocated to health authorities. Those resources increased by 6.6 per cent. this year and will increase by 6.8 per cent. next year. NICE guidance will tackle the different local interpretations of evidence that have led to unacceptable variations in access to treatment and care.
Dr. Gibson: Does my hon. Friend agree that drugs, such as Taxotere, which is extremely effective in advanced breast cancer, and Taxol for ovarian cancer, are not being spread throughout our population? Many women are not being given the right to be prescribed them. Does he agree that we need to allocate more resources to that matter? If NICE finally comes to its senses and realises that those drugs are effective, will my hon. Friend supplement the budgets of health authorities which want to use those drugs to treat everyone who would benefit from them?
Mr. Denham: My hon. Friend will understand that it would be wrong for me to comment on topics that are under proper consideration by NICE. However, in general the problem is often one of different local priorities--different views of the evidence. The whole point of referring key drugs to NICE is to provide consistent guidance through the NHS to identify those drugs that are both clinically effective and cost effective, and which represent a good use of NHS resources. When NICE produces such approved guidelines, we expect NHS organisations systematically and consistently to take account of them. Clinical governance and the Commission for Health Improvement will help to ensure that.
We are keen that clinically effective and cost-effective treatments are spread more quickly throughout the NHS than they have been in the past. The issue of authoritative guidance from NICE will help to ensure that and will tackle the unacceptable variations to which my hon. Friend has drawn attention.
Mr. Douglas Hogg (Sleaford and North Hykeham):
The hon. Gentleman will be aware that I have raised in the House and in correspondence the relative unavailability in Lincolnshire of beta interferon. He will understand that we all welcome the reference of beta interferon to NICE. However, does he realise that the problem is the lack of resources in Lincolnshire? Unless he is willing--in the event of a positive recommendation from NICE--to put more resources into the authority's budget, it will not be possible to give expression to the institute's recommendation.
Mr. Denham:
Again, it would be wrong for me to comment on a particular drug that is being considered by NICE, but I have two things to say to the right hon. and learned Gentleman. The system that has led to very uneven availability of this drug and others was introduced by the previous Government. The existing guidance on the use of beta interferon was introduced by the previous Government, and that is where the problem originated. It is precisely because we do not find such a situation acceptable that we have set up NICE, and we have referred several drugs to it.
I believe that people locally are taking different views of the evidence, which leads to differences in the availability of different treatments. When we have guidance from NICE, that will be consistent and authoritative and we would expect people taking decisions to take full account of it.
Mr. Denis MacShane (Rotherham):
In welcoming NICE, which will put an end to the Tory racket of postcode prescribing, is my hon. Friend aware that there are a great many rising expectations of NICE, and that if NICE strikes a drug that many believe is of use off the list that is available on the NHS, that will greatly disappoint many people? Is he, in his discussions with NICE, drawing its attention to the need to make more drugs available, not fewer?
Mr. Denham:
NICE is aware of the resources that are available to the national health service. It is aware that those resources are rising and that spending on drugs has increased faster than the resources available to the national health service.
The good news for my hon. Friend is that NICE is taking its decisions in the context of a Government who are committed to investing in the national health service and to increasing that investment, because we certainly want to ensure that clinically effective and cost-effective treatments which are a good use of those resources are made available in the national health service. That is so very different from the record of the Conservative Government, who introduced a system of postcode prescribing which determined what sort of treatment a person could obtain. The Conservatives now have a new
policy--they want to do away with the previous one and simply tell people that they can obtain treatment only if they can afford to pay for it.
Rev. Martin Smyth (Belfast, South):
I understand the problem to which the Minister refers, but what answer would he give to the lady who wrote to me to say that she had taken part in randomised testing, at the end of which, after she had found benefit from the treatment, she was told by the doctor that she had been taking not a placebo but beta interferon, but that, because of the restrictions, it was unlikely that she would be able to get it in future? Surely the hon. Member for Norwich, North (Dr. Gibson) was emphasising an issue that needs to be addressed, namely, to provide effective treatment throughout the country.
Mr. Denham:
One of our problems is that the results of proper drug trials are sometimes interpreted differently by different clinicians and different health authorities, which can lead to a difference in the pattern of provision. The great advantage of NICE is that it brings together leading clinicians within an organisation that draws heavily on the expertise not just of clinicians, but of managers and of patients' groups, in order to make an authoritative assessment of the evidence emerging from those trials.
I believe that that will be a great strength to the national health service, because it will mean that the advice that is available to decision makers is based on the best evidence about what works clinically, is cost-effective and is a good use of NHS resources. I hope that that will mean that those patients who may be in the position that the hon. Gentleman's constituent describes get treatment if that treatment is clinically effective and cost-effective for them.
