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Lord Clement-Jones: My Lords, before the Minister concludes, I wonder whether he can confirm one matter. He has outlined the process but is he saying, effectively, that in no sense is there any indication that the department will be learning from the "Viagra experience", so to speak? Is the department prepared to learn from that experience of rationing in terms of its handling of such matters in future? Moreover, will it consider whether or not the Secretary of State should be the sole decision-maker on these matters? Is there not some mechanism which could be adopted to bring a wider public interest consideration to bear?

Lord Hunt of Kings Heath: My Lords, I hope that the Department of Health would always consider itself to be a learning organisation. Clearly, there is a continuous process of learning as policy develops and we learn from experience in the field; and as we see the impacts of NICE, the Commission for Health

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Improvement and the health improvement programmes. I am sure that lessons will be learnt from the way in which we have approached the issue of Viagra.

The circumstances surrounding Viagra and the way in which they had to be handled are unique. It would be very unwise to set that as a precedent for the future which would then be used for other drugs and other situations. However, perhaps I may say that the substantive point raised by the noble Lord is a well chosen one. Healthcare, above all other services, is one area in which we constantly have to learn from experience when planning and developing ideas for the future.

Earl Howe: My Lords, I thank the Minister for that full reply and for the trouble he has taken in attempting to respond to the points I made. He has been of considerable help in clarifying much of the Government's thinking on this vexed issue. Unfortunately, I do not think that he has succeeded in resolving what I regard as the anomalies which the regulations create. Indeed, I do not believe that he or anyone would have been capable of so doing. I suspect that in his heart of hearts the Minister is as conscious as I am of the illogicality and unfairness inherent in the rules drawn up by the Government.

Were it not for the convention of your Lordships' House that statutory instruments should not be put to a vote, I should wish to divide the House on this issue. The issues are certainly important enough to do so. However, I shall not do that. I merely conclude by making a couple of observations.

The first relates to the role of NICE. It seems to me that responsibility for rationing, which is essentially what this is--I pay due credit to the Secretary of State for admitting that that is what this is--cannot in any sense be delegated to NICE, which is an advisory body. It is for Ministers accountable to Parliament to confront the hard decisions about rationing and funding. The difficulty here relates to the way in which they have done so in the case of anti-impotence treatments.

Prof Michael Rawlins, the chairman of NICE, does not want this to be used as a tool of rationing. He has written that anyone who believes that NICE will reduce NHS expenditure is "whistling in the wind", according

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to The Times of 27th May. We should therefore look carefully at the role of the National Institute for Clinical Excellence in this kind of context.

The key point I wish the Minister to take away is that the Government should assess this whole matter after no less than a year in the context of the overall demand for anti-impotence treatments and the NHS expenditure on them. I take some comfort from the Minister's assurances on whether and to what extent the Viagra saga should be regarded as a precedent for things to come. I sincerely hope it will not be a precedent. In the meantime, this has been an extremely useful debate and I beg leave to withdraw the Motion.

Motion, by leave, withdrawn.

National Health Service (General Medical Services) (Scotland) Amendment (No. 3) Regulations 1999

Earl Howe: My Lords, not moved.

Trustee Delegation Bill [H.L.]

Returned from the Commons agreed to.

Commonwealth Development Corporation Bill [H.L.]

Returned from the Commons agreed to with amendments and with a privilege amendment; it was ordered that the Commons amendments be printed. (HL Bill 83)

Pollution Prevention and Control Bill [H.L.]

Returned from the Commons agreed to with amendments and with a privilege amendment; it was ordered that the Commons amendments be printed. (HL Bill 84)

        House adjourned at half-past eight o'clock.

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