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Limited List Prescribing

Volume 75: debated on Tuesday 12 March 1985

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asked the Secretary of State for Social Services what representations he has received since he announced his revised limited list about a possible appeal mechanism for the prescribing of non-listed medicines.


asked the Secretary of State for Social Services how many representations he has received concerning the revised final version of his limited list of drugs available on the National Health Service.

We have received 123 letters commenting on the selected list which I announced on 21 February. Ninety-five have been from doctors or patients, of which 11 have been about a mechanism which would enable drugs not available at NHS expense to be prescribed in particular circumstances.

As the Minister has conceded that his first attempt at a limited list was unsatisfactory, why is he so self-confident as to believe that his second attempt is absolutely perfect and foresees every possible clinical need, given that some doctors believe that even with the new list they will be unable to prescribe appropriate pain killers for some cancer sufferers? Does he recognise that he may greatly reduce the opposition to the limited list if he provides a mechanism through which special cases could be dealt with and had it in operation as soon as the list comes into operation?

I hear what the hon. Gentleman says. The expert committee that looked at the list of drugs believed unanimously that the selected list would meet all clinical requirements. The vast majority of concern has now been met. Nevertheless, if the profession wishes to propose some appeal mechanism I am ready to discuss it with the profession. That will mean that the profession will have to come and see me and talk about it.

Is my right hon. Friend aware that many Conservative Members who strongly support his proposals nevertheless believe that it would be in the interests of patients to have an appeals procedure, whereby drugs that are not on the list but are later proven to be essential can be made available? Has he received any communication from the British Medical Association—a minority of whose members have behaved callously towards elderly and sick patients—as to whether it will assist in the appeals procedure?

We have received independent advice from about 2,000 general practitoners, but regrettably the British Medical Association has said that until the House debates the subject next Monday it will not take part in talks. I regret that, but I hope that after Monday's debate the BMA will come to see me and my right hon. and learned Friend the Minister for Health as quickly as possible.

Does the Secretary of State agree that the Government's handling of this has been ham-handed, to say the least, and that anxiety among the sick, especially the elderly sick, could have been avoided had the matter been handled differently? Is it not clear that he must do something immediately to remove people's anxiety over whether they will continue to be provided with drugs that have been successful?

I do not accept what the hon. Gentleman says. We have always made it clear that we would consult on our proposals and that the original list was provisional. The result of consultation is the extended list. The vast majority of the public and of the medical profession accept that the list is now good.

Does my right hon. Friend agree that, although restricting the variety of prescriptions may be necessary, restricting the quantity of drugs prescribed is vital? Will he require doctors to limit prescriptions to 28 days' supply at a time, which would be cheaper, safer and less wasteful?

I am not sure that I can require them to do that. An advantage of the debate that we have had is that there is now much more concern about prescribing habits, and I hope to be able to follow that with further advice from the Department. In principle, I have great sympathy with my hon. Friend's point.

Does the Minister realise that we have received a heavier postbag on this issue than on almost anything else, which is the real reason why so many Tories are standing up? Does he realise that every week there is a new and developing onslaught on the NHS, which causes more and more people to worry about what the Government will do? Is this the creeping privatisation of the Health Service by 1,000 cuts, of which this cut is a major part?

The hon. Gentleman is being more than usually absurd. He must recognise that we are trying to raise money for the NHS. However, it does not surprise me that he comes to such a conclusion. He and the Labour party want more spending on the Health Service but have not thought about how that money will be raised.

Although I welcome the tone of my right hon. Friend's answers this afternoon, especially the feeler that he put out to the medical profession, does he accept that if he met doctors' concern about an appeals procedure in cases where doctors genuinely believe that certain drugs must go to their patients he would do much to defuse all reasonable opposition?

Indeed, and that is why I said that my door is open to listen to representations on that. I am sympathetic to the principle, but it is reasonable to say that if the BMA wants talks it must come to me and discuss the matter.

What consultations is the Secretary of State having with his opposite numbers at the Department of Trade and Industry, who commissioned a working paper from the pharmaceutical industry on extending patent life, which would be a way of moving towards generic substitution and thereby forgoing the shambles which this limited list has caused?

The hon. Gentleman's description of the position is not remotely fair or accurate, and I should be sorry if he took that view into the Division Lobby. Clearly, I am consulting my right hon. Friend the Secretary of State for Trade and Industry, but, as the hon. Gentleman will know, I am the sponsor of the pharmaceutical industry, which has made it clear that, despite the controversy over the limited list, it wants the DHSS to continue as a sponsoring Department.

Will my right hon. Friend say what representations he has made to the ABPI? Does he agree that its newspaper campaign has not only been misleading, but has caused quite unnecessary concern, particularly to elderly people?

I think that the campaign of the ABPI —and I would say that at times the ABPI has not been speaking for some of the excellent companies in the industry — on occasions has been disgraceful and hypocritical. It must be pointed out that its latest proposal, in which it suggests that old people will be affected, goes ill with its suggestion that exemption should be removed as one of the ways of making money.

Will the Secretary of State tell the House how much of the cost of his estimated saving of £75 million will be borne by pensioners? If he cannot give the House a figure, will he say why not? Surely he does not intend to take some free medicines away from pensioners without knowing first how many will be affected and how much money they will lose?

I do not think that our proposals will affect the pensioners. What we expect this to do is to cut the drugs bill by £75 million immediately. We have always recognised that consultation would mean less saving. The aim is to look for further ways of getting better value for the drugs bill.

Will my right hon. Friend confirm that the savings made under the limited list system will redound to the benefit of the National Health Service and not simply to the benefit of the Treasury?

Yes, that is the whole point of the proposal. The money saved will go to health care. The Opposition have been consistent in pressing me to make economies in the drugs bill. The difference is that the Government are doing something about it. The fact is, as my hon. Friend the Member for Banbury (Mr. Baldry) says, that the proceeds from that will go into health care.