The Lord Chancellor (Lord Irvine of Lairg): My Lords, before the commencement of business, I take the opportunity to inform the House that I am to open the annual exhibition of the Worshipful Company of Painter-Stainers in the City of London on Friday 17th, March when the House will sit. Accordingly, I trust that the House will grant me leave of absence.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the National Institute for Clinical Excellence will help to end the current inequities of access by advising which treatments are clinically and cost effective. Where the institute advises against the use of a treatment, it will give guidance about patients currently receiving it. In some cases it may be possible to switch patients to more effective therapy.
Baroness Gardner of Parkes: My Lords, I thank the Minister for the Answer, which, of course, I do not find satisfactory. We were told that the National Institute for Clinical Excellence (NICE) would constitute a levelling up, not a levelling down. Will the Minister assure me that in cases where treatments are considered costly but where research has shown that they are definitely effective--such as Beta Interferon for multiple sclerosis and the taxanes for ovarian and breast cancer--those patients receiving such treatments will be allowed to continue to receive them? It is bad enough for people not to be able to receive a treatment, but to receive effective, though costly, treatment and then have it taken away is rather like an employee whose firm is taken over and finds that his or her wages are cut. Will the Minister assure me that that will not happen?
Lord Clement-Jones: My Lords, would the Minister care to give advice to a doctor faced with postcode prescribing affecting the treatment that he thinks would benefit a patient? Should he not tell him or her about the existence of a treatment; or lie, as some cancer specialists admit that they have to do? Or would he tell the patient about a treatment but say that the health authority cannot afford it?
Lord Hunt of Kings Heath: My Lords, it is not for me to advise clinicians in the exercise of their clinical judgment. Our concern is to ensure that the situation which has existed for many years of woefully inconsistent availability of treatments is ended. We believe that the processes we have set in train in the National Institute for Clinical Excellence and the advice that it can give on whether treatments are cost effective and clinically effective, the introduction of clinical governance at local level and the involvement of the Commission for Health Improvement will enable us to ensure that the public receive high quality, consistent care across the country.
Baroness Knight of Collingtree: My Lords, will the Minister answer one simple question? Can he assure the House that when the changes in the arrangements are introduced no patients will be worse off than they are now?
Lord Hunt of Kings Heath: My Lords, I refer to the matter of a current treatment which is being evaluated by NICE where the institute advises against the use of that treatment. We have asked NICE to give us its best advice on what should happen in those circumstances. Over the years the National Institute for Clinical Excellence will have referred to it many treatments and many medicines. I do not believe that one can state a simple principle in relation to all the potential future treatments and drugs. However, as I say--this is important--we shall ask NICE to give us advice in relation to each treatment or medicine.
The Countess of Mar: My Lords, does the Minister recall that I have written to him on a number of occasions about people who require treatment through environmental medicine because nothing else has succeeded? Is he aware that, in order to get such treatment validated, I have had meetings with representatives of NICE? I have found them extremely co-operative, helpful and very understanding of the situation. They have given me and the doctor practitioner a large amount of advice on how to get the treatment validated. Will the Minister pass my thanks on to them?
Lord Hunt of Kings Heath: My Lords, that is the kind of supplementary question I am always happy to agree to. The House can have confidence in the process. We have brought together some extremely high calibre people to assist the NHS in ensuring that the best possible treatments are available throughout the whole of the health service. Careful appraisals and an ability for organisations to submit their views to the commission give us a great deal of confidence in the impact that this will have in the future.
Earl Howe: My Lords, does the Minister agree that, apart from clinical and cost effectiveness, the other part of NICE's remit is to assess the effective use of available resources? Does not that mean that NICE will be the judge and jury on the affordability of treatments in a national context? How will that not prevent a situation in which doctors find themselves obliged to withdraw established effective treatments from patients who have been receiving them?
Lord Hunt of Kings Heath: My Lords, I do not follow the noble Earl's argument. As I have said, traditionally, new treatments in the NHS have been introduced in a very patchy way, as has the phasing out
As to the issue of absolute affordability, it is worth making the point that, in relation to some of the medicines we have referred to NICE for appraisal, some health authorities have been funding them and others have not. That is a reflection of the inconsistency of the current decision-making process. It is the very reason why we need the mechanisms of NICE to ensure greater consistency in the NHS.
Lord Hunt of Kings Heath: My Lords, the bed modelling for the 16 major acute hospital projects currently being built under the PFI scheme considers the same major factors and drivers as identified in the national beds inquiry. To be approved, PFI schemes need to demonstrate flexibility. Experience already shows that changes can be accommodated at PFI hospitals.
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