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Lord McIntosh of Haringey: My Lords, I did not expect that the theme of the Taylor report was going to lead to us talking about terraces in our theatres. I do not think that that would be a very good idea. The problem arises particularly in commercial theatres in the West End of London and in a number of our regional and provincial theatres. The problem that they have is that the sites are extremely restricted and they have great difficulty in raising money for capital programmes. We cannot help them by intervening in commercial theatre. But what we can do, and what we shall be doing, is to increase the amount of public money which goes to the touring theatre, to the support of the art itself rather than the venue for the arts. In turn, that will help the economics of the commercial theatres and will help them to have money for other purposes.

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Lord Jenkins of Putney: My Lords, is my noble friend aware that the way to become more fully aware of the problems of the theatre is to listen to the Theatres Trust? Is my noble friend aware also that both the previous government and the present Government have shown signs that they appreciate the nature of the problem? I am afraid that in future, the trust will need more backing for the financial consequences of the situation which it now faces. I hope that when the request comes forward, the Government will be eager to fulfil it.

Lord McIntosh of Haringey: My Lords, I have already expressed my warm appreciation for the work of the Theatres Trust and the role of my noble friend in setting it up. Of course, he is right that what is needed is more money. But the difficulty that I have is that today is 7th March and tomorrow, on 8th March, the Government will be announcing a further allocation of £25 million to the theatre in England, which will clearly help a large number of the programmes which have been referred to in debate this afternoon. But I cannot give the detail of how that £25 million is to be allocated.

Baroness Gardner of Parkes: My Lords, recalling the experience on the Greater London Council which the Minister and I shared, will he join with me in welcoming the funds that have been raised to restore the Hackney Empire to, I understand, its full grandeur?

Lord McIntosh of Haringey: My Lords, under the arm's length principle, that matter is devolved to the Arts Council. I am extremely sympathetic to what the noble Baroness says, as I am sympathetic to her reference to our joint painful experiences on the GLC Film Viewing Committee.

Baroness McIntosh of Hudnall: My Lords, without in any way undervaluing the importance of buildings, does my noble friend agree that audiences are attracted into the theatres mainly because of what takes place there? Does he also agree that there is a significant dependence in the commercial sector of theatre on work that originates in the subsidised sector? Can he add to what he said about how the Government will help money and other resources go towards theatre practice as opposed to theatre building?

Lord McIntosh of Haringey: My Lords, I strongly agree with what my noble friend says. Historically, support from the National Lottery has been to buildings rather than to the people who work in them. More recently, the Arts Council, encouraged by the Government, has had a deliberate policy to divert that support from the buildings to the people. In particular, the support that the Arts Council now gives to touring theatre and productions for new theatre audiences should be a great encouragement to both commercial and subsidised theatres.

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Multiple Sclerosis: Prescribing Policy

2.52 p.m.

Lord Addington asked Her Majesty's Government:

    Whether the National Institute for Clinical Excellence (NICE), in assessing the cost-effectiveness of disease-modifying drugs in multiple sclerosis, will take into account all relevant cost savings to health and social services and the social security system.

Lord Hunt of Kings Heath: My Lords, the appraisal approach taken by the National Institute for Clinical Excellence has been set out very clearly. NICE will directly take into account the impact on National Health Service and personal social services budgets. It is also open to NICE to take into account a wider range of factors and it is open to those who submit evidence to include evidence on such a range of factors.

Lord Addington: My Lords, I thank the Minister for that Answer. Does he agree that there is a general feeling that an across-government look at funding has not taken place? It is difficult to see how the sums involved can be justified because someone who does not receive beta interferon or--if I can pronounce it properly--glutarimer acetate quickly enough may end up being dependent on social services and on the social security system for his income for many years as opposed to being able to generate his own income and pay taxes.

Lord Hunt of Kings Heath: My Lords, certainly those factors can be taken into consideration by NICE. It is up to the manufacturer or the patient group concerned, if it has robust evidence, to ask for that to be considered by NICE. On the general point raised by the noble Lord, of course I understand the keenness of MS sufferers for the final NICE decision to be made. The whole basis of NICE is that its decisions are made on the most robust evidence possible. At the moment NICE is going through the process, which is taking some time, but in the end it is better to be thorough.

Lord Morris of Manchester: My Lords, is my noble friend aware that, in desperation, many people with multiple sclerosis who are waiting for these drugs are purchasing them privately and putting themselves ever more deeply into debt to do so? What kind of comment is that on NICE's priorities, and indeed on the founding principles of the National Health Service in which all of us on these Benches, not least my noble friend, take such legitimate pride?

Lord Hunt of Kings Heath: My Lords, these are matters for NICE. Clearly, if any delay that could be put at the door of NICE were involved in coming to a final recommendation, that would be a matter for considerable regret. My understanding is that there is a systematic approach with, first, a provisional appraisal and then a final appraisal, after which there

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is an appeal option, which has been gone through, and a decision is made in the light of that for more work to be considered. At the end of the day the whole purpose of NICE is to give the best possible evidence available to the NHS of effectiveness and cost-effectiveness. It is important that the integrity of that process is maintained.

Lord Elton: My Lords, does the noble Lord recall sending me a Written Answer on 16th October in which he revealed that the number of people who had died of multiple sclerosis-related diseases was almost exactly double the number of people who died of AIDS and that in the last year in which a comparison could be made for cost, 1995-96, the money spent on research into AIDS was no less than 216 times greater than that spent on research into MS-related diseases? Does the Minister consider that there is something wrong with the priorities?

Lord Hunt of Kings Heath: My Lords, I believe that the noble Lord is right to draw attention to the number of people affected by multiple sclerosis. The fact that we have referred this matter to the National Institute for Clinical Excellence indicates the Government's seriousness of purpose in this area. I regret, as do many noble Lords, that the institute is taking so long to come to a conclusion--it will be some months before it does--but at the end of the day it is vital that the process is of the highest integrity. The whole purpose of NICE is to ensure that we have the consistent, high-quality treatment that we want for MS sufferers.

Lord Walton of Detchant: My Lords, while NICE has carried out some excellent work--it is chaired by a most distinguished clinical scientist--does the Minister agree that the timetable for assessing the situation is exceptionally lengthy, considering that we are told that no decision will be made before November of this year? Bearing in mind that international research has demonstrated, without doubt, the efficacy of beta interferon and glutarimer acetate in relapsing and remitting multiple sclerosis, is it right that at the moment only 2 per cent of patients in the UK receive it compared with between 13 and 20 per cent of patients in other countries in the European Union? Can nothing be done to expedite the process?

Lord Hunt of Kings Heath: My Lords, in relation to the number of people receiving beta interferon in the UK, the noble Lord is right. I believe it is between 2 and 3 per cent. There is a variation in prescribing rates through the rest of Europe ranging from 3 per cent in Turkey to 21 per cent in Austria, with prescribing rates in Germany, France and Italy at 12 per cent. I have listened with a great deal of sympathy to the noble Lord, but at the end of the day the whole purpose of NICE is to conduct a rigorous process. Clearly it is a rigorous process because it has gone through three

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stages, at the end of which an appeal has been upheld. It is having to commission and to look at more work. I believe that we should await the outcome of that work.


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