House of Commons
Tuesday 28 March 2000
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
PRIVATE BUSINESS
City of Newcastle Upon Tyne Bill [Lords] (By Order)
Order for Third Reading read.
To be read the Third time on Tuesday 4 April.
Order for Second Reading read.
To be read a Second time on Tuesday 4 April.
1. Mr. Andrew Stunell (Hazel Grove):
What estimate he has made of the additional cost to the NHS of permitting prescription of beta interferon wherever clinically indicated. [115148]
The Minister of State, Department of Health (Mr. John Denham):
No estimate has been made, since opinions vary about when beta interferon is clinically indicated. We have referred beta interferon to the National Institute for Clinical Excellence, and we expect to receive its draft report at the end of May.
Mr. Stunell:
I am sure that, in the next 60 minutes, we will hear several times about the large amounts of money going into the NHS. Will the Minister give an undertaking that when the decision on beta interferon is made, affordability will not be a barrier, and that treatment levels of the drug will rise to the European level of 12 per cent. against the current 3 per cent?
Mr. Denham:
It is for NICE to give guidance on the clinical and cost-effectiveness of beta interferon to enable us to make the best use of resources. It remains, as it always has been, the responsibility of Ministers to determine the level of resources available in the NHS.
Mr. Harry Barnes (North-East Derbyshire):
Has the Minister seen the league tables in The Mirror today which show the health authority provision of medicines and drugs, with a variety of provision for beta interferon? Some areas are not supplied, some are partially supplied and some are fully supplied. What lessons does my hon. Friend draw from that information?
Mr. Denham:
I draw the lesson that the Conservative party is the mother and father of the postcode lottery in care. The following of the guidance on the prescription of beta interferon, which was introduced by the previous Government, remains, and has led to this situation. I am pleased that this Government have been able to set up NICE, which will tackle the postcode lottery of care, and that we have been able to announce a substantial increase in resources for the NHS to enable spending on the treatment of patients to increase.
Mrs. Ann Winterton (Congleton):
The national health service is supposed to be precisely that--national. Multiple sclerosis patients have a right to expect that, where it is clinically approved, they should have the drug of their choice. When will the Minister take charge of the situation, and not use NICE as a cop-out?
Mr. Denham:
The hon. Lady must know that the guidance currently being followed by the NHS was introduced several years ago by the previous Administration. It is precisely because the Government were not happy with that situation that we created NICE. We referred beta interferon to it as one of its first year's programmes of work. We look forward to receiving advice later this summer, as this is the only way in which we can tackle the postcode lottery of care from which so many people are suffering.
Mr. Nick Ainger (West Carmarthen and South Pembrokeshire):
Does my hon. Friend agree that there is another drug, prostocyclin, with the same problems as beta interferon, in that health authorities cannot afford to pay for it? As a result, patients are dying. In the United States, the same British-made drug is four times cheaper than it is here. Is not the solution that those high-priced drugs with relatively small use are modulated, in that their prices drop to an affordable level while the general price of drugs provided by the same drug company is slightly increased? If so, the price to the NHS would remain the same; we would not have postcode prescribing; and, in the case of prostocyclin, patients would live.
Mr. Denham:
I am aware of my hon. Friend's concerns about the use of prostocyclin for pulmonary hypertension. This drug has not been licensed to treat that condition, which means that it is prescribable only on a named-patient basis. That means that it is being prescribed in small numbers, and there are not the economies of scale that are seen in America, where the drug is more widely licensed. In general, US drug prices are some 70 per cent. higher than in the NHS. The pharmaceutical price regulation scheme will save some £200 million in the coming year from the drugs budget, which will become
Mrs. Caroline Spelman (Meriden):
The fact that affordability was slipped into the criteria used by NICE by virtue of a statutory instrument amending the Health Act 1999 would mean that NICE, in deciding on treatments such as beta interferon, could be at odds with the Secretary of State, who said on 8 March:
Mr. Denham:
As I have already said, the ultimate determinant of affordability is the level of resources available to the national health service. I am very proud that, over the next four years, this Government are committed to putting a level of resources into the national health service that will be twice the rate of increase achieved by the previous Conservative Government, under whose stewardship so many of the problems arose. If a Conservative Government were returned to power, they would return to a policy of postcode lottery and underfunding. They would promote a policy of forcing patients to buy their own drugs.
2. Mr. Michael Clapham (Barnsley, West and Penistone):
What assessment he has made of the improvements brought about by health action zones. [115149]
The Secretary of State for Health (Mr. Alan Milburn):
Our own monitoring of health action zones and independent evaluations both show that the extra resources that we have committed to them are helping them to modernise health services and tackle health inequalities. Today, I am making further funds available for health authorities in health action zone areas, and for authorities in all parts of the country.
