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The noble Lord said: My Lords, I have read with great care and interest what the Minister said last week. I should also like to place on record my thanks to him for his very full follow-up letter. He will, I am sure, be delighted to see that I have slightly changed the wording of my amendment for this afternoons proceedings.
I remind the House that the purpose of this very simple amendment is twofold: to encourage patients to finish their prescribed drugs and to realise what outstanding value for money they are getting. I have consulted widely on this subjectit appears to have met with support from the medical profession and, indeed, from all the pharmacists with whom I have spoken. I do so hope that, with the revised wording, the Minister will now be able to accept the amendment. I beg to move.
Baroness Finlay of Llandaff: My Lords, I commend the noble Lord, Lord Palmer, on tabling the amendment, which has a great deal of merit in it. He is right that many patients obtain repeat prescriptions without thinking about whether they need them and accumulate boxes of different drugs, some of which are expensive. The trouble is that some of the most responsible and sickest patients will look at the price of their drugs, feel horrified and feel honour bound to the rest of the population to stop them. Therefore, there is a tension between this action coming out of the blue and remaining with the status quo. As far as I know, there has never been a large-scale study of the merits or otherwise of pricing up the drugs for patients. There are merits too in terms of giving information to patients.
I hope that the noble Lord, Lord Palmer, will accept that the amendment is probably a little before its time and that when a definitive study has been carried outmany people have the hunch that he will be proved rightit may then be a good measure in terms of informing the public about the drugs that they are taking and openness of information.
Earl Howe: My Lords, on Report I was happy to support the noble Lord, Lord Palmer, in the case that he made for transparency of pricing on medicines. Having listened to him again I still think that the idea has merit. Indeed, I was encouraged that the Minister himself acknowledged that there is benefit in patients having access to as much information as possible. However, the noble Baroness, Lady Finlay, has made an extremely important point. We are to a large extent treading into the unknown and it would be nice to have more information than we do on some of the key issues rightly raised by the Minister in his letter to the
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While the noble Lords idea has more than a germ of merit to it, it is perhaps premature to consider it seriously in the context of the Bill. Nevertheless, I hope that the Minister will consider the idea seriously as he takes the Bill away.
Lord Walton of Detchant: My Lords, at first sight I too found this an attractive amendment. One of the problems that we have encountered over many years in the National Health Service is that patients have had little information or understanding of the cost of many of the procedures to which they are subjected, not least in relation to the cost of drugs that they receive. At the same time I share some of the anxieties expressed by my noble friend Lady Finlay about the amendment. It seems to me that the Minister might consider the possibility that at the right moment a limited pilot study of the effects of something similar might be well worth carrying out in order to inform the public and to inform government policy at some time in the future.
Baroness Barker: My Lords, I indicated during our earlier discussions that we, too, have a great deal of sympathy with the noble Lord, Lord Palmer. I believe that he has the basis of an extremely good idea here. I support it not because it is likely to dissuade patients from taking medicines that they are prescribed but because it might enable them to have a far more informed discussion with the different people in different parts of the NHS who are involved in prescribing medicines and taking medicines away and who frequently give patients conflicting instructions that do not seem to make sense. Anything that informs patients is positive. Some patient groups are incredibly well informed about medication, while others are not. But if this enables that to happen and sometimes presents a challenge to clinicians, it is not a bad thing.
Lord Warner: My Lords, as I indicated on Report, I had a good deal of sympathy with the thinking behind this amendmentand I still have that sympathy. I must acknowledge that the noble Lord, Lord Palmer, has made some effort to improve the amendment and has taken on board my comment that it would be easier to indicate the cost of medicines to the NHS than the full retail cost. As I said on Report, I agree that patients should be as well informed as possible about NHS services that they receive. However, as a number of noble Lords have
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I shall not repeat all the points that I made in my letter and to some extent on Report about some of the practical issues. There are practical issues involved in implementing a system of this kind. It is not quite as simple as one might think. There are issues about prescriptions coming from different sources and how you deal with those; there are issues about appliances, prescriptions from walk-in centres and resulting from patient group directions, and so on. We know that there would have to be a consistent system of computer upgrades to cope with a system of this kind, the cost of which would certainly run into tens of millions of pounds. We are not saying that that makes it a showstopper or that it makes it impossible, but we need to consider the practicalities before going forward.
We also have some doubts as to whether amending the NHS charges regulations is the correct vehicle for a change of this kind. This is not the most obvious place to make a change of this kind. However, to give some comfort to the noble Lord, Lord Palmer, and to other noble Lords who have indicated a degree of qualified support for the amendment, I can say that my colleague, Andy Burnham, the Minister of State for delivering quality, who is actually responsible for this policy area in the Department of Health, is considering, outside the Health Bill, further work to see whether indicating the cost will discourage patients from taking vital medicines and, if it does not, will look to see whether it would be justifiable to introduce a similar but more limited flexible arrangement to that which would be established by the amendment.
