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Drugs: Nhs Limited List

Volume 475: debated on Tuesday 3 June 1986

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My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government what are their criteria for adding drugs to the limited list.

The Parliamentary Under-Secretary of State, Department of Health and Social Security
(Baroness Trumpington)

My Lords, the criteria used by the Advisory Committee on NHS Drugs in considering whether individual products should be available for prescription under the NHS are the same in each therapeutic group covered by the selected list scheme. First, if the product is required to satisfy a real clinical or therapeutic need not met as effectively by any other product available, it should be made available regardless of cost. Secondly, if it meets a real clinical need or therapeutic need at least as effectively and at the same price as or more cheaply than any other available product, it too should be made available.

My Lords, I thank the noble Baroness for her Answer. May I ask her why there are no mucolytics for children with "glue ear" and for patients with excessive viscous mucous in their respiratory tracks when systemic mucolytics are recognised as being useful for patients under 18 with tracheostomy? May I also ask the noble Baroness whether she will ask the committee to consider adding to the list of systemic decongestants, on the basis that there is no universal drug for every illness?

My Lords, the noble Baroness gave me advance warning. The advisory committee considered a great deal of information about the use and therapeutic value of oral mucolytics not only from within the UK but from America, Australia and elsewhere. They concluded, on the basis of all the evidence available, that patients suffering from chest conditions or "glue ear" will obtain no real advantage from taking oral mucolytics.

My Lords, in thanking the noble Baroness for her replies, especially that to the supplementary, may I ask to what extent there is a social motivation to include medication for people with chronic conditions, bearing in mind particularly the present cost of prescriptions? To what extent is the motivation cash saving as opposed to the promotion of good health?

My Lords, the promotion of good health is always our aim. The aim was to save money by getting the best drugs available for the cheapest price. By so doing we shall save £75 million in the year.

My Lords, can the noble Baroness explain where the saving comes in when a patient with chronic bronchitis has to have his lungs physically drained once a month under anaesthetic in a National Health Service hospital, when previously the mucolytic was given to him orally and he did not suffer from these problems?

My Lords, I cannot answer any question as technical as the one the noble Baroness has asked, but I would point out that our commitment was never to provide exact alternative but appropriate alternative treatment. For many scheduled drugs this means similar, cheaper ones. However, where we are advised by experts that a specified drug is of no proven therapeutic value—for example, in the case of oral mucolytics—the appropriate alternative treatment might involve a very different drug, or indeed no drugs at all.