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Health Bill

My Lords, as I indicated on Report, I had a good deal of sympathy with the thinking behind this amendment—and I still have that sympathy. I must acknowledge that the noble Lord, Lord Palmer, has made some effort to improve the amendment and has taken on board my comment that it would be easier to indicate the cost of medicines to the NHS than the full retail cost. As I said on Report, I agree that patients should be as well informed as possible about NHS services that they receive. However, as a number of noble Lords have said, my greatest concern is that this measure could lead to some patients, especially older people, stopping taking or failing to reorder vital medication that they know to be expensive because they do not wish to be a burden on the NHS. We simply do not know. We do not have the evidence about how people would react and it is not appropriate to put a change of this kind in primary legislation before we have that evidence. I shall not repeat all the points that I made in my letter and to some extent on Report about some of the practical issues. There are a number of practical issues involved in implementing a system of this kind. It is not quite as simple as one might think. There are issues about prescriptions coming from different sources and how you deal with those; there are issues about appliances, prescriptions from walk-in centres and resulting from patient group directions, and so on. We know that there would have to be a consistent system of computer upgrades to cope with a system of this kind, the cost of which would certainly run into tens of millions of pounds. We are not saying that that makes it a showstopper or that it makes it impossible, but we need to consider the practicalities before going forward. We also have some doubts as to whether amending the NHS charges regulations is the correct vehicle for a change of this kind. This is not the most obvious place to make a change of this kind. However, to give some comfort to the noble Lord, Lord Palmer, and to other noble Lords who have indicated a degree of qualified support for the amendment, I can say that my colleague, Andy Burnham, the Minister of State for delivering quality, who is actually responsible for this policy area in the Department of Health, is considering, outside the Health Bill, further work to see whether indicating the cost will discourage patients from taking vital medicines and, if it does not, will look to see whether it would be justifiable to introduce a similar but more limited flexible arrangement to that which would be established by the proposed amendment. The noble Lord has certainly gained Health Ministers’ attention with the amendment. We want to take the issue forward with a proper study and I congratulate him on pursuing with some tenacity his views on the issue, with which, as I said earlier, we have some sympathy. In that context, I hope he will be willing not to proceed with his amendment.