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Mr. Bercow: I am confused about the stances of different members of the Government. How does my hon. Friend reconcile--if it is possible--the stated position of the Secretary of State in respect of Viagra and the oft quoted remark of the Minister for Tourism, Film and Broadcasting that there would be more and better sex under Labour?
Mr. Denham: He is embarrassed.
Mr. Hammond: I am somewhat at a loss. I thought that my hon. Friend was going to challenge me to reconcile the actions of the Secretary of State with the remarks of the Minister for Public Health; I am afraid that he has thrown me a little. I must confess that I cannot reconcile the Secretary of State's actions with that rather unwise promise.
This is a matter of significance and not merely something for the tabloid press to titter at. Until September 1998, when the Government introduced their interim guidance on Viagra, treatment for erectile dysfunction was fully funded throughout the NHS. The Government may have been panicked by media stories exaggerating the likely demand for Viagra when it became available in the United States; the Secretary of State has said that the stories were material considerations in formulating the policy. It has subsequently appeared that such stories were exaggerated both here and in the United States.
The Government issued interim guidance advising general practitioners that they should not prescribe Viagra other than in exceptional circumstances--which were not properly defined. The High Court recently found that guidance to be illegal on the grounds that it contravenes both the doctor's professional duty to treat his patient and the requirements of European Union law. You see, Mr. Deputy Speaker, that I was not being facetious when I mentioned Brussels earlier.
Mr. Fabricant:
Does not my hon. Friend find it worrying that several Labour Members have said that the problem is a life style issue? Is not it far from being that?
Mr. Hammond:
That is right, and some of the early scaremongering in the popular press focused on that. However, in fairness to the Secretary of State, he has made it clear that erectile dysfunction is a serious medical condition with serious consequences. Until recently, its treatment was fully funded under the national health service, but an arbitrary decision has been made to cease that funding for all patients. The result will be discrimination between groups of patients.
I suspect that the medical profession's outrage at the Secretary of State's decision to use schedule 11 to the 1992 regulations to limit the prescription of treatments for erectile dysfunction is what has caused the hon. Member for Oxford, West and Abingdon to take action. The British Medical Association said that the Secretary of State's action was arbitrary and that it would exclude people with genuine clinical need. It is important to recognise the significance of that: for the first time, official policy has acknowledged that people in genuine clinical need will be denied a treatment. That is a change in the ethos of the national health service, and deserves serious exploration.
New clauses 16 and 17 would make it impossible for the Secretary of State to resort to the mechanism that he has used previously to limit the availability of such a drug. If the Minister could bring himself to recognise the rationing that exists, he might say that the proposal from the hon. Member for Oxford, West and Abingdon is not the best way to deal with the matter. He might admit that a mechanism is needed to resolve the problem posed when a clinically effective but increasingly expensive drug is available for use but cannot be afforded within the national health service's resource constraints. Both I and my right hon. Friend the Member for Maidstone and The Weald has been saying that for the past year, but there cannot be a sensible debate until the Government acknowledge that rationing exists.
The real objection, which we share with many clinicians, is to the fact that the Government make rationing decisions on grounds of costs--and it is clear that the decision about the availability of Viagra is one such--but then try to justify them on pseudo-medical grounds that are quickly disowned by authoritative medical opinion. One of the important issues to flow from the recent decision is the question of discrimination in the NHS, a matter to which we shall come in a later debate. However, that discrimination will not be for reasons of gender, race, sexual orientation or age. People with a given condition will suffer discrimination based on how they came to have the condition.
That is equivalent to accident and emergency departments being asked to treat people with broken arms differently depending on whether the limb was broken in the course of work or leisure. Instinctively, we find that inappropriate, and new clauses 16 and 17 would make it impossible in the future.
The Government's approach to the treatment of male erectile dysfunction has shown the reality of the existence of rationing. There are, however, numerous examples of so-called post code rationing, when health authorities themselves have decided that they will or will not fund something. That is incompatible with the Government's expressed desire for universality in the NHS and their commitment that doctors should be free to treat patients according to clinical need. Given the resource constraints of the NHS, the Government must explain how they will square their desire to eliminate unjustifiable regional variations--a form of discrimination--with the lack of any significant additional resources to enable levelling up.
