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Health and Social Care Bill

As the noble Earl, Lord Howe, outlined in his opening and powerfully argued remarks, which of course I take very seriously, the amendments all in some way seek to ensure that the importance of guidance and technology appraisals produced by the National Institute for Health and Clinical Excellence is explicit in the Bill. The Government established NICE nine years ago to provide independent, authoritative advice to the NHS on the clinical effectiveness and the cost-effectiveness of new and existing treatments and, by doing so, to help to tackle variations in prescribing practice, as has been ably described by my noble friend Lord Warner. As mentioned by the noble Lord, Lord Walton of Detchant, whom we are delighted to see here, NICE has made a great success of that challenging brief, developing an international reputation for its work and improving its performance in recent years, and remains at the heart of the Government’s plans for driving forward quality improvement in the NHS. I know how valuable NICE guidance is in supporting evidence-based decision-making. I therefore fully understand the desire of Members of the Committee to include specific mention of material produced by NICE in the Bill and genuinely appreciate the intention to support NICE that lies behind that. However, we cannot support the amendments. I will explain why for each in turn. It is the classic situation, as the Committee will realise as I go through, of what you put in the Bill and what you put in guidance, and testing which of those we think will be most effective. At the moment, we think that the words in the guidance are the most effective way. Amendment No. 21 would amend Clause 2 to require the new commission in everything it did to have regard to the consistent application of NICE’s technological appraisals and other guidance as a means of providing equity of access to treatments and medicines. NICE guidance is of course an important and authoritative source of advice for the NHS on issues of clinical effectiveness and cost-effectiveness. I welcome the spirit of the amendment in underlining that fact. However, the amendment is very specific and what it would prescribe is not appropriate as an overarching factor that the commission should have regard to in carrying out its work. Factors that the commission should have regard to are not intended to be a list of specific sources of advice and guidance from specific organisations. To ensure that flexibility is maintained, the registration requirements on which we are currently consulting are the appropriate place to deal with this issue. I have ensured that a pile of these documents is available at the door and I urge noble Lords who have not read the document from cover to cover to do so. I appreciate it particularly because it is written in plain English. Indeed, our first proposed registration requirement is, "““making sure people get the care and treatment that meet their needs safely and effectively””." The commission can take account of the relevant NICE guidance, specifically including NICE’s interventional procedures guidance, to ensure that the most appropriate treatments are being provided across all registered providers of care. Our consultation document gives examples of how this proposed requirement is intended to work. The requirement on page 57 states: "““It will take account of NICE guidance about safety and efficacy issued through its interventional procedure programme, or other authoritative evidence-based guidance as to safety and effectiveness (where NICE guidance is not relevant), to ensure appropriate treatment is provided safely””." Let us remind ourselves that, where registered care providers fail to meet registration requirements, the commission will be able to use the full range of its enforcement powers. This seems to be a more appropriate means to address the intention behind Amendment No. 21. Amendment No. 71 refers to NICE guidance and technology appraisals produced by NICE in relation to standards. Standards in Clause 41 are to be used by PCTs and registered providers as brief common descriptions of aspects of healthcare quality, with the intention of informing improvement effort. I agree with the remarks of my noble friend Lord Warner and the noble Lord, Lord Kirkwood, in this respect. We want wide consultation and discussion on the detailed content of these standards. The Bill, therefore, contains a statutory requirement for these standards to be consulted on and kept under review. Given our commitment to an open consultation on these standards, we would not want to make specific provisions in advance of the consultation process. NICE will, of course, be an important contributor to this consultation, and material produced by it is very likely to inform the development of specific standards. It is certainly not our intention to undermine NICE’s work by setting out a standards regime that is inconsistent with its guidance. Amendment No. 88 relates to special reviews. Again, while appreciating the spirit of this amendment, I am unable to support it. Clause 44 already makes provision for the commission to carry out general service reviews, more specific reviews into particular matters and investigations into specific aspects of care. The commission will be free to take account of anything that it reasonably considers is relevant. The provisions as drafted would enable the commission to carry out reviews of the nature proposed by Amendment No. 88, which is, therefore, unnecessary.