The noble Lord has certainly gained Health Ministers attention with the amendment. We want to take the issue forward with a proper study and I congratulate him on pursuing with some tenacity his views on the issue, with which, as I said earlier, we have some sympathy. In that context, I hope he will be willing not to proceed with his amendment.
I am heartened by what the Minister said about his colleague in another place looking into this whole subject. It has concerned me for at least 20 years, particularly the terrible wastage of the amount of drugs that must simply get thrown away. On the premise that the Minister will give me his unqualified support and ensure that something will be done about looking into this issue, I beg leave to withdraw the amendment.
Lord Warner: My Lords, I beg to move that this Bill do now pass. I thank all those who have taken part in our debates over the past four months, particularly noble Lords on the Front Benches. My noble friend Lord Faulkner and the noble Lord, Lord Walton, have given us a great deal of informed support and help with this Bill. Their contributions have always been constructive, informed and helpful. I thank my noble friend Lady Royall for her help, particularly during Grand Committee.
Lord Faulkner of Worcester: My Lords, I thank my noble friend Lord Warner for his kind comments and congratulate him on the skill, patience and good humour with which he has taken the Bill through the House. I think he would agree that his task would have been rather more difficult if the Bill had come to this place in exactly the same form in which it entered the House of Commons, with the exemptions it then contained. Now, though, we have a Bill which in my view, and, I think, in the view of the great majority of noble Lords, will do more for the public health of our country than almost any other measure since the introduction of the Clean Air Acts. I am delighted to support it.
Because we are passing a Bill that contains comprehensive smoke-free provisions, I am able to tell the House that the private Bill I introduced on behalf of the city of Liverpool to make it smoke-free will no longer be needed, and the formal steps to withdraw the Liverpool City Council (Prohibition of Smoking in Places of Work) Bill will be taken by the promoters parliamentary agents. I understand that formal Member approval is required first, and that that will be obtained later this month.
The noble Baroness, Lady Howarth of Breckland, will make a similar statement in respect of the London local authorities Bill which she introduced. She and I and the promoters believe that these two Bills played some part in winning the debate for smoke-free provision, and we are grateful to all noble Lords who supported us at Second Reading on 20 July last year.
I should also mention the third local authority private Bill on smoking, the Merseyside Local Authorities (Prohibition of Smoking in Places of Work) Bill, which was introduced into this House on 23 January. The promoters of that Bill also propose to withdraw it on the basis that the Governments Health Bill achieves virtually all they hoped for from theirs. That Bill would have been the responsibility of the late Lord Chan, whose untimely and sudden death earlier this year was widely mourned in this House and across Merseyside.
Lord Chans greatest legacy lay in developing child health in the developing world, and the work he started is being continued by the countless students he trained. He will be most remembered on Merseyside for his commitment to tackling health inequalities and helping those who suffered from deprivation. He saw the provision of smoke-free workplaces as an essential element in that. Lord Chan would have been as delighted as I am to see this Bill pass today.
Baroness Howarth of Breckland: My Lords, I am happy to follow the noble Lord, Lord Faulkner of Worcester, in his celebration of a full ban on smoking in the Governments Bill. I also celebrate the role played by the Liverpool and Merseyside private Bills, and particularly the role of my friend, the late Lord Chan, whom I miss greatly in this House.
I remind the House of the role of the London Local Authorities (Prohibition of Smoking in Places of Work) Bill, which was promoted by the vast majority of local authorities in London through the Association of London Government. The Bill, which was considered
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Credit should be given to the London boroughs, as well as to the Liverpool and other Merseyside local authorities, for their work in pushing forward the debate in favour of a full ban. We must remember, as the noble Lord, Lord Faulkner, has mentioned, that at the time of the debate on the London and Liverpool Bills the Government had not yet brought forward legislation and were suggesting a partial ban. I was personally delighted that the Government listened and changed their mind for the betterthat is what modern democracy is truly about.
Now that we will have a Health Bill providing for a full ban, I have been advised by the Association of London Government, speaking on behalf of the London boroughs, that it will take steps to instruct the withdrawal of the London local authorities Bill from Parliament. I thank this House and the Government for ensuring that legislation exists to protect all workers from the harmful effects of second-hand smoke. In particular, I thank the Minister for his extraordinary patience through this long Bill.
Baroness Anelay of St Johns: I gave notice of my intention to oppose Schedule 2, as I retain significant concerns about several aspects of the schedule. We had a full debate on those matters on our first day in Committee and I do not intend to repeat what was said. We covered such matters as the way in which BCUs would be organised and their coterminosity; the possibility of a change to operational technique that might not be to the benefit of the police; the problems that could accrue in the membership of police authorities; and the possible extension of the intervention powers of the Secretary of State in police forces and how he will be able to give directions.
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