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NHS: Medicines

Volume 697: debated on Wednesday 9 January 2008

asked Her Majesty’s Government:

How many NHS prescribable medicines are restricted to Scotland and not available in England.

My Lords, English GPs are able to prescribe any licensed medicine on the National Health Service unless it is listed in Schedules 1 or 2 of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004. Scotland has similar arrangements backed up by separate legislation. There are no significant differences between the two countries in this area of policy. Hospital consultants are not affected by these statutory restrictions.

My Lords, in the light of the Minister’s Answer, is she aware that Scotland’s equivalent to NICE licenses medicines some nine months before England? Does that not result in the fact that England is subsidising Scotland? Is it not about time that we had a real National Health Service and that drugs were prescribable across the whole of the United Kingdom and not parts of it?

My Lords, we live with the realities of devolution, whether or not the noble Lord likes them. Devolution means that the operation of systems for assessing new drugs in Scotland is a matter for the devolved Administration. That is where we are. In respect of the timescales, NICE has introduced a new, swifter single process and that is now almost as fast as the Scottish process, and is more robust.

My Lords, does my noble friend agree that it is perfectly reasonable for any part of the UK to choose its own priorities, but what is more important is that each part of the UK should receive a fair distribution of public expenditure?

Yes, my Lords, it is perfectly fair that each part of the United Kingdom should be able to address its own needs, but there must be fairness in the receipt of resources. I am confident that that is the case.

My Lords, given the natural divergence in provision that occurs with devolution, local decision-making and local commissioning decisions, are the Government giving any consideration to reviewing their attitude to co-payments so that patients are able to pay for rare drugs which are not being commissioned without having to pay privately for the whole of that episode of care?

No, my Lords, the Government are not giving any further reflection to the system of co-payments because we believe that such a system would risk creating a two-tier National Health Service, and I am sure that is not what noble Lords wish.

My Lords, does the noble Baroness agree that it is good news when Scotland decides to operate part of its National Health Service quicker, as it has with regard to the prescription of drugs, and England follows by speeding up its process? Such competition does no harm at all.

My Lords, is my noble friend aware that this is not the only difference between Scotland and England in this kind of provision? Scotland is moving towards free prescriptions, as is already the case in Wales. There is free personal care for the elderly. This is perfectly okay within devolution as long as it comes within the overall block grant, which is decided on a very clever formula, which was devised by a very clever man who now sits in this House and has some very clever ideas for the future. As long as that is done, that is perfectly okay. But if we constantly attack what is happening in Scotland and pretend that advantages are given to the people of Scotland when that is not the case, we shall play into the hands of the SNP, which wants to break up Britain, which would be devastating not just for Scotland but for the whole of the United Kingdom.

My Lords, as a Scot living in England, I ask the Minister whether she agrees with me that Scotland has always put a higher priority on the health of its population.

No, my Lords, I do not agree with the noble Baroness in this instance. Healthcare throughout the United Kingdom is rather good, and the quality of healthcare in England and in all parts of the United Kingdom has always been very good.

My Lords, can the Minister clarify her answer to my noble friend? Was she really saying that the newspaper reports that we have all read over the past few years that indicate that life-saving drugs are available in Scotland that are not available to patients in England are completely incorrect? Is she saying that it is only a matter of timing, or is there a difference? How can it be justified that the Government’s policy in England should be sustained by the votes of Scottish MPs, whose constituents benefit from the advantage of the health service in Scotland?

My Lords, I will respond to the first part of the question, which relates to the original Question. Only one drug has been recommended by the Scottish Medicines Consortium—the equivalent of NICE—that has not been recommended by NICE for patients in England. That drug is Fludara, for the treatment of chronic leukaemia. I believe that all other drugs are available in Scotland, England, Wales and Northern Ireland.

My Lords, does the Minister agree that since each Administration regularly conducts strategic reviews of the health inequalities in their countries, which are different, it is entirely logical that they will have different spending priorities for drugs?

My Lords, will the Minister answer the second part of the question asked by my noble friend Lord Forsyth? Does that mean that all the newspaper reports are wrong?