11. Mr. Harry Cohen (Leyton and Wanstead):
If he will make a statement on the number of acute beds in NHS hospitals. [106248]
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart):
Acute beds have remained broadly stable under this Government at around 108,000. Even so, there is a view that in some places hospital bed reductions may have gone too far or alternative services may not have been put in place. That is why the national beds inquiry was set up. It is now nearing completion and its findings will be published shortly.
Mr. Cohen:
Is the Minister aware that local NHS chiefs have said that more beds are needed in my health area, Redbridge and Waltham Forest, and that the Association of Community Health Councils has said that more beds are needed nationally? Under the previous Government, 40,000 NHS beds were cut. In September 1998, the present Government set up the national beds inquiry. Is it not time that it reported, and that the Government responded to it? Is it not the case that we need more beds--not only acute beds, but mental health and intensive care beds? I hope that the Government will not go to sleep on this issue.
Ms Stuart:
I can assure my hon. Friend that we have no intention of going to sleep on anything, unlike previous
It is not just a question of beds and the use of beds--we needed to make sure that we considered the use of hospitals as a whole system and that we examined the use of day-care beds for elective surgery, the use of acute beds and the use of beds for critical care. The latest information arrived in December and we are processing and analysing the data. We shall publish the report shortly.
Mrs. Marion Roe (Broxbourne):
Acute beds need nursing staff to care for the people in them. How does the Minister intend to tackle the problem of nurse recruitment, given that the Labour Government's campaign has been less than successful? The United Kingdom Central Council nursing register continues to fall. It shows that 12 per cent. of those on the register are over the age of 55 and that fewer than 20 per cent. are under the age of 30, thus creating an age timebomb. How does the Minister intend to tackle that problem?
Ms Stuart:
Unlike the previous Government, we responded to the need for nurses not by cutting nurse training places, but by increasing them. Since the Government came to power, 2,500 extra places for training have been created, 2,500 nurses have returned to the profession and we have also trained extra doctors. That is forward looking. We have not cut services and then tried to blame someone else for that.
Mr. Bill Rammell (Harlow):
Does my hon. Friend agree that nobody with any credibility will listen to the criticisms made by Conservatives Members about acute bed numbers or the number of nurses in the system? Does she agree that the problem of acute beds is the result not only of the 40,000 beds that were cut under the previous Government, but of developing a belief in the health service that increased efficiency would always reduce the number of beds? Therefore, if the inquiry suggests that we have too few acute beds in the system, will the Government act on its findings as a matter of urgency?
Ms Stuart:
Of course, techniques change and the use of beds has to be assessed. That is why the national beds inquiry will consider the matter. There has been an increase in elective surgery and something like half of all elective surgery now takes place in day-care units. The important point is that we shall examine the system, modernise the NHS and respond to strategic needs. We will not say that the answer to long-term problems is the private sector and privatising the national health service.
Dr. Liam Fox (Woodspring):
During the past year, how many intensive care beds have been created?
Ms Stuart:
I am aware that on a previous occasion I told the House that some 100 critical care beds have been created. I am delighted to say that that figure is not correct.
Dr. Fox:
That was an interesting answer, but to a different question. I did not ask about critical care beds; I asked about intensive care beds. In the last health debate, the Secretary of State said that he had managed to identify eight; in his letter to me of 6 January he said that there were 100; on "Breakfast with Frost" the Prime Minister said that there were 60; and when my hon. Friend the Member for Daventry (Mr. Boswell) asked about the number of additional intensive care beds that had been created in each NHS trust in 1999 he was told:
Ms Stuart:
My right hon. Friend the Secretary of State has written to the hon. Gentleman to clarify the position. However, if he is really interested in patient care, he will look at the figures published in the latest research, which was verified on 17 January. If he is interested in the truth, he will look at that rather than scoring cheap points that do not benefit any patients at all.
Dr. Fox:
Imagine the audacity of the House of Commons in wanting information from a Minister! These Ministers could not ask for water if they were thirsty. Is not the truth that information that the Government do not like is denied, distorted or withheld? Like the Home Secretary's numbers, the Health Secretary's intensive care beds are complete fantasy. Will the Minister guarantee that by this time next year there will be an increase in the number of intensive care beds as well as critical care beds, and that those figures will be published monthly by trusts throughout the country? We could all then know the truth--we certainly cannot take the Government's word for it.
Ms Stuart:
The hon. Gentleman has to make up his mind about what kind of backseat driver he wants to be. Does he want to keep saying, "Give us information faster and faster", or does he want reliable information that is analysed properly? Information, such as that produced by the national beds inquiry, is being analysed properly and will then be made available, and other information will be made available more quickly. Surely we should give out appropriate information at the right time and in the right place when it is most useful for management decisions.
"Information is not available in the form requested."--[Official Report, 24 January 2000; Vol. 343, c. 103W.]
Given that all those answers cannot be correct, which ones were untrue?
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