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Health and Social Care Bill

My Lords, this is a disparate group of amendments. I support a number of them. Some seem to be counter to others, but I hope that they will come together at some point. Amendment 110A seeks to strengthen the need to take into account the guidance from NICE. From time to time, NICE faces someone complaining about the way it goes about its business. Sometimes patient groups suggest that it is taking its time or is working against their best interests. The pharmaceutical industry complains from time to time that it takes too long and maybe gets things wrong—perhaps that is a good thing on behalf of NICE. Others complain about the methodology that NICE uses, using QALYs—quality-adjusted life years—as its measure of whether a drug or treatment is effective. Despite all that, I believe that NICE does a marvellous job, as do many who know what it does. It makes sure that the suggestion of treatments is based on clear, independent evidence of their effectiveness. Its approval is something of a kitemark for the standards that GPs and PCTs should follow and the system is envied across the world. There are others trying to emulate NICE. This amendment makes it clear that the boards must work in accordance with NICE guidance. My question to the noble Earl is: why have the Government seen fit seemingly to weaken the role of NICE by making its advice be just that—advice—without any of the teeth that it previously had? There is a subtle difference between what its guidance means now and what it will mean in the future. It would be good to have that clarified. I support Amendment 109A, in the name of the noble Lords, Lord Butler and Lord Newton, because it provides a little get-out clause. It definitely provides NICE guidance but it also provides the possibility for a new treatment, which has not been tried or looked at by NICE, still to have an opportunity to be used and looked at under very specific and controlled conditions. Therefore, the two amendments can be looked at together. Amendment 110ZA refers to specialist nurses, who of course do a marvellous job. I owe them some personal gratitude, although I will not enlarge on that to noble Lords. The specialist nurses who are threatened are those in the community, who work across the community-NHS divide. They include specialist diabetes nurses, stoma care nurses, psychiatric nurses and a range of others. They do a fantastic job but, unfortunately, they are threatened. I hope we can see our way to making them unthreatened by ensuring that their joint funding, which comes partly from the local authority and partly from the NHS, is encouraged by the board and takes place. Will the noble Earl try to ensure that the board can promote this idea?