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Mr. Hammond: I thank the Minister for that clarification. If he has made no moves in that direction and has not begun any consultation, what changed between the date of his letter to my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) the week before last and his tabling of the new clause last week?

Mr. Denham: The answer to that question is that the clause was tabled after further examination of the issue and the provision that we should make.

I have always regretted the introduction of new clauses at a late stage in a Bill, as I did when we were in opposition. During the passage of the National Health Service (Primary Care) Bill, which was considerably less lengthy and complex than this Bill, three times as many new clauses were introduced on Report than have been introduced for this Bill, which I thought regrettable. I recall Conservative Members making speeches from the Government Benches that deprecated the fact that so many new clauses were introduced--well, I would like to think that I can recall that, but I think that they overlooked the matter at the time.

The final and most important question concerns the funding arrangements. I do not intend to debate the entire Barnett formula, save to note again that hon. Members who have suddenly discovered its existence seemed to be silent about its dire consequences throughout most of the 18 years of the previous Administration.

We intend that the allocations of the health authorities and boards concerned will be adjusted to reflect the new arrangements and through that the different level of funding. It is intended that the adjustment should affect the actual level of spending on the patients concerned as is reflected in current commissioning arrangements.

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For example, the allocation of an English health authority or primary care trust would be increased to reflect the current levels of spending on any Scots on the GP list. There is no question of money being lost to Scots patients because of the arrangements.

However, that is not to push the concept of capitation funding too far. It is not as though each individual is entitled to a fixed amount, which flows--ultimately--from the Barnett formula. Even under the previous Conservative Administration, the health service was not divided up with a fixed sum per head. A health authority, a health board or a primary care trust will use its funds to respond flexibly to the needs of its local population--whatever level of capitation each individual may, notionally, have attracted. That applies on both sides of the border.

It is worth bearing in mind that the existing arrangements have their drawbacks, which is why we want to take this action. Those arrangements take up time, energy and resources that might better be devoted to patient care. For example, at present, practices have to provide different arrangements for their English and Scottish patients. As I pointed out earlier, one practice reported having to liaise with six different teams of community staff to cover its scattered population.

A question was put about the letter from my predecessor to Dr. John Chisholm of the GPC--part of the British Medical Association. When my predecessor wrote that letter, the then Minister at the Scottish Office with responsibility for health wrote to the BMA in Scotland and gave similar guarantees. I am advised that those were repeated in guidance issued to local health care committees in Scotland on 8 February this year.

Mr. Hammond: Does the Minister know whether the assurances given by Scottish Ministers in this Parliament have been repeated by Ministers in the Scottish Executive since that body came into being?

Mr. Denham: I have no knowledge of that, although I shall look to the Under-Secretary of State for Scotland, my hon. Friend the Member for Western Isles (Mr. Macdonald), for information on that point. That matter is clearly not my responsibility.

I confirm that, fortunately for geography teachers and students throughout the country, there is no debate on which areas of England and Scotland lie adjacent to the border. There is no option in that matter. The English health authorities defined in the Bill will be North Cumbria and Northumberland and the Scottish health boards will be Borders and Dumfries and Galloway.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 4

Criteria for appraisals by the National Institute for Clinical Excellence

'The Special Health Authority known as the National Institute for Clinical Excellence shall make its appraisals of different treatments and clinical interventions on the basis of clinical efficacy or relative cost-effectiveness compared with alternative treatments or clinical

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interventions for the same symptoms, but not on the basis of their affordability in relation to the funds available to the National Health Service.'.--[Dr. Harris.]

Brought up, and read the First time.

Dr. Evan Harris : I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this, it will be convenient to discuss the following: New clause 14--National Institute for Clinical Excellence (duties and consultation with public)--

'.--(1) The Special Health Authority known as the National Institute for Clinical Excellence (the "Authority") shall meet in public.
(2) The Authority shall publish annually a report on its activities during the preceding calendar year which the Secretary of State shall lay before Parliament.
(3) The Secretary of State shall establish a public consultative committee in relation to the Authority, which shall have the duty of advising the Authority on the public's view on the priority to be accorded to different treatments and clinical interventions within the NHS.
(4) The constitution and membership of the committee mentioned in subsection (3) shall be such as the Secretary of State may determine in Regulations.'.

New clause 16--Protection of doctors' clinical freedom to prescribe appropriate drugs--

'.--The Secretary of State shall not exercise his powers to include a drug in schedule 11 to the National Health Service (General Medical Services) Regulations 1992 (as subsequently amended) in such a way as to restrict the circumstances in which the drug may be prescribed by reference to the different underlying causes of the symptoms for whose treatment it is clinically effective.'.

New clause 17--Cost or affordability not to be criteria for restricting prescribing of drugs--

'.--In issuing guidance on prescribing, or in exercising his powers to include a drug in schedule 10 (drugs and other substances not to be prescribed for supply under pharmaceutical services) or schedule 11 (drugs to be prescribed under pharmaceutical services only in certain circumstances) to the National Health Service (General Medical Services) Regulations 1992 (as subsequently amended), the Secretary of State shall not base his decision on the criterion of either the cost or the affordability of the drug in question.'.

Dr. Harris: I hope to introduce the new clauses relatively quickly, but at this point it is appropriate to pay tribute to the work of the hon. Member for Runnymede and Weybridge (Mr. Hammond), who in Committee paid great attention to the detail of our proposals--as I am sure he will do to these proposals. He did so assiduously during the Bill's Committee proceedings, while simultaneously fathering a child--or rather overseeing the birth of a child--[Interruption.]--There was some confusion as to that point in Committee.

More than mere scrutiny of the Government is involved in the new clauses. Like the other groups of amendments that we shall discuss in the near future, they show that some critical issues must be decided. On this occasion, the Liberal Democrats are raising those issues--of rationing in this group of new clauses; and of the hours worked by junior doctors and discrimination in the national health service in later groups. For more than three hours, we debated the border provisions in Scotland and we shall probably have a long debate on this and future groups of new clauses. One cannot help but think that the contributions of hon. Members--I am sure that those

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contributions were always in order--were lengthy because of hon. Members' chagrin that they had not tabled such important new clauses as those that we are now discussing.

Mr. Bercow: Will the hon. Gentleman give way?

Dr. Harris: I shall do so in a moment.

It seems strange that, at the rate that we are carrying out our scrutiny of the Bill, we may well be discussing the hours of junior doctors in the middle of the night and spending a great deal of time discussing other matters that were covered at length in Committee. Nevertheless, although the House will want to discuss those issues, for those outside the House, it should be pointed out that something is going on--

Mr. Deputy Speaker: Order. We should not be worrying about what is to come; we need to worry only about the new clauses before us.

Dr. Harris: Thank you, Mr. Deputy Speaker. I was keen to point out that I will attempt to keep the substance of my remarks brief, because I know that Conservative Members will want to contribute--probably at length.

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