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Lord Bassam of Brighton: My Lords, I really enjoyed that question.

Baroness Wilcox: My Lords, will the Minister admit that the Government's reliance on commissions, task forces and quangos raises serious questions of accountability in the way that the country is governed? Does he agree that it really is time that we had a Civil Service Bill?

Lord Bassam of Brighton: My Lords, those two issues are not linked in the least. The noble Baroness, Lady Wilcox, is something of an expert on non-departmental bodies. She was a member of the National Consumer Council from 1990 to 1996, of the Inland Revenue Board from 1992 to 1995 and of the advisory panel on the Citizens' Charter Unit—that was a useful body, wasn't it?—from 1992 to 1997.

Noble Lords: Oh!

Lord Bassam of Brighton: I have more: the noble Baroness was also on the Local Government Commission from 1992 to 1995, the Port of London Authority from 1993 to 2000 and the Citizens' Charter Complaints Task Force from 1993 to 1995. I rest my case.

Baroness Williams of Crosby: My Lords, does not the Minister's response suggest that the noble Baroness, Lady Wilcox, knows what she is talking about and that she may therefore have valid points to make?

One of those agencies, the Health and Safety Executive, is virtually out of control. All over this country, schools and youth clubs that want to have trips outside, for example, or open playgrounds and places for games, and so forth, are unable to do so because of the operations of that non-departmental public body. Will the Minister look closely at that? There is a strong feeling among the public that that executive body is going beyond its remit and should be curbed by the Government.

Lord Bassam of Brighton: My Lords, naturally I acknowledge the great expertise of the noble Baroness, Lady Wilcox. The noble Baroness, Lady Williams, makes a good point. It is the job of government to ensure that regulators work effectively
 
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and do not hinder those voluntary organisations to which the noble Baroness referred, and which do an extremely good job. That is one reason why we place great emphasis on ensuring that, through the Better Regulation Task Force, we keep those bodies in check and monitor their work effectively.

Lord Sheldon: My Lords, is there not a very serious question here about the method of selecting members of these commissions? Should that not be much wider and open to interpretation by a number of different bodies that put names forward and can justify them?

Lord Bassam of Brighton: My Lords, I entirely agree with my noble friend. Since we have been in government, we have tried to ensure diversity in appointments. We have had considerable success and made great progress there. We have also tried to broaden the range of people appointed to those bodies because of the important work that they do. I would argue that we are fortunate to have a body which properly regulates appointments. I pay tribute to the noble Baroness, Lady Fritchie, for her work as the most recent commissioner in charge of that. Because of those things, we keep these matters properly in check and have a sensible approach to the nature of appointments to public bodies.

Lord Marlesford: My Lords, do the Government recognise that a plausible explanation of the flood of regulations which follows from the bodies to which my noble friend referred is that the Government are obsessed with massaging employment figures, harking back to Keynes's recommendation of digging holes and filling them in again? The Government are digging the holes and the rest of us are having to fill them in.

Lord Bassam of Brighton: My Lords, we have gone over that issue at some length. We have a mechanism for checking on regulations; hence we have regulatory impact assessments. We in government have actually been praised for our proportionate approach to regulation. That is a little wide of the issue about non-departmental public bodies but, again, we have steadily reduced the number of those bodies since 1997. To help the noble Lord and perhaps make him feel rather better about this, I point out that we recently reduced the number of regulating organisations and bodies from 31 to 11. That says much about our success in having a balanced, proportionate approach to the subject.

Baroness Whitaker: My Lords, as a former employee of the Health and Safety Executive, may I ask the Minister to confirm that the fact that we have among the lowest figures in Europe for deaths and illnesses at work is in no small measure due to the robustness and good sense of the HSE? Furthermore, was not it, and several other very good non-departmental bodies, set up under a Conservative government with all-party support?

Lord Bassam of Brighton: My Lords, the Health and Safety Executive was set up by a Labour government
 
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with a very important objective: to enhance the protection of workers going about their daily business of providing goods and services to our nation.

Baroness Fookes: My Lords, why is the Minister directing us to where to find the answer instead of giving the answer to the original Question? May we have it now?

Lord Bassam of Brighton: My Lords, I have given an accurate and correct Answer. We have been over this issue on a number of occasions. On 30 November I explained that in 1997 there were some 1,128 public bodies. As of March this year the number of bodies has now been reduced to 910, reporting directly to United Kingdom departments.

National Institute for Health and Clinical Excellence

11.16 am

Earl Howe asked Her Majesty's Government:

How the National Institute for Health and Clinical Excellence assesses the potential impact on patients' quality of life when conducting appraisals of medicines and other treatments.

The Minister of State, Department of Health (Lord Warner): My Lords, in responding to the noble Earl's Question, perhaps I may say how delighted I am to be accountable to Parliament for the work of this body. The National Institute for Health and Clinical Excellence assesses the potential impact on quality of life by looking at evidence submitted by patient and carer groups. This could include the difference a product would make to the physical, psychological and emotional well-being of both patients and their carers. The institute's Guide to the Methods of Technology Appraisal process manual is available on its website.

Earl Howe: My Lords, with absolutely no criticism of the work done by NICE, is this not a difficult issue? There is a good example in the drug, erythropoeitin. Cancer patients who take this drug will say unhesitatingly that it is cost-effective because it transforms their lives, but it scores low marks with NICE because it is not designed to improve survival rates. Should we not be equipping NICE with a methodology that is able to take better account of these quality-of-life issues?

Lord Warner: My Lords, on the general issue of methodologies, the methodologies used by NICE have been commended as world class by the World Health Organisation. On the particular product mentioned by the noble Earl, NICE has not yet produced guidance for the NHS on EPO for the treatment of cancer treatment-induced anaemia. During the consultation on the draft guidance, we raised concerns with NICE about the negative impact of regular transfusion support to patients; that is, the social dislocation and
 
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the longer term medical issues. We are confident that NICE will consider these aspects in its continuing work on these drugs.

Baroness Neuberger: My Lords, while Members on these Benches also wish to pay tribute to the very effective work done by NICE, doubts and worries exist about the major impact of chronic diseases such as psoriasis and some autoimmune diseases on quality of life, as well as the issue of cancer patients raised by the noble Earl, Lord Howe. Do the Government now plan to stipulate some minimum standard of quality-of-life assessment to inform major clinical guidance decisions on issues such as these? This seems to be where the problem lies.

Lord Warner: My Lords, given the background of the noble Baroness, I think she is well aware that there is no perfect way of assessing quality of life. A certain degree of value judgment and assumption underpins such calculations. We accept that these are difficult issues, but NICE does invite submissions from patient and carer groups when making its appraisals. Moreover—and I commend the institute on this—it has established a 30-member citizens' council to help it to tease out some of the many complex social, moral and ethical issues involved in some of the judgments it has to make.

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