Skip to main content

NHS: Expenditure

Volume 704: debated on Monday 6 October 2008

asked Her Majesty’s Government:

What percentage of NHS expenditure was spent on medicines in 1997 and in 2006.

My Lords, the percentage of NHS expenditure on drugs was 14.3 per cent in 1996-97, which is £4,735 million, and 13.1 per cent, which is £10,545 million, in 2006-07. However, I am afraid that we are not comparing like with like because funding for the NHS in 1996-97 was on a cash basis and in 2006-07 it had changed to a more accurate measure of resources. By using restated figures, we are in fact spending more money than before.

My Lords, I doubt that anyone is convinced by these new statistics. The Compendium of Health Statistics, which is the official version, states that the cut is from 11.7 per cent to 10.5 per cent—in effect, a cut of £1 billion. Is that not, in effect, the reason why our cancer patients do not get the drugs they deserve and which other countries provide? Is it not about time that the NICE management was brought to task so that its methodology is published and that it takes a reasonable, not immense, amount of time evaluating these drugs? Finally, will the Minister recognise that these poor patients, who have a very short life, deserve these drugs?

My Lords, that is a compendium supplementary question. I shall do my best to cover some of the points raised by the noble Lord; if I do not cover them all, I undertake to write to him. The growth in drugs over that period has been higher than the growth in overall NHS expenditure. The average growth of drugs was 5.6 per cent clear above inflation compared to the average growth of 5.2 per cent in overall NHS expenditure. The noble Lord referred to issues around cancer patients. He will know that from next year we are abolishing prescription charges for all cancer patients. He may also be aware that the review of top-up fees being completed by Professor Richards will be with us very shortly. The Government are committed to not only providing cost-effective drug treatment for NHS patients but also to allowing the innovation that is necessary to ensure that the new drugs are available to those who need them.

My Lords, does my noble friend agree that the way to measure our expenditure is to see what the outcomes are? Does she agree that satisfaction with the NHS is much higher now than it was 10 years ago?

My Lords, my noble friend is right that satisfaction is much higher than it was. Indeed, the Government are working hard to ensure that we use our resources in the best possible way. For example, we have issued guidance to the NHS saying that it is not acceptable to use a lack of NICE guidance to refuse treatment, and that the funding is available for the treatment that people need.

My Lords, there are serious ethical, as well as financial, issues in the noble Lord’s Question. Do the Government agree that a starting point might be to speed up the processes of authorising new drugs, particularly the work of the National Institute for Clinical Excellence? I am told that Scotland is quicker than England in this regard, so perhaps we have some catching up to do south of the border. Another starting point might be a much more robust and transparent discussion of what costs are, both in developing drugs and in using them. We must not forget that this is not about balancing books; it is about anxious patients, of which I have been one, who are sometimes brought into the discussion and are involved in some of the judgments made about how long people might live.

My Lords, the right reverend Prelate is correct that this is not about balancing the books. The Government have recently expressed the opinion that NICE needs to be quicker with its guidance.

NICE’s guidance is based on a thorough assessment of the best available evidence, and it is recognised across the world as a leader in its field. The reason that Scotland occasionally reaches a decision more quickly is that it does not go into the same detail that NICE does; it does not use the same evidence. That is why that happens.

My Lords, is not the problem with NICE that it is not actually nice at all? It is designed to be nasty and to ration the amount of money that is made available for drugs in this country. Clearly, we cannot spend indefinite sums, so NICE has the invidious task of deciding who should have drugs and who should not.

My Lords, NICE issues guidance about the appropriate drugs for the appropriate conditions. It is then, quite rightly, up to the doctors to decide how those are prescribed.

The NHS has some of the most efficient prescribing practices in the world. It has long had a policy of encouraging generic prescribing to ensure that lower-cost generics are used as soon as higher-cost branded medicines lose their patent rights, for example, so the rate of generic prescribing has risen from 51 per cent to 83 per cent, the highest in Europe. We are not spending unnecessary money on branded drugs, but we are making sure that those drugs that need to be available are available.

My Lords, does the Minister agree that Britain has done extremely well, partly through NICE, in decreasing the prescribing of drugs for weak clinical indications, but that the criteria that NICE uses when assessing potentially life-saving drugs such as cancer drugs may need to be viewed differently from the criteria for those that are much more symptomatic and for more minor conditions? Does she agree that the current position of withdrawing NHS funding from patients who have purchased drugs has damaged people’s confidence in the whole NHS and the system as it stands?

My Lords, the noble Baroness is, as ever, very informative. With regard to her question, that is why the Secretary of State asked Professor Richards to do a very quick review of top-up fees and report shortly on it.

My Lords, when will the NICE review be concluded, and how soon after that do the Government expect to implement its findings?

My Lords, is the noble Baroness referring to the top-up fees review? We expect that Professor Richards will make his report to the Secretary of State in October—this month. When he has considered it, he intends to publish its findings as quickly as possible.