NHS: Health and Social Care Act 2012

Lord Naseby Excerpts

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

I can give the noble Lord an absolute assurance on both those counts.

[Lord Naseby (Con)]

Surely my noble friend can confirm that, broadly speaking, the tendering processes under the Act have gone well and are broadly within budget. Although there are various dimensions to the tendering process as raised by my noble friend from the Liberal Democrat Benches, nevertheless, in broad terms, we are well satisfied with the way that it has gone. If there are differences and small amendments are necessary, will my noble friend confirm that those will be looked at speedily?

[Earl Howe]

My Lords, I agree with my noble friend in that I am not aware of any tendering process that has gone horribly awry. Certainly the Government are always open to looking at any provisions that are not working as they should, but I am not aware of any.

Smoking: Cigarette Packaging

Lord Naseby Excerpts

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, we want to keep a close eye on what is happening around the world before making a decision. We are keeping standardised packaging under active consideration. It has been newly introduced in Australia, and other countries are intending to follow suit, so it is sensible for us to see what we can learn from other countries’ experience. The impacts could be several. They could include, for example, health benefits, as well as impacts on businesses such as retailers and tobacco manufacturers, and could possibly bring about a change in attitude to smoking.

On the risk to children, the noble Baroness is of course absolutely right. Evidence suggests that action needs to be taken to reshape social norms around smoking so that tobacco becomes less desirable, less acceptable and less accessible, particularly to the young. That is why we are committed to ending tobacco displays in shops. We have a TV-led marketing campaign to encourage smokers not to smoke at home or in cars and we have banned the sale of tobacco in vending machines, which has removed a source of cigarettes that underage smokers could access as often as they liked. There is a range of work going on.

[Lord Naseby]

May I—

[Lord Foulkes of Cumnock]

My Lords—

[The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford)]

We will briefly hear from my noble friend and then go over to the other side.

[Lord Naseby]

I congratulate my noble friend on not rushing in to another unproven restriction on the consumption of alcohol, particularly one which has legal dimensions that affect intellectual property rights. Can he confirm that consumption of cigarettes is already falling, and that we are already spending something like over £50 million on tobacco control? Is not the greatest problem at the moment illegal smuggling of cigarettes into this country, which costs the Revenue a huge amount of money—close on £200 million—and is consumed principally by young people?

[Earl Howe]

My Lords, smoking rates in the UK are lower than those in many comparable western societies, but our reductions in prevalence still lag behind those in countries such as Canada and the United States, and in some Australian states. Overall prevalence is gradually coming down, but we still need to worry about smoking take-up by the young. There is no doubt that smoking is a significant cause of health inequalities in the UK.

On illicit trade, the story is quite positive. In 2000 around 21% of the UK’s cigarette market was illicit, whereas the latest estimate from HMRC for 2010-11 is that around 9% of the cigarette market is illicit. That is too much; nevertheless, we are heading in the right direction.

Health: Degenerative Brain Diseases

Lord Naseby Excerpts

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

My Lords, I am glad to know that. It provides a telling and important example of how this can be done in a sensitive way, and in a way that best meets the requirements of researchers. If there is a possibility of planning in advance the donation of a brain—or, indeed, any organ—it is much easier for the family and gives the patients themselves much satisfaction.

[Lord Naseby]

Is my noble friend aware that a great deal of work is being done through the EMEA and, through that organisation, by a number of countries in Europe? As one who has raised the issue of orphan drugs before, can we, on this occasion, make sure that NICE co-operates with these other bodies and we do not start duplicating work across the whole of Europe?

[Earl Howe]

My Lords, I am aware that NICE co-operates with its counterpart bodies not only in Europe but in other parts of the world; its work has an international dimension. As the same time, I say to my noble friend that NICE is seen as a world leader in its field. Many other countries look to NICE for the methodology that it adopts.

NHS: Private Companies

Lord Naseby Excerpts

Monday 11th February 2013 Lords Chamber

[Lord Naseby]

My noble friend mentioned tariffs. Will it be a tariff across the whole of England or will it reflect the differing costs, particularly in overheads, of, say, an operation in London and an operation further north?

[Earl Howe]

My Lords, there are tariffs that are nationally set and others that may be locally set, but there is scope to vary even the national tariffs if there is a good reason to do so on the grounds of local variation in costs. There is some flexibility in the system, but the main basis of the policy, as I stressed earlier, is that, where competition occurs, it should be on the basis of quality and not price.

Tobacco: Control

Lord Naseby Excerpts

Tuesday 19th June 2012 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government whether they will meet representatives of non-governmental organisations, the tobacco industry and retailers to discuss tobacco control issues, publishing the minutes of such meetings, in line with both the requirements of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control and the practice of the European Commission and other member states.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, Health Ministers consider all meeting requests carefully. Article 5.3 of the Framework Convention on Tobacco Control requires the Government to protect the development of public health policies from the vested and commercial interests of the tobacco industry. The tobacco industry is welcome to share its views on tobacco control issues with us in writing at any time.

