---

Health and Social Care Bill

I, too, put my name to these amendments and I endorse what the noble Lord, Lord Walton, has just said. I do not often pay tribute to the Government, but I do on this occasion: NICE has been one of their great successes. It is interesting that, although NICE cannot be exactly replicated in other countries, because they do not have the same connections or sockets or whatever makes the NHS work, NICE is nevertheless now giving advice and support. Indeed, it is founding an international consultancy to help other countries. As the noble Lord said, it has done a very good job. Of course, NICE is not universally popular; we know that. On occasion it disappoints industry or it disappoints patient groups that are fighting for the drugs that they feel their members need. NICE does not seek popularity, but it strives to make sensible judgments within the parameters in which it has to work. As my noble friend said, however, one of the drawbacks and frustrations has been the lack of implementation, of which he gave some good examples. I co-chaired the All-Party Osteoporosis Group and we heard a lot of evidence, but my noble friend has covered that. Another example is the three cycles of IVF for women who want to have a baby; that has not been implemented across the country. Then there is rheumatology and the drugs that my noble friend mentioned. We have to be practical, though. Until fairly recently, PCTs have been strapped for cash; in my area, they still are. They have to set their priorities locally. It would be fair to the population, to patient groups and to the pharmaceutical industry if more information were to come from PCTs, when setting their priorities, if they cannot make something a high priority because they have a lot of calls on their resources. It would be better if they could tell the general public and if there were a means—we suggest that it could be through the Care Quality Commission—of saying where their priorities were and where their needs, as they see them, were to be met. On occasions when they have to introduce a drug and cannot afford it immediately because it is new and expensive and all the rest of it, they should say how long it will take to introduce it within their patch. They should say who needs that drug and how they will make an assessment according to the need. This is a plea not only for some oversight by the Care Quality Commission, as the Healthcare Commission has already taken that area pretty seriously, but for transparency. The local population should know what the different priorities are in their area. Our pharmaceutical industry—and I declare an interest in that I am not a shareholder in it—is number one in trade surplus rankings. It is an important part of our national economy. It employs some 73,000 people. It spends £9 million every day on research and development and it has discovered 20 per cent of the world’s top medicines. For a small country, that is fantastic. I chair the Association of Medical Research Charities. We have to be careful to avoid discouraging the pharmaceutical industry, as a result of some of our mechanisms, from investing as much in research. One of the difficulties that it faces is that it takes some 10 years to produce a new medicine. If at the end of that time that medicine is not allowed to be prescribed, there is an issue that needs resolving. There is a simple issue about the funding of the NHS for these expensive drugs. I may well be wrong, but I believe that there is a £1.8 billion surplus in the NHS. Can the Minister tell us where that money is and how it will be spent?