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Lord Roberts of Conwy: My Lords, I am grateful to the Minister for that Answer. I remind him that there are 600,000 sufferers from rheumatoid arthritis in the United Kingdom. It is a very painful and often progressive disease. Many of them cannot get anti-TNF drugs, even though the best clinical judgment in the country prescribes them, because of the shortage of funds in the NHS. Will the Government set up some special funding for that treatment rather than allowing this dreadful suffering to continue?

Lord Hunt of Kings Heath: My Lords, I certainly agree that rheumatoid arthritis is a distressing illness. Many members of our community suffer a great deal of pain and distress as a result of it. It was because of issues around the anti-TNF drugs that the noble Lord has mentioned that we referred the question to the National Institute for Clinical Excellence. The purpose of the institute is to give definitive advice on whether a particular drug is clinically effective and cost effective. I expect that the Government and the National Assembly for Wales will receive the outcome of that advice next spring. We must await that moment before any further decisions can be made. I do not believe that a special fund is the answer. We must have a proper process of independent advice so that proper decisions can then be made.

Lord Walton of Detchant: My Lords, I accept the Minister's points. But does he accept that although for many years traditional treatments such as gold and, more recently, non-steroidal anti-inflammatory agents have been helpful for some patients with rheumatoid arthritis, the first really effective treatment to strike at the heart of the disease and to have shown itself as likely to prevent its advance is the anti-tumour

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necrosis factor? Is it not therefore important that the treatment should be made widely available? At the moment it is subject to the problem of postcode prescribing.

Lord Hunt of Kings Heath: My Lords, that is exactly why we have referred the drugs to the National Institute for Clinical Excellence. The tradition of the NHS is for postcode prescribing under which a particular drug can be obtained in one part of the country and not in another. The existence of the institute enables independent judgment to be made on the clinical and cost effectiveness of a particular drug. If the institute so advises, there will be uniform provision of the drug across the country. I understand the impatience of patients over NICE reaching its conclusions, but we must await the outcome of the process. At the moment we are in the middle of it.

Lord Morris of Manchester: My Lords, I too appreciate my noble friend's concern and he will understand my interest in the question. Is it known why more than three times more women than men develop this cruelly devastating condition; and does it not conflict with the founding principles of the National Health Service that postcode rationing can still discriminate between them?

Lord Hunt of Kings Heath: My Lords, the answer to the first question is that I am not aware of any specific evidence as to why more women than men should be affected, although I shall draw the noble Lord's question to the attention of those responsible for NHS research and development. On the general point, postcode prescribing is unacceptable in a national health service. That is why we set up the National Institute for Clinical Excellence. The longer that it does its work and the more advice that it gives to the Government, the more we will eradicate postcode prescribing.

Lord Addington: My Lords, if taken sufficiently early, the drug in question can prevent a condition becoming debilitating. Should it not be a basic consideration, whenever any such drugs are considered, whether they can prevent a condition becoming disabling? Should that not be at the front of all of NICE's considerations?

Lord Hunt of Kings Heath: My Lords, that is one of the factors on which NICE will have to make a judgment. Before NICE was introduced, new and innovative drugs were often taken up very slowly. We have already seen that the result of NICE decisions is that, once it has given advice that a drug is likely to be clinically effective and cost effective, take-up in the NHS is quicker. We are also seeing that the initial results of advice given by NICE is considerably to increase the amount that the NHS spends on drugs.

Baroness Gardner of Parkes: My Lords, is it not a fact that NICE considers clinical effectiveness only in terms of the cost of the drug? Is it not important to

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consider the cost of the social care of patients if they are not given the drug and therefore rely on the state for everything? Should that not be a further factor to be considered in the equation?

Lord Hunt of Kings Heath: My Lords, I understand the point raised by the noble Baroness. However, NICE's approach is fully consistent with what is described in the jargon as a societal perspective. That certainly falls within NICE's responsibility to promote clinical effectiveness and cost effectiveness.

Housing Renewal

2.52 p.m.

Lord Greaves asked her Majesty's Government:

    Whether they intend to bring forward proposals to assist with housing problems in areas such as east Lancashire, which have large numbers of cheap and substandard terraced houses many of which are standing empty.

The Minister of State, Department for Transport, Local Government and the Regions (Lord Falconer of Thoroton): My Lords, having recently visited east Lancashire, I fully recognise the severity of the housing problems in that area. The Government already support a substantial programme of local government expenditure on private sector housing renewal, and we will soon put legislation before Parliament to allow authorities much greater freedom to develop their strategies.

My department has also just received a proposal for the creation of a market renewal fund. I cannot, of course, commit the Government to pursuing that approach, but I welcome the work that is being done collectively by local authorities and housing providers in the North and the Midlands on that issue.

Lord Greaves: My Lords, I thank the Minister for that interesting and intriguing Answer. The problem is that in many parts of England, the bottom end of the housing market has simply collapsed. Houses can be bought extremely cheaply or, in many cases, are worthless. The Minister is quoted as saying in a local paper, the Pendle Citizen, on 8th November that the sub-region has,

    "consistently missed out on cash from central government and European union regeneration schemes".

Will he confirm that that is his view? Will he also comment on the fact that in my local authority area of Pendle, where I live, the amount of money available for private sector housing regeneration work was cut by a massive 30 per cent this year compared to last year, and, since the mid-1980s, has fallen by about 70 per cent in cash terms?

Lord Falconer of Thoroton: My Lords, yes, I confirm the quotation. I do not know what are the precise figures for money available for private sector

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expenditure by local authorities on housing in the area identified by the noble Lord, but I shall write to him about them.

The overall position is that English local authorities presently provide about £400 million a year for private sector renewal. I accept that in the east Lancashire area, which I visited, local authorities have insufficient money to deal with the range of private sector housing problems—although the problem does not involve just housing but must be considered across the board. The problem involves housing, bringing jobs to the area, providing economic prosperity and working together to try to find solutions. One of the most impressive things I found when I visited six local authority areas in east Lancashire was that they were all working together with the private sector and other statutory providers to seek solutions to what are deep-seated problems.

Baroness Knight of Collingtree: My Lords, to what extent do the Government advise local authorities to consider the parts of their areas that are amply provided with terraced houses that are falling into disrepair and are unused before they give permission for further housing to be built?

Lord Falconer of Thoroton: My Lords, the planning system is intended to deal with that issue. In our planning policy, we have sought to promote the idea that local authorities consider housing strategically throughout their area. They should consider what social housing and private sector stock exists and address the housing needs of the community as a whole, so that when they consider which houses in their possession to renovate and which planning permissions to grant, they have a strategic view of the community's needs.

Lord Brookman: My Lords, my noble and learned friend the Minister will be aware of the work that my noble friend Lord Clarke of Hampstead—he is a good friend—is doing in Burnley. Perhaps the Minister had Burnley in mind when he mentioned visiting that area. Does he agree with my noble friend Lord Clarke that demolition of houses is a priority and that money should be provided to get the housing catastrophe into some order?

Lord Falconer of Thoroton: My Lords, I am aware of the good work that my noble friend Lord Clarke is doing in Burnley, and I should like to pay tribute to the amount of time and effort that he has put into his report.

When one visits east Lancashire—and other parts of the country—it is perfectly plain that there are significant areas in which substantial abandonment of housing is occurring. Once abandonment starts, it destroys communities. In some places, demolition and clearance will be the right course; but not in others.

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Each place will have a different solution, and the right thing is to identify what is the particular solution for the particular area.

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