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Lord Roberts of Conwy: My Lords, I am most grateful to the noble Lord for giving way. Can he tell us whether NICE, in assessing the cost effectiveness of drugs and treatments, can take into account factors outside the NHS such as employment, the loss of it, benefit costs and so on?
Lord Hunt of Kings Heath: My Lords, in broad terms it can. I was going to respond to the noble Lord later on that point. The point I am trying to make here, in answering the noble Earl, Lord Howe, is that I believe it is right that NICE makes judgments about cost effectiveness alongside clinical effectiveness, but Ministers are ultimately responsible for the affordability of NICE guidance. It is our responsibility to ensure that the National Health Service has the resources for that guidance. I believe that we are providing the level of resources to enable that to happen. I do not agree with the noble Earl that we should earmark those resources. In fact, I am always influenced by the noble Earl's strictures about too much central direction. In this case it is within the general allocations.
Lord Clement-Jones: My Lords, since this is such a crucial question and there are different interpretations of NICE'S remit, can the Minister absolutely and categorically say that no NICE appraisal has taken into account affordability?
Lord Hunt of Kings Heath: My Lords, the issue for NICE is judgments on cost and clinical effectiveness. The issue for Ministers is affordability. I believe that I have made it abundantly clear that there are respective responsibilities and it is quite clear as to who is responsible for what.
The noble Earl, Lord Howe, asked about criticisms of individual judgments and errors. I believe that it is unrealistic to believe that all expert opinions will always agree with NICE guidance because, at the end of the day, NICE will often have to make a fine judgment weighing up a range of evidence and opinions. But I believe that the experience so far has been that overall its judgments are robust because it seeks out all the available evidence and draws on the top experts in the field as well as on patient and carer evidence.
The noble Lord, Lord Roberts, and the noble Lord, Lord Addington, asked about the considerations that NICE can take into account. The appraisals that it carries out are done in accordance with its framework document. That document states that its task is to assess the evidence of all the clinical and health-related benefits of an intervention, taking this in a wide sense, to include impact on quality of life, relief of pain or disability as well as any impact on likely length of life; to estimate the associated costs and to reach a judgment on whether on balance this intervention can be recommended as a cost effective use of NHS and personal social service resources. I hope that answers the question and makes clear that NICE can take into account those wider considerations.
Lord Addington: My Lords, the only real point in raising the matter is that we hear about joined-up government and we have heard today about how the health department is borrowing from one part of it to meet a deficit in another. I was merely suggesting that we expand the suggestion so that another department helps in the National Health Service because such drug treatment may help people to stay in employment and keep off benefits.
Lord Hunt of Kings Heath: My Lords, I am always anxious to grab more resources from other government departments. I am unlikely to get much support for that across Whitehall. Of course I understand the point that the noble Lord raises. I believe that at the moment we have a sensible balance, which essentially allows NICE to take into account the wider considerations. But the balance on cost effectiveness is based on the use of NHS and PSS resources.
Obviously, these matters will continue to be debated. That brings me to the point made by the noble Lord, Lord Clement-Jones, about a review of NICE. We consider that the effect of our response to the Kennedy report, the publication shortly of a consultation document which will cover the detail of the process of topic selection, and our consideration of the inquiry by the Health Select Committee into NICE will provide a very helpful and comprehensive look at many of the current issues that face the national institute.
Indeed, considering our response to the Kennedy report brings me to another point raised by the noble Lord, Lord Colwyn, who always has many interesting insights into dentistry. He knows of my own keenness to ensure that the dental profession further develops its excellent quality and expands its services to the public.
