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3. Mr. John Heppell (Nottingham, East): How many people he estimates are now receiving drugs who would not have received them in their area before recommendations by the National Institute for Clinical Excellence. 
The Minister of State, Department of Health (Mr. John Denham): NICE has completed its appraisal of the taxane drugs. It estimates that an additional 4,000 women with advanced breast cancer and 1,000 with advanced ovarian cancer should now be offered treatment with taxane drugs who might have been denied access to those treatments before guidance was issued.
Mr. Heppell: I thank my hon. Friend for that answer. It is particularly pleasing to know that 5,000 women suffering from breast cancer will receive a proven and effective treatment for that cancer, which they would not have previously received under the postcode prescription
Mr. Denham: The health authorities will be able to meet the costs of this decision from the record increases in funding that we have made available to the national health service and, in particular, the £660 million allocated to health authorities just after the recent Budget.
I am pleased to be able to tell my hon. Friend that, in Nottingham, provision for taxanes has risen from less than £30,000 in the early part of last year to more than £300,000. My officials advise me that that should be sufficient to make the drug available as indicated by the guidelines.
Mr. Nick Harvey (North Devon): Is the Minister satisfied with the progress that NICE is making? Was its original objective to examine not only new and existing drugs, but other procedures and interventions throughout the health service? Given that its first work programme was to examine only 13 drugs, that the plan is to get that number to only 30 per annum and that more than 100 new drugs come on to the market each year, how on earth will it catch up with the task of examining even just the new drugs, let alone its original task of considering all existing procedures in the NHS?
Mr. Denham: I am very pleased with NICE's progress. It has given important guidance on relenza, stents, wisdom teeth and a variety of drugs and procedures. In the first year, it has been essential that NICE establish its credibility in its decision-making and appraisal systems. It will move on to assess more drugs. We are currently consulting on the referral of about a dozen extra cancer drugs to NICE and shall shortly announce decisions on that referral. At the same time, NICE is commissioning guidelines on the handling of several different conditions.
NICE has therefore made a good start to its work. However, the hon. Gentleman is right: NICE is a critical part of the future of the national health service and we must ensure that it has the capacity to do its job fully.
Mr. Michael Jabez Foster (Hastings and Rye): May I tell my hon. Friend how welcome was the recent announcement to add zyban, the anti-smoking drug, to the possibilities to help people give up that terrible habit? However, will he explain why a ban has been placed on the prescription of that drug in East Sussex, Brighton and Hove health authority? Is that simply a local decision, and can my hon. Friend do anything to assist in making the drug available?
Mr. Denham: I shall certainly examine the position in Sussex. The answer is that that would have been a local decision by the health authority. Clearly, we are giving consideration to the question of whether zyban should be referred to the National Institute for Clinical Excellence.
Dr. Liam Fox (Woodspring): On that point, what criteria were used to make sure that beta interferon was referred to NICE, but that zyban was not, before the Secretary of State's decision was announced?
Mr. Denham: There is a set of well-publicised criteria, including the likely impact on the national health service
Dr. Fox: Will the Minister tell us what is the difference, in his view, between affordability and the effective use of clinical resources?
Mr. Denham: Quite clearly, NICE has been asked to assess the clinical effectiveness and cost-effectiveness of drugs and treatments. I believe that, in a speech last week, the hon. Gentleman supported the Government's position that NICE should examine clinical effectiveness and cost-effectiveness. The question of the total amount of resources available to the NHS is clearly a responsibility of Ministers and government.
Dr. Fox: What a muddle. Is it not true that there is no difference between the concept of affordability and the effective use of clinical resources? The Government changed the criteria for NICE because that was merely another spin trick for Ministers who wanted an arm's-length rationing mechanism as they were too cowardly to take decisions directly. Is not the real reason that zyban was rushed in that the Government were desperate to get another good news story on health, regardless of its consequences or even their own policy? Does that not show that Ken Follett was spot-on with his analysis of the Government, when he said that they were intellectually bankrupt, morally suspect, all spin and no substance, and were willing to let anyone suffer, as long as Ministers got good headlines?
Mr. Denham: I do not agree with what the hon. Gentleman says. We have made it perfectly clear, from the time that NICE was first proposed, that it would need to consider clinical effectiveness and cost-effectiveness. That is in all the documents that the Government published. We have made it clear many times that we amended the establishment order for NICE last summer because we had received legal advice that, as the order was drafted, NICE would not have been able to consider cost-effectiveness at all. Given that the hon. Gentleman believes that NICE needs to consider cost-effectiveness as well as clinical effectiveness, he would have been required to make that amendment, had he been in that position--[Interruption.] I must tell Conservative Members that that advice was received by the Government.
5. Mr. Phil Sawford (Kettering): What advice his Department gives to health authorities regarding mergers of NHS trusts. 
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): We have said that mergers should proceed only where they bring clear benefits for health and health care. Every merger must save at least
Mr. Sawford: I thank my hon. Friend for that answer. Does she recognise that in trust mergers, services do not always dovetail perfectly? Where they do not, will she give guidance and ensure that services are levelled up, rather than down, that there is no fragmentation of services and that services to patients are the principal factor guiding the process?
Ms Stuart: Of course, I agree with my hon. Friend, and the proposals for Northamptonshire make it clear that we want to create a new organisation that delivers community-based services throughout the county. It is intended that the new organisation will capitalise on best practice, and the main outcome will be that local people and staff will have access to high-quality, modern community services. My hon. Friend will be aware that consultation on the proposals is well under way, and the outcome will be accepted by Ministers only when it is clear that the proposals represent the best possible options for patients locally.
Sir Sydney Chapman (Chipping Barnet): Can the Minister give a categorical assurance that when two NHS trusts merge, each with its own hospital with an accident and emergency department, it will not lead to one of those departments closing? I am thinking in particular of the merger between Chase Farm and Barnet.
Ms Stuart: It may be helpful if I remind the hon. Gentleman that mergers of trusts should not be confused with hospital services reconfigurations. Merger proposals concern the merging of organisations and management, and the services that are to be provided form part of the reorganisation structure. Trust mergers do not always lead to the closure of associated hospitals--that is always a matter for local consultation.
Mr. Bill O'Brien (Normanton): When considering trust mergers, will my hon. Friend have regard to the fact that we now have community health trusts, whose functions are changing? Are there are any proposals to make trust mergers more efficient by merging community health trusts with hospital trusts, or is there a general policy in the Department to review the workings of community health trusts?
Ms Stuart: As it stands, it is unlikely that community and acute trusts will be merging. It is important to stress that mergers and reconfigurations are being considered because we have ended the competition of the internal market in which one hospital competed with another, and our policy has a wider scope and focuses on the provision of decent services for local areas. I take on board what my hon. Friend said about the provision of community services, but any mergers have to be in the interests of the patients and must provide significant savings for the local community.
Mr. John Wilkinson (Ruislip-Northwood): When contemplating trust mergers, will the hon. Lady always bear it in mind that a clear line of responsibility and chain of command are crucial for the effective provision of
Ms Stuart: I agree with the hon. Gentleman that the whole purpose of the process must be to improve patient care, and that sometimes requires sensitive handling of discussions and negotiations, because some of us fear change more than others. That is why we are always sensitive about the need to consult locally with all key stakeholders and to come up with service configurations that serve local communities. Sometimes that is difficult: when we inherit health economies that have run up huge deficits, hard choices have to be made. However, I reassure the hon. Gentleman that the bottom line for any decision is patient care.