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Health and Social Care Bill

I wish to make a few observations, but first I should declare an interest in that I was the Minister responsible for the pharmaceutical industry and NICE between 2003 and 2005, when of course everything worked perfectly in this area. The noble Baroness, Lady Cumberlege, made an important point about the pharmaceutical industry. When NICE began—I, too, believe that it is one of the Government’s great achievements and a real success story—the pharmaceutical industry was less than thrilled with it. Part of the deal was that NICE should produce certainty. When new drugs were presented to NICE, its set of recommendations sometimes went against the industry’s interests and the industry was not always thrilled by that. But part of the deal was that, when drugs were approved, there was an expectation that the decision would be implemented and that the drugs would be used across the country. If we are honest—and I can speak only from my experience—we must recognise that we have struggled to reconcile issues in this area. It is right that, after NICE has made its pronouncement, the drugs and, in particular, the technology appraisals should be implemented across the NHS. But we have often had thrown back at us the issue of local priority setting down at the PCT level. That argument has some legitimacy. We ended up with a situation, certainly when I was a Minister, where we wove into the standards that were produced, following the standard-setting provisions of the 2003 Act, requirements for authorities to adhere to NICE guidelines and findings on technology appraisals and on national service frameworks. For some time, the Healthcare Commission has been able to inspect against those standards in its rating of health authorities, so there is a link at the moment. However, under Schedule 15 to the Bill, the standard-setting powers in the 2003 Act are abandoned. We will have a new set of standard-setting provisions and we will need to see what those are at some time in the future. For all I know, the Government may proceed with the same set of standards or amend them in some way. The standards provide for the current commission to inspect against NICE guidelines and to have some expectation of the guidance being implemented. This is not an easy area. There is great strength in the amendments on standards and on functions but, before we get too carried away, it is worth dealing with the issue of the cost of implementing NICE guidelines. One of the factors taken into account in bunching a group of referrals to NICE is what the cost is ultimately likely to be for the NHS and how that relates to the totality of the budget. NICE guidelines and technology appraisals up to the end of 2007-08 have cost about £1.5 billion. However, we are spending more than £10 billion a year on pharmaceuticals of one kind or another, so the NICE recommendations are a relatively small part of the total spend. We should be a little cautious about feeling too sorry for local PCTs that say that they cannot afford to do the job. Given the amount of money that has gone into the NHS in recent years, we should not be overly sympathetic about that. There is an issue about how we can make the system work more effectively. The provisions in the Bill may help, but we will still need to truck away on these issues, as we have been doing for the past few years.