[Lord Naseby]

My Lords, that is a depressing Answer. How is it possible that in a country that believes in freedom of speech, a highly regulated and legitimate industry employing thousands of people and providing millions of pounds of revenue for Her Majesty's Government can be treated quite so shabbily when the Government are developing new regulations affecting plain packaging, which affects intellectual property, and are involved in consumer safety? I ask my noble friend to think again and to receive representations. The Government may not want to agree with those representations, but surely it is the legitimate right of every elector and every employer in this country to make their representations in person to Her Majesty’s Government.

[Earl Howe]

My Lords, we welcome the views of tobacco companies, retailers and all those with an interest in tobacco-related policy. Ministers in other departments may have legitimate reasons to meet the tobacco industry—I understand that, from time to time, they do—but Health Ministers and Department of Health officials would have a good reason to meet tobacco companies only if a specific matter, as opposed to general issues to do with tobacco control, demanded that. We would have to think carefully whether there was a good reason.

NHS: Risk Register

Lord Naseby Excerpts

Tuesday 15th May 2012 Lords Chamber

[Earl Howe]

My Lords, we do not agree with that. We have, as I have mentioned, published a document setting out a summary of all the risks in the register and the mitigating actions associated with each category, but we resist publishing the risk register itself at present. It is essential that officials are able to formulate sensitive advice to Ministers, making frank assessments and using direct language, without the fear of causing unnecessary embarrassment for the Government or damage to their area of policy. That is the essence of the reason.

[Lord Naseby]

Is my noble friend aware that there is nobody more passionate about the NHS than I am, but that a great many people outside want civil servants and other advisers to Ministers to point out the whole extremity of risks in any policy, whether it is policy A, B or C? At the end of the day, they expect Ministers to look at those risks and take appropriate decisions. Against that background, therefore, the strategy that my noble friend is following is understood outside by the ordinary public. It may not be understood by the lobby groups; nevertheless, it is the public whom we serve.

[Earl Howe]

My Lords, I am very grateful to my noble friend, and he is right. The risk assessment process, carried out by civil servants and detailed in these registers, is an integral part of the formulation and development of government policy. It is in the public interest that this process be as effective as possible. We are clear that where policy is sensitive, that necessitates confidentiality.

NHS: Management Consultants

Lord Naseby Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

The noble Lord is, I think, insinuating some impropriety on the part of McKinsey and, perhaps, on the part of civil servants. I know of no such impropriety. Indeed, as I said earlier, there are clear and strict rules about transparency and openness. Declaring hospitality received is something that all civil servants and Ministers have to do. The results are published regularly. I will of course ask the question of McKinsey, which I have not yet had time to do. If I discover that there is any substance to the questions that the noble Lord has asked, I shall of course write to him and place a copy in the Library, but I very much doubt that I shall find any substance to them.

[Lord Naseby]

My Lords, as the Question refers to consultants and not to any specific consultant, is it not a fact that consultants provide a good interim role of management, suggestion or policy for consideration for Her Majesty's Government rather than their taking on ever more central staff? Is that not particularly appropriate, bearing in mind that the Prime Minister held a consultation on the whole of the Bill, as a result of which, as I understand it from listening to the debates in this House, changes have been made to the Bill which will have to be implemented pretty quickly? One can understand why consultants are brought in at the centre of the National Health Service. Surely on the whole it can only be healthy to have consultants there to speed up the implementation of this very important Bill.

[Earl Howe]

My noble friend is quite right. As I said earlier, the use of consultants—provided that that use is judicious and they are engaged in open competition processes—can be very cost-effective. It is a very flexible way of obtaining high-class advice without incurring long-term costs.

Tobacco

Lord Naseby Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, I wonder too.

[Lord Naseby]

My Lords, the Minister says that the control of illegal importation of tobacco is showing progress. Is it not the reality that the vast majority of illegally imported tobacco and cigarettes is being consumed by young people, and that while the official statistics may show one thing, all the evidence, when I inquired of the tobacco industry on this particular aspect, is that this is still the major problem in terms of young people taking up smoking?

[Earl Howe]

My noble friend is absolutely right that that is where the problem principally lies: 320,000 young people experiment with smoking or take it up every year. That is a very serious rate of incidence and it must be tackled at every possible level. The tobacco control plan sets out a concerted programme of action to try to do just that.

Health and Social Care Bill

Lord Naseby Excerpts

Monday 19th December 2011 Lords Chamber

Debate on whether Clause 240 should stand part of the Bill.