We would have been delighted if the Government had accompanied the introduction of the National Institute for Clinical Excellence with an announcement that it would provide a levelling-up process so that the best and most clinically effective practice would be made universally available. That would have been good news for many patients, but it would have raised questions of how the improvement would be paid for and how the wider debate over rationing would be dealt with.
Rationing is one of the most serious problems faced by the NHS, and the Government and Parliament, rather than institutions with powers and responsibilities devolved by the Secretary of State, must confront it. It is, and must remain, intrinsically a political issue. As new clause 4 implies, NICE must remain an advisory body, and Ministers must take the hard decisions.
Although new clause 4 usefully highlights the rationalisation potential of NICE and the Government's unwritten agenda of using it as a rationing device, it does not fully answer the problem of rationing. With the greatest respect to the hon. Member for Oxford, West and Abingdon, that is not compatible with new clause 14.
New clauses 16 and 17, by contrast, go to the heart of rationing, demanding a coherent response from the Government and something more than the mantra that rationing does not exist--a denial which does not move the debate a millimetre forward. Despite the Minister's consistent assurances that he is anxious to engage in constructive debate, the denial that rationing happens continues to prevent sensible debates that would benefit our constituents and the people of the UK. Instead, the Government have condemned themselves to continual stonewalling and have boxed themselves into an absurd position.
Mr. Bercow:
I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on the presentation of his argument. As my hon. Friend the hon. Member for Runnymede and Weybridge (Mr. Hammond) observed, there are flaws in his position and in that of his party. There is not a complete identity of view between the stance of the Liberal Democrats and that of the official Opposition. However, I respect the hon. Gentleman's medical experience, in spite of the occasional eccentricity of his political viewpoint. A good deal of the rationale behind his arguments will have commended itself to hon. Members and to people outside the House. In so far as it attempts to flush out the Government's position and to deny them the opportunity of continued obfuscation, it is welcome.
The contribution of my hon. Friend the Member for Runnymede and Weybridge was typically succinct. It was a remarkable performance for my hon. Friend to confine
his remarks to one hour in the interests of the progress of the debate. His lucidity and eloquence are such that we should have been happy to listen to a continued exposition of the arguments for considerably longer. I can only assume that his natural concern that others should get in on the debate caused him to relent and resume his seat.
At the heart of this debate and essential to any meaningful discussion of new clause 4, and certainly to discussion of new clauses 14, 16 and 17, is the concept of rationing. We come back to that central issue time and again.
Without giving him any advanced warning, I asked my hon. Friend the Member for Runnymede and Weybridge what he considered to be the difference between rationing and the prioritisation of resources, or at least the allocation of resources, within a finite budget. My hon. Friend legitimately chose not to answer directly. He cannot be expected to surmise exactly what Ministers are thinking. Much of the time their thoughts are impenetrable and their expression of whatever thoughts they have, still more so. It is not reasonable for my hon. Friend to be expected to decipher exactly what Ministers--in their statements or lack of them--intend us to infer. However, the Minister has the opportunity to tell us tonight his understanding of the difference.
For the avoidance of doubt, the challenge is simple. What is the difference between rationing and the prioritisation of the allocation of resources within a finite budget in the national health service? I cannot conceive of a way in which the question and the challenge could be more simply put. I appeal to the hon. Gentleman to answer that question tonight.
Also, I ask the Minister to confirm that he is content absolutely with the reply on rationing offered by his right hon. Friend the Minister for Public Health on 15 December 1998 at Health Question Time, which is in Hansard, column 746--it is important to be precise about these matters. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) challenged the right hon. Lady as to whether there was rationing in the NHS. On that occasion, the Minister for Public Health looked like a rabbit caught in front of the headlights. I say that with no disrespect to the right hon. Lady. Her predicament was understandable. My right hon. Friend the Member for Maidstone and The Weald scares the living daylights out of me and she is my right hon. Friend, so it is perfectly imaginable that she would have caused terror in the heart and mind of the Minister for Public Health. Nevertheless, the right hon. Lady was obviously frit. She did not know what to say and thought that the shortest possible answer was probably the best escape route. She unwisely replied to the challenge of whether there was rationing in the NHS, "No." Moreover, she did not content herself with giving that answer once. Working on the assumption, I think, that having said it once it was best to stick to it and say it as many times as necessary, she repeated that answer on two further occasions in response to challenges from my right hon. Friend.
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