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Health Bill

My Lords, I certainly agree with the noble Lord, Lord Palmer, that patients should be as well informed as possible about the NHS services they receive to enable them to make informed decisions about their treatment. Making them aware of the cost of their prescription medicines would probably contribute to that and might reduce waste if patients are less inclined to reorder repeat prescriptions that are not required. However, while I am sympathetic to some of the underlying arguments behind the new clause, I have to say to the noble Lord that life is not quite as simple as he suggests and that there would be a number of practical problems, which mean that I am unable to support it. First, changes to primary legislation are not required in order to effect the change the noble Lord intends here. The amendment would enshrine a regulatory change in primary legislation with no flexibility to amend the regulation by secondary legislation if that were required in the future. That is of particular concern because the effect of this measure on patients is as yet unknown. It may, for example, discourage some from taking their medication—a particular risk among elderly patients, I should think. Further, we may find that providing information on the label may not be the most appropriate way to identify the cost to a patient. Secondly, the scope of this amendment means that it would affect many more areas of the NHS than just prescriptions dispensed by a pharmacy or a dispensing doctor in primary care. It would affect, for example, prescriptions dispensed by appliance contractors and out-of-hours service providers, prescriptions dispensed to hospital outpatients, treatments from walk-in centres, as well as those resulting from patient group directions. So it would range widely over a varied set of circumstances relating to patients. This would add to the complexity and cost of implementing such an arrangement. I have to say to the noble Lord that this is not a cost-free option. All dispensing contractors and suppliers of medicines would need to have mechanisms in place to establish a price and label their medicines appropriately. In most cases this would mean upgrading their computer software to print prices on dispensing labels, and computer pricing databases would need to be kept up to date. It is also expected, especially to begin with, that patients would ask about the price indicated on the label. Given that, I think that I have said enough to suggest that simply pressing a button would not be the way one could introduce this measure. I have further arguments along these lines but I will not delight the noble Lord with them. However, I am happy to give him a fuller set of arguments. Lastly, I want to point out that what is meant by the ““full retail cost”” is not clear. While suppliers publish a list price for a product, that is not necessarily the cost to the NHS of supplying it to the patient. The cost of supplying a product to the patient from a dispensing contractor, for example, would need to take into account any service fee provided to the contractor, along with any discount arrangements and additional expenses that may be claimed. Dispensers would not be in a position to know all these details, so further practical problems would arise in that area. On balance, I believe that the amendment should be rejected because of its legislative inflexibility, the risk that it may discourage some patients from taking vital medicines, and the very considerable practical problems and costs which it would create. I am sorry to disappoint the noble Lord in that response, but life is just a bit more complicated than he may have thought when he tabled the amendment.