[Lord Naseby]

My Lords, the Deputy Speaker called the amendment and it was agreed, but I did not specifically hear that Clause 240 should stand part. If I may, I will intervene briefly on whether the clause should stand part, particularly the additional functions under subsection (1)(a). It states:

“NICE may do any of the following … acquire, produce, manufacture and supply goods”.

I have a query for my noble friend on the Front Bench. We are well aware that in the past some hospitals have manufactured certain generic medicines and marketed them, which has caused the normal market for medicine and pharmaceuticals to be disrupted. Secondly, we are aware, particularly recently, of certain hospitals that have been selling medicines in another market, which has caused disruption to that market and particular difficulties for parts of the country where there has been a shortage of medicines.

I may be wrong but, as I read it, this clause means that NICE will be in a position to manufacture directly, maybe even under a licence. I see that under paragraph (f) NICE will be able to,

“exploit ideas and exploit intellectual property”.

Can we be quite clear? Is my noble friend really saying that NICE, the adjudicator of value for money and all the other dimensions in the Bill to do with pharmaceuticals, medicines et cetera, will manufacture certain medicines on the side? That does not seem to be part of the role of the regulator. It seems, frankly, to be virtually direct labour within the context of NICE. I would be most grateful if my noble friend would respond. If he is not able to respond today, perhaps he will respond on Report or write to me.

[Earl Howe]

My Lords, I hope I can assist my noble friend. Clause 240 enables NICE to undertake additional functions, such as supplying new services and exploiting intellectual property. These functions must be related to the provision of health and social care. They seek to reproduce the income-generation powers that NICE currently enjoys as a special health authority and do not therefore represent an expansion of its powers. NICE may do this for any number or type of organisations, including the private sector and overseas Governments. This clause allows NICE to charge for carrying out these additional functions on an appropriate commercial basis.

In the White Paper Liberating the NHS: Report of the Arm’s-Length Bodies Review, the Government stated that,

“where appropriate, arm’s-length bodies will be expected to exploit commercial opportunities and maximise commercial discipline across the sector”.

NICE may carry out these additional functions provided that they do not have an impact on its ability to carry out its functions. We do not envisage, and nor does NICE, that the performance of any of these functions will interfere with its normal work programme. I hope that that is helpful to my noble friend. It is certainly not the case that NICE will be manufacturing medicines, as I think he feared.

--- Later in debate ---

[Earl Howe]

The noble Lord is exactly right. He will know from his time as a Minister with responsibility in this area that NICE has steadily grown its reputation overseas, and that with that have come opportunities to sell its services in a number of quarters. We simply want to see that continue.

[Lord Naseby]

I understand that and I understand the point made by the noble Lord, Lord Hunt. Nevertheless, to the best of my knowledge, NICE has never manufactured, and presumably from what my noble friend has said is not going to manufacture, in which case perhaps “manufacture” can be deleted from the Bill when it returns on Report.

[Earl Howe]

I will take advice on why “manufacture” is in the Bill and come back to my noble friend.

National Institute for Health and Clinical Excellence

Lord Naseby Excerpts

Wednesday 14th December 2011 Lords Chamber

Asked By

[Lord Naseby]

To ask Her Majesty’s Government what, if any, changes there will be in the procedures of the National Institute for Health and Clinical Excellence as a result of the recent life sciences Statement.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government’s Statement on the life sciences set out a range of actions to support the adoption and diffusion of innovation in the NHS. This includes a commitment to establish, through the National Institute for Health and Clinical Excellence, an advice service to support medical technology companies in demonstrating the value of their products, and measures to improve NHS compliance with NICE guidance. It is for NICE to consider any changes to its procedures as a result.

[Lord Naseby]

Is my noble friend aware how welcome the Statement on life sciences was both to patients who suffer from chronic diseases and indeed to the pharmaceutical industry? However, that welcome is tempered by the statement that my noble friend has just made, because, quite frankly, NICE is and has been a dead hand on development for many medicines. I note that the current chairman has been in position for 12 years, and is scheduled to stay for another two, while the chief executive has been there for 12 years, and is scheduled for an unlimited term beyond that. Many charities have commented on NICE, and I will quote briefly from Sarcoma UK: “In the UK the delays caused by NICE can add years to introduction and mean patients die waiting”. Against that background, will my noble friend ensure that NICE has a new, younger and more modern management?

[Earl Howe]

My Lords, I need to put on record that I have every confidence in the senior leadership of NICE. The current chair and chief executive have overseen NICE’s development into an organisation of global repute that provides robust, independent guidance on a range of issues. Continuity of leadership can be a very good thing, and I believe that it is in this case, where the leadership is of the highest calibre. I would also say that significant improvements have been made to the timeliness of NICE appraisal guidance on new drugs. NICE is now able to issue draft or final guidance for a significant majority of the drugs that it appraises within six months of a drug being licensed. That is extremely good, considering the complexity of some of these assessments.