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9.15 pm
I am sure that the Minister will be interested to hear the official definition. I have taken the trouble to find out that, on page 2482 of "The New Shorter Oxford English Dictionary"--copies of which are available for consultation in the Library during the drier parts of my speech--the verb "to ration" is defined as follows:
Mr. Swayne:
Is not the attitude and the new-speak of the Labour Government made manifest in the Bill by NICE, CHIMP and PRODIGY?
Mr. Bercow:
I am grateful to my hon. Friend for making that point. In previous reflections on these matters, I have challenged the Government as to the profusion of those new bodies and the peculiarly inelegant titles that Ministers have conferred on them. Indeed, on one occasion I regarded it as a particular pleasure to reel off no fewer than six such bodies during a question to the former Minister of State at the Department of Health, the right hon. Member for Darlington (Mr. Milburn), now the Chief Secretary to the Treasury. I should like to trouble my hon. Friend for further details, but fear that I should try your patience, Mr. Deputy Speaker, if I did so tonight.
I should be happy to give way to the Minister at any point in my remarks, if he feels inclined to answer this central question: if there is no rationing, what is happening now? If there is no rationing, why does almost everyone in the United Kingdom--intelligent, unintelligent or of varying degrees of intelligence--believe that there is? Why is it that the Government are right about this question, even though they are in a tiny minority and are disbelieved, but that everyone else is wrong?
Sir Richard Body (Boston and Skegness):
Surely, the origin of rationing was to give to five people what was normally available for four--hence the word "ratio". In relation to the health service, in most of our
Mr. Bercow:
Rationing can take a variety of different forms. It is not in dispute that, because of the constraint of insufficient resources, if people cannot receive treatment, or cannot receive it until a certain period has elapsed, that constitutes a form of rationing. My hon. Friend is right to describe another form of rationing, but if people cannot have treatment now because there is no money to pay for it--or there is money to pay for treatment for only four people, rather than for five--manifestly, in ordinary, everyday parlance, we must conclude that that constitutes a rationing of the available treatment.
I hope that the Minister will agree with that. I look to him, with beads of sweat upon my brow, in eager anticipation of a straightforward answer to a straightforward challenge. He sits there, he cogitates, he looks down at his notes--
Mr. Bercow:
I am not in a position to confirm the accuracy or otherwise of that observation. I simply ask the Minister to confirm that he accepts--so far, because I want to take him step by step through this issue--the validity of what I have said. Does he accept the definition of rationing that I have given?
Mr. Deputy Speaker (Mr. Michael Lord):
Order. I am sure the House will agree that we have now dealt adequately with the definition of rationing. Perhaps the hon. Gentleman will now move on.
Mr. Bercow:
I am happy always to be guided by you, Mr. Deputy Speaker. Although I immediately accept your ruling that we have adequately debated the definition of rationing for tonight and that to avoid tedious repetition and defiance of the rules of order we cannot continue to have that debate on this occasion, there will be ample opportunities in the course of this Parliament for debate to be rejoined.
I say to the Minister of State in the friendliest spirit, he should not imagine that he can get away with avoiding an answer to my question tonight, because we shall be back. We shall be back before breakfast, before lunch, before tea, before dinner and before we consume the bedtime Ovaltine to harangue him on this issue. He knows that all of those present in the Chamber are assiduous attenders of parliamentary debate, as is my hon. Friend the Member for Boston and Skegness, and we shall pursue the issue at every opportunity.
New clause 4, moved by the hon. Member for Oxford, West and Abingdon, specifies that clinical efficacy or relative cost effectiveness should be the criterion on which treatments are prescribed. He suggests that overall cost or the possibility of additional cost to the NHS should, of itself, not be a criterion. However, I agree with my hon. Friend the Member for Runnymede and Weybridge that there have to be limits to total expenditure. We would argue an absurdity if we were to suggest that there could be limitless expenditure.
I have reflected carefully on this issue. I have reflected carefully on the unpopularity of rationing: it is almost the inadmissible sin of the operation of the NHS. It is to the great credit of my hon. Friend the Member for Runnymede and Weybridge and my right hon. Friend the Member for Maidstone and The Weald that they have tried to cut the Gordian knot of that debate. They acknowledge that there are, of course, limitations of resources within which judgments have to be made, but that ordinarily clinical judgments should be respected and once there is a budget known, Ministers should not retreat into arguments about resources when to do so negates the power and clinical freedom of, for example, in the field of multiple sclerosis, neurologists.
The hon. Member for Oxford, West and Abingdon referred to the debate about beta interferon. He and I are currently engaged in a correspondence on this important matter, and I know that hon. Members on both sides of the House with genuine concern about multiple sclerosis sufferers have raised with Ministers the question of the funding of beta interferon and its continuing provision.
My concern is that the Government are not being up front and saying that resources are of the essence and that it is a lack of resources that is causing them to think about ways in which to restrict the availability of the drug. Even though to make that admission would give rise to some hostility and considerable debate, the admission would be honest. I would go so far as to wager--and I believe that my right hon. Friend the Member for Maidstone and The Weald would concur with me on this--that the Government would win respect for candour and openness. In respect of beta interferon, it is their pretence that factors other than limitations on resources are uppermost in their minds that leads sufferers from that chronic neurological disease to distrust them.
I would go so far as to say that there are some who despise the attitude of the Government because it is not frank, candid or open. The Government treat the people of this country and the sufferers of the disease who know about it and feel it in a way that none of us can emulate as stupid: they simply consider that they cannot grasp the issue. That is unfair.
Let us take the particular case of the provision of beta interferon to sufferers of multiple sclerosis. The House will be aware that there are four forms of multiple sclerosis, of which the two most commonly debated in the Chamber are the relapsing-remitting and the secondary progressive forms of the disease. There is a limited number of manufacturers of the drug beta interferon, of which perhaps the most notable is Schering Health Care plc. It currently supplies beta interferon to those who suffer from the relapsing-remitting form of the disease, but it has recently been granted a licence--I believe I am correct in saying that it is currently the only manufacturer to have been granted such a licence--to supply that version of the product that treats the secondary progressive form of the disease.
"to limit to a fixed allowance."
The dictionary helpfully continues with another definition of the verb:
"to share out in fixed quantities."
I am grateful to my hon. Friend the Member for Boston and Skegness (Sir R. Body) for suggesting that ratios are involved in this matter. To ration implies the existence of ratios. I hope that, at least on that point, there can be unanimity among the parties in the Chamber. Does the Minister accept those meanings of the word "ration", or is this new Labour Government so arrogant that they believe that they know the definition of words better than the distinguished sources who compiled the "New Shorter Oxford English Dictionary". We know not. Perhaps we shall be told. I hope that we shall hear about that before the conclusion of the debate.
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