A total of £600 million is being allocated today from the extra resources that my right hon. Friend the Chancellor announced for the NHS in his Budget. The new resources will put local health services on a sound financial footing. They will help in preparing better for winter, in tackling waiting lists and waiting times, and in putting NICE recommendations into action.
I am directing health authorities to pass all the money directly to primary care groups, which in turn will pass it on to NHS trusts and hospitals, so that patients feel the benefit in better, faster front-line services. There will also be a bonus fund of £60 million to reward good performance in achieving local targets.
I am writing today to all hon. Members, including those in health action zone areas, with details of these extra funds.
Mr. Clapham:
I thank my right hon. Friend for that answer, and I especially welcome the new resources that he is to make available to health action zones. The health
I hear what my right hon. Friend says about the money going straight to primary care groups, but will he ensure that there is a close working relationship between the PCGs and the health action zones so that, in tandem, they can tackle the priorities identified in the health improvement plan?
Mr. Milburn:
I am aware of the work of the health action zone in my hon. Friend's constituency--indeed, I think that I launched it a couple of years ago. I am glad that it is making progress, and that my hon. Friend is closely involved with it.
I can assure my hon. Friend that we want the health action zones, the primary care groups, the NHS trusts, the health authorities and the local authorities to work very closely in tandem. We want there to be one care system in future, rather than the competing care systems that may have existed in the past.
I can further assure my hon. Friend that I have a very clear message for the health service. The Government have provided the extra resources that were being demanded for the national health service. The challenge now, for health services in my hon. Friend's area and elsewhere, is to use that money to good effect, to get it to the front line, and to start to make a difference that patients can see.
Mrs. Marion Roe (Broxbourne):
I was most interested in that reply from the Secretary of State, but I should be even more interested to hear his response to the findings contained in the report entitled "The Widening Gap". It found that the areas selected for health action zones are vague, and that they are not based on greatest health needs. What is the right hon. Gentleman's response to that?
Mr. Milburn:
If the hon. Lady had bothered to visit the constituency of my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham)--who I think would be very happy to extend an invitation and where I am sure that she would be extremely welcome--she would understand about health inequalities and the sort of problems that my hon. Friend's constituents face. The Government are determined to achieve two things. First, we aim to improve the health of the population overall, which of course is the right thing to do. Secondly, we aim to improve the health of the worst off at a faster rate--precisely in order to narrow the health inequalities that are a scar on our nation.
Mrs. Linda Gilroy (Plymouth, Sutton):
I thank my right hon. Friend for his reply to my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham). He is very welcome to visit the health action zone in Plymouth, as is the hon. Member for Broxbourne (Mrs. Roe), who seemed so sceptical about its ability to deliver.
Last Friday, we launched a parents forum in Plymouth. My right hon. Friend earlier mentioned partnership values: does he agree that it is very important to involve parents in the future health of their children?
Mr. Milburn:
I welcome the initiative with which my hon. Friend the Member for Plymouth, Sutton
There is an important lesson for the health service in general here. In the future, we want to see much better engagement, not just with parents but with patients. After all, that is what the national health service exists to do--to provide services for patients. In the health action zones, and in other parts of the country, now that the NHS has the resources that it was calling for--the significant increases in funding at historic levels on a sustained basis--we want to see a real engagement, not just nationally but locally, with patients organisations, so that patients receive the services they deserve.
Dr. Peter Brand (Isle of Wight):
I am sure that the Secretary of State will accept that all the country is a health action zone of one type or another, and that much work has been done to create the health improvement programmes that are the basis of health delivery in a given locality. Can the right hon. Gentleman assure us that the criteria set for the money flowing down into localities, and the bonus payments, will be local criteria, accepted by the Secretary of State as part of his health improvement programme, but that the determination of the flow of money will be made locally rather than at Richmond house?
Mr. Milburn:
I should explain to the hon. Gentleman that today I am making available two sources of extra funding for the national health service from the money that the Chancellor announced last Tuesday. First, there is £600 million extra for the NHS to deal with the very real service pressures that the hon. Gentleman, and others, have been banging on about for some time. That money was called for by the NHS Confederation the weekend before the Budget statement. It is to deal with the issues of winter, waiting, and getting back into financial balance. On top of that, a further £60 million is available, but that is dependent on good performance. Frankly, once we provide these extra significant levels of resources--twice the level of real-terms growth that we have seen in the NHS over the past 25 to 30 years--there should no longer be any excuse for poor performance. Patients in every part of the country want excellence, not excuses, and the new fund is designed to incentivise good performance.
"I take decisions about affordability."--[Official Report, 8 March 2000; Vol. 345, c. 1022.]
If NICE agrees that beta interferon is an effective treatment, will the Minister still stand in the way by saying that it is not affordable to the NHS?
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