He raised a concern that in a sense NICE might be given a monopoly for setting all national clinical standards. It was the recommendation of the Kennedy inquiry that NICE should be responsible for co-ordinating all action relating to the setting, issuing and keeping under review of national clinical standards. We rejected that view because while we believe that NICE is the foremost body to provide authoritative clinical guidelines and appraisals, there are many other
bodies which are best placed to set standards in their fields. We would not wish to inhibit their excellent role in doing so.The noble Lord, Lord Astor of Hever, asked a number of questions and in particular about the establishment of a council for quality. Its role would be to facilitate co-operative working between constituent organisations including NICE, CHI, the Clinical Assessment Agency and the National Patients Safety Agency. It would also help those bodies to work closely together with the Social Services Inspectorate, the Audit Commission and others. I accept that there is a need to co-ordinate. We want to avoid duplication and too much inspection in relation to individual organisations where a co-ordinated approach is likely to be much more effective.
As regards the other points raised by the noble Lord about public health, I do not believe that the Government are failing in those areas. I believe that our public health strategy, our strategy to tackle health inequalities, the consultative paper on sexual health strategy and the recent CMO's report on public health surveillance show that we are taking these matters very seriously. Of course, I share the noble Lord's concern about the low uptake of MMR, particularly in London, but also in other parts of the country. I believe that we have a massive job to do to restore public confidence in these vaccines.
I also believe that at the local level it is important to have a strong public health function. In response to the worries in relation to the BMA, we have made it abundantly clear that every primary care trust will appoint a director of public health. There will be a senior public health doctor at the strategic health authority level. I believe that making the primary care trust the primary public health body at local level will help to ensure a much closer relationship between public health and primary care. I believe that that is where we can tackle the issue of the low uptake of vaccination in a more effective way in the future.
The noble Lord, Lord Roberts, will know that the particular drugs that he mentioned are the subject of work being carried out by NICE at the moment. Taken as a whole, it is much better to have a situation where such drugs are properly assessed rather than leaving that to the ravages of postcode prescribing, which he so aptly described.
I also listened to the remarks about "NICE blight". I want to make it abundantly clear that it is unacceptable that health authorities should decide that a treatment should be prescribed while awaiting an appraisal of that treatment. I believe that Health Service Circular 1999/176 is clear about that. If health authorities are seen to make arbitrary judgments outwith the terms of that circular, I have made it clear that any complaint that is received will be investigated.
I have spoken at length but I believe that it is important to answer many of the points that have been raised in this important debate. I can reassure the noble Earl, Lord Howe, that of course we listen to comments made. They are taken into account in regular discussions with the National Institute for
Clinical Excellence. However, at the end of the day I believe that NICE has established robust mechanisms and that it is helping to ensure quicker update of new treatments, new technologies and new drugs. I also believe that that is the way forward. It will enable the NHS to ensure that, overall, patients will receive effective treatments quickly, and that is the NHS that we wish to achieve for the future.7.12 p.m.
Baroness Knight of Collingtree: My Lords, we have had an interesting and well-informed debate. I warmly thank noble Lords who have taken part, particularly my noble friend Lord Colwyn. It is always a great pleasure to hear from experts who speak about their own field of expertise. I listened to him with enormous interest.
My noble friend Lord Roberts told of his experience from a more personal angle, but his speech was also important. We have heard clear expressions of concern. The noble Lord, Lord Clement-Jones, gave a trenchant speech, pointing out many areas of concern, and my noble friend Lord Howe made some important points that must be borne in mind all the time.
I am grateful that the Minister took on board the fact that unless NICE is respected, and unless the public feel that it is a body that is of real service, it will not be of much use. The noble Baroness, Lady Howells, for whom I have a warm regard, gave a statutory few moments of support for NICE, which we were all pleased to hear.
I wish I could feel more gratitude to the Minister, but questions were raised in the debate that he has not answered. Perhaps he would kindly read the speeches made and answer directly some of the clear questions that were put. He tried to answer one or two. Having said that the point was not to make savings, later he said much about being cost-effective. To me being cost-effective is allied to making savings. I listened carefully to what the Minister said, but when he said that the Government will fund the recommendations of NICE, did he mean that there will be other areas of treatment that will suffer because the money will go to the treatments that have been recommended by NICE? We do not know. We have had an interesting and helpful debate. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
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