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10.17 pm
The Minister for Health (Mr. Gerald Malone): Such is the attraction of the invitation of my hon. Friend the Member for Bosworth (Mr. Tredinnick) to improve by ministerial diktat the happiness and health of the nation that I might be tempted to accept, but I am not sure that it is within ministerial gift. However, I will try to help him. He has raised several important points with which I am happy to deal. I stand in need of some sort of nutritional supplement or form of medication to deal with my cold.
It may help my hon. Friend if I first set out the system. He said at the outset that supplements were being removed from lists of items that can be prescribed by doctors. That is not so, as will become clear as I explain the system. There is no NHS prescription list that says what products general practitioners can prescribe at NHS expense. The reverse is true: GPs are free to prescribe nutritional supplements or any other preparation for their patients unless they are included in the blacklist. The blacklist scores out some items that are available generally; it does not refer back to a list on which it has been decided to incorporate certain substances.
I shall give examples, which are extreme, but which illustrate the freedom of the medical profession. When I visited the prescription pricing agency in Newcastle, it had a number of interesting examples of items that GPs had prescribed. You, Mr. Deputy Speaker, might consider it unusual if, when you next visited your GP, he prescribed you a pint of Guinness, but it has been done--and done within the letter of the rules. Another example involved a prescription for a Christmas pudding.
The difficulty is that GPs who prescribe in that way must be prepared to justify challenges to their prescribing by the health authority . If the health authority decides that such items, or any other unlicensed products--be they
dietary foods, supplements or toiletries--should not be regarded as a drug for reimbursement purposes, the GP must justify the issue of the prescription. If justification cannot be given, the GP may be asked to repay the cost.
It is different when a pattern begins to emerge of a consistent habit of prescribing, at a cost to the NHS, certain specific products. That is the point on which my hon. Friend has concentrated tonight. When the spending level of such products becomes significant, it is referred to the Advisory Committee on Borderline Substances for consideration.
The issue that my hon. Friend has raised relates to the recent public consultation on the addition of further items to the list of products that may not be prescribed at NHS expense. Those products included unlicensed dietary supplements. To understand the issue, it is important to emphasise the vital nature of the word "unlicensed"--it refers to a category of products that are separate from other products that have gained a licence, and are dealt with in a different way.
The list makes an important contribution--and has done for some years--to the Government's strategy to secure best value for money from the NHS drugs bill, and to secure the greatest benefit for patients. That is the point on which my hon. Friend wanted reassurance; he wanted to know that I had an open mind about what might constitute the greatest benefit to patients. I hope to say something helpful later.
The ACBS has an important role in our strategy, through its advice to Ministers on items that it considers should no longer be prescribable at NHS expense if it has not been demonstrated that they meet a therapeutic need in the community, or if they do not meet a need as economically as possible. If therapeutic value is in doubt, it is logical that the existence of alternatives is irrelevant.
The ACBS is aware that the Department's general advice is that most nutritional problems can be treated by dietary changes--that is the scheme's history. It was the view taken by the chief medical officer in the mid-1980s, when the scheme came into play; it is a view that still holds. I am sure that my hon. Friend and the House will agree that the supply of food--the best way to treat the deficiencies--to patients in the community is not a reasonable NHS function.
Not only does the ACBS consult the company involved before offering advice to Ministers, but there is a further period of consultation with interested bodies in advance of any final decision on changes. My hon. Friend mentioned the consultation period. I was of course concerned that there should be a proper period. I am not sure that the methodology employed by those who have lobbied on the matter--dividing the amount of time by the number of products--was necessarily accurate or the right method to use. But I can assure my hon. Friend that I was extremely concerned that there should be a proper period.
In fact, a longer period was allowed in view of the Christmas and new year holiday. I would point out that this is a consultation period that has precedent in previous and similar exercises, where the consultation period was deemed to be broadly satisfactory by all those participating.
Following the most recent such consultation, which began in November and did not end until 9 January, I carefully considered the comments made--indeed,
I varied four of the original proposals put before me on the basis of the evidence gleaned from the consultation evidence. I assure my hon. Friend that time was provided, and that Ministers listened to what was said, leading to the original advice being changed as a result of the consultation.
I did consider the views of the society to which my hon. Friend referred, and also took account of the opinions of a whole range of learned societies that have a knowledge of these matters. Having been specifically consulted, many of them did not object to the proposals. For example, neither the Royal College of General Practitioners, nor the general medical services committee of the British Medical Association raised objections to the recommendations.
My hon. Friend specifically pressed me about the membership of the ACBS, and passed on others' suggestions that it lacks expertise on nutritional matters. That is not true. The committee consists of several people: my hon. Friend wanted reassurance that they had some involvement in nutrition, and I can tell him that the expertise of two of the members is specifically directed towards that field. Those members are Dr. Simon Allison, who is head of the nutrition team of the Queen's Medical Centre in Nottingham; and, in a practical and more down-to-earth way, Ms Julie Fenton, who is the chief dietician at Queen Mary's university hospital, who has great insight into the sort of cases described by my hon. Friend.
Whatever the recommendations of the ACBS, it is open to the producers of high-strength multi-vitamin and mineral preparations to apply for their products to be licensed as medicines. They would have to provide evidence of the product's safety, quality and efficacy for the specified indications, and if they did so, a marketing authorisation could be granted.
That answers my hon. Friend's other point regarding a special category. There is no need to have a special category, because the way forward for those who market these products, if they think that they are of substantive therapeutic value, is simply to put them through the licensing process. If the products can be proven to be of therapeutic value, they, like all other products, will get a license, and will fall automatically within a category which can be prescribed by doctors.
I have some knowledge of what are commonly referred to, albeit slightly pejoratively, as alternative medicines. If there is a growing body of evidence of efficacy, which those who either market these products or claim that they have a worth are able to marshal, they will have a right--as would anyone else who claimed that their product had a therapeutic effect--to go through the licensing system so that the products could be available. I therefore issue something of a challenge to my hon. Friend: if the evidence is brought forward, it will be considered in an open way, which is the usual way in which evidence is considered on matters that may provoke a therapeutic change for the best.
I looked at the case study to which my hon. Friend referred, and I would be happy to look at further details, if he can provide them. It set out what were claimed to
be the facts of the matter, but I have to say that it was based substantially not on strong evidence, but on assertion. I should be happy to see better and further evidence--if such exists--to sustain the claims made for the product referred to in the study.
My hon. Friend referred to vitamin B6. To bring him up to date, I can tell him that officials from the Ministry of Agriculture, Fisheries and Food and the Department of Health are meeting interested parties to discuss certain recommendations that have been made. Those interested parties have also been invited to submit any relevant data
they might have which demonstrates that vitamin B6 is safe and of use. All such data that are received will be considered in full. That is the right way forward--there are no closed minds. I hope that my hon. Friend will find that answer helpful.
At the end of the day, I cannot give my hon. Friend specific assurances on his four points asking me to make concessions. The system we have works well, and it protects the national health service in terms of cost. It is a fair and open system, and, on this occasion, it has worked, and worked well.
Question put and agreed to.
Adjourned accordingly at half-past Ten o'clock.
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