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14. Mr. John Bercow (Buckingham): What action he is taking to ensure that patients are represented during the deliberations of the National Institute for Clinical Excellence. [127523]

The Minister of State, Department of Health (Mr. John Denham): The National Institute for Clinical Excellence is responsible for determining its own processes. However, NICE invites submissions from relevant patient groups and offers them the opportunity to comment on draft conclusions of its guidance. There is also patient or lay representation on all of NICE's key committees, including the appraisal committee, the guidelines committee and the appeals panel.

Mr. Bercow: I am grateful to the Minister for that reply. However, given that, on his own admission, patients are not directly represented on NICE, will he confirm that NICE's assessment of the cost-effectiveness of beta interferon has taken full account of the costs of home care, domestic adaptations, welfare payments and tax revenues forgone when individuals who are clinically suitable for the drug are denied it? Will the Minister also confirm that the institute will publish in full its findings on those important considerations?

Mr. Denham: I think the House and the hon. Gentleman will understand that the Government will not comment on a leak of a draft appraisal--there is some way to go before the full appraisal is published. Publication will occur possibly in August, depending on whether there is an appeal. In general terms, I can say that NICE will receive whatever evidence manufacturers, patient groups or others wish to give about the wider social costs that should be taken into account, and the way in which that should be done.

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NICE is certainly required to consider the costs and impact on the NHS and personal social services expenditure. On publication, it is for NICE to determine the way in which it publishes its guidance. On past performance, NICE normally sets out clearly the assessment it has made of the evidence and the way in which it has reached its conclusions. I therefore have no reason at this stage to believe that this case will be any different.

Dr. Phyllis Starkey (Milton Keynes, South-West): Will my hon. Friend confirm that when NICE makes its assessment of drugs and treatments, it takes into account patients' views on the way in which those treatments or drugs have improved their quality of life as well as abated

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their symptoms, but that that evidence must be subject to the same rigorous scientific assessment? That would avoid the clouding that the placebo effect provides.

Mr. Denham: My hon. Friend makes an important point. It is obviously essential that NICE's decisions and conclusions command confidence, not only among clinicians but among patients. That is why NICE invites patients' organisations to give evidence. I am sure that those organisations put forward the views of individual patients as well as their assessment of the scientific evidence. However, it is for NICE to determine the methodology that it wants to use, and to reach a conclusion about the evidence, its form and the weight it wishes to give it. I am sure that it gives great weight to properly validated scientific evidence.

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Civil List

3.30 pm

The Prime Minister (Mr. Tony Blair): With permission, Madam Speaker, I should like to make a statement on the civil list, which supports Her Majesty the Queen in carrying out her official duties as head of state.

The Civil List Act 1972 requires the royal trustees--my right hon. Friend the Chancellor of the Exchequer, the Queen's Treasurer and me--to report at least once every 10 years on the royal finances, and to make recommendations to the Government on future civil list arrangements. The current 10-year period ends later this year. We have therefore reviewed the current arrangements, and are today laying a report before the House. It proposes that the amount of the civil list should remain exactly the same over the next decade as it has over the preceding one. It also proposes that the civil list should take on some costs of the monarchy currently met from other sources.

The report sets out not only expenditure on the civil list, but expenditure on the monarchy more widely. That includes the grants in aid for the royal palaces and travel, and spending undertaken by Departments. The report records the very substantial saving of 55 per cent. in real terms over the last 10 years on spending on the monarchy generally.

The annual figure for the civil list was set by the last Government at £7.9 million in 1990. With Her Majesty the Queen's agreement, and following consultation with the Leader of the Opposition, the Government propose that the annual payment should remain at £7.9 million for the next 10-year period. By the year 2010, therefore, the cost of the Queen's civil list will have remained at exactly the same level for 20 years. In addition, there will be costs transferred from public spending in Departments which will now be met by the Queen's civil list. All in all, this represents a substantial saving as a result of lower inflation, and the efficiency of the way in which the Queen's expenses have been managed.

The principal additions to civil list expenditure will be pension contributions to be paid to the Consolidated Fund, and some of the running costs of the royal palaces which are currently funded within the property services grant-in-aid. In total, around £25 million of extra spending over the next 10 years will be transferred to civil list expenditure from other sources. By expanding the costs for which the royal household is directly responsible, we will contribute to the continuing drive for efficiency to which I know it is committed.

We are able to make this proposal for two reasons. First, as I said, the royal household has achieved substantial efficiencies in the civil list over the last decade, amounting in total to some 10 per cent. in real terms. Indeed, the actual increase in expenditure over the decade has been held below inflation. In addition, when the figure of £7.9 million was set 10 years ago, it allowed for an inflation rate of 7.5 per cent. per annum, in line with the average annual inflation of the 1980s. Inflation has turned out much lower than was allowed for. As a result of those factors, a surplus of £35 million on the civil list has accumulated, including interest of around £12 million.

Under the Civil List Act 1972, civil list provision may be increased by order, but it may not be reduced. However, the Act also provides that any surplus at the

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end of one civil list period be carried forward to meet official expenditure in later years. This is what will now happen. We expect, nevertheless, that there will be a prudent balance at the end of the period, amounting to around one year's spending at that time. That will enable unforeseen eventualities to be met, should any arise. If they do not, the surplus will be available to fund civil list spending during the current reign from 2011 onwards.

The Queen, supported by other members of the royal family, carries out a wide range of duties on behalf of the nation as head of state. The arrangements that I have announced will provide proper support for Her Majesty in that role. They also reflect the principles that Parliament has embodied in legislation, and which I am happy to reaffirm. They support continuing improvements in efficiency by ensuring that financial and management responsibility go hand in hand; and they are in keeping with the honour and dignity of the Crown, the importance of the role carried out for the nation, and the high regard and affection in which the Queen and the royal family are held.

Mr. William Hague (Richmond, Yorks): May I thank the Prime Minister for his statement and for giving me advance notice of it, and express the Opposition's support for what he has announced? We shall, of course, study the trustees' report carefully, but we remain of the view that the Civil List Act 1972 set out the best framework for the determination of civil list expenditure. We therefore support the future arrangements that he has announced. They are in line with the principles set out in the previous statement on the matter by the then Prime Minister, Baroness Thatcher.

Does the Prime Minister agree--I am sure that he does, given his statement--that the record of the past 10 years provides clear evidence that the civil list is spent wisely and that the royal household has been managed well? Is it not the case that the royal household has made the most of its resources, has been willing to adapt and has supplemented the revenue from the civil list with the prudent use of other sources of income? Does he further agree that the opening of Buckingham palace to the public, the royal family's commitment to pay income tax and the publication of an annual report on royal expenditure have demonstrated a commitment to openness and a willingness to change?

The new arrangement reflects the climate of low inflation, which the Government inherited from their predecessors. However, we--and more particularly Her Majesty the Queen and the royal family--are being asked to take on trust that it will continue. As Members on both sides of the House know, economic forecasts should always be treated with some scepticism. Does the Prime Minister therefore agree that the trustees should lay a further report if it became clear during the coming decade that inflation was significantly outpacing the Chancellor's forecast?

We on the Conservative Benches believe that the value of the service given by the Queen and her family to our country far exceeds any sum granted in the civil list. We are in no doubt of the importance of the monarchy to our national life. As Members of Parliament, we swear

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allegiance to the Queen with pride. We hope and pray that she and her family will continue to give service to our country for many years to come.

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