Health and Care Bill

Rob Roberts Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Anne Marie Morris]

Then I would like to see you wishing to press it to a vote and putting your vote—and your feet—where your mouth is. [Interruption.] I apologise, Madam Deputy Speaker; it is not your mouth. I was carried away by an overwhelming desire to get my point across, and I apologise most profoundly.

I turn to access to medicines. Most Members believe, do they not, that medicines that have been approved by the National Institute for Health and Care Excellence are available to all our constituents? The reality is that they are not. A medicine may have gone through the Medicines and Healthcare products Regulatory Agency and been proved to be safe, and through NICE and been said to be cost-effective, but each CCG—each ICB, as they will be—and hospital trust, and every other NHS body responsible for prescribing, sets its own formulary, and those formularies do not include all NICE drugs. If a medicine is not on the formulary, then no consultant or GP will be able to get reimbursement, so they will not be allowed to prescribe it.

In my constituency, a number of individuals have come to me because they cannot get access to a particular medicine, yet people in another constituency can. I do not believe that a postcode lottery is right. We all talk about the NHS, and health and care, being free at the point of delivery, and we all assume that we can get access, whether to GPs or to hospitals, but I do not think it occurs to most of us—it had not occurred to me—that we cannot necessarily get access to medicines.

My amendment 21 to clause 15 would effectively oblige every ICB, where any individual patient has the advice of their clinician that they should have a particular medicine and it has been approved by NICE, to make provision to ensure that that medicine is provided—perhaps from a neighbouring ICB, taking advantage of the duty to collaborate across ICBs. That would ensure that even if a medicine was not on the formulary in the area of an individual ICB, it could be obtained from another area. Bear in mind that there is no financial loss in doing that, because all NICE-approved drugs are subject to a voluntary pricing agreement between the pharmaceutical companies and NHS England. Under that agreement, x number of drugs will be provided at an agreed cost. Anything above that will be reimbursed by the drug company, so the Government and the NHS will not be out of pocket. Why would that not be a good clause? To provide belt and braces, under amendments 20 and 22, all NICE treatments would automatically be added to all formularies within 28 days of market authorisation and every ICB would be obligated to report.

My last area—I will be very brief, Madam Deputy Speaker—is research, which is so important, as we discovered during the pandemic. I would like to draw the attention of the House to some of the challenges. Some of the anti-viral solutions to coronavirus were late to market because we could not get the clinical trials. Why? Because we could not get access to the records of the patients who had had covid or been diagnosed with covid so that we then had the appropriate cohort to be able to test the anti-virals. It therefore seems very clear that research must be taken on board across every hospital trust and across every ICB. If every ICB and hospital trust had in place a system to ensure research was part of their DNA—that they had to report on what research they were undertaking and had an obligation, if they were asked and had the appropriate cohort, to recruit the patient base so that particular clinical trials could take place—we would get more medicines faster to market. I think most people would say that that was a win.

[Rob Roberts (Delyn) (Ind)]

I declare an interest in that my partner is a clinical research nurse—working in cardiac research—so I completely appreciate and understand exactly where the hon. Lady is coming from. Does she agree that to find patients for studies, often tens of thousands of pounds is spent on radio and online adverts? If her amendment 17 is successful, it could be revolutionary for research in this country.

[Anne Marie Morris]

I thank the hon. Gentleman. He is absolutely right. If we could have this new system, so there was a research strategy and an obligation to consider clinical trial requests and then report, we would be in a very different place.

Madam Deputy Speaker, you have been incredibly indulgent and so have all hon. Members. On that note, having had my time for my four areas, I thank the House for its indulgence and I look forward to the Minister’s reply.

--- Later in debate ---

[Matt Hancock]

This part of the package was described in September, because it was made clear in September that the £86,000 cap was a cap on individual costs. It did not say then that that included the costs that local government may make on someone’s behalf. I think it is a strong Conservative principle that, when we say we are capping the costs that an individual pays, we do not include the costs that another part of the state should pay. I think that that was clear, and more details have now been set out. Most importantly, this is a package that takes things forward in a way that has not been achieved for decades.

[Rob Roberts]

I do not think anyone across the House would argue that the measures that have been put forward are a significant step forward from where we are. However, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for South West Surrey (Jeremy Hunt) mentioned earlier, they are not necessarily what we might have been led to expect. Would my right hon. Friend like to comment on that?

[Matt Hancock]

I will happily comment on that. In the debate over the past few days, many people have been comparing the package put forward by the Government with the proposals from Sir Andrew Dilnot in 2014-15, but there is a reason those proposals were never enacted and never came into force. It is because they had a huge price tag, and there was no successful debate on how to pay for them. It has been easy to ask for social care reform for the past three decades, but until this Government did it, nobody had come forward with a plan for how to pay for it. We simply cannot magic things out of thin air. If we are a grown-up Government, we have to come forward with a grown-up package, which includes saying how it will be paid for. That is what has happened, and that is why this package hangs together. We should support this new clause, because it is part of that overall funded package.

I want to turn briefly to the measures on integrated care systems. The purpose of the ICSs is to have a more preventive, more flexible and less siloed approach than we have under the current clinical commissioning groups, without removing the grit in the oyster that is the purchaser-provider split and without upsetting the 1948 settlement involving local authorities doing social care and having a national NHS. Amendment 76 in particular contains a lot of suggestions that might seem tempting. There are people who have an important voice in the debate. The problem, as we have seen with existing legislation, is that if we put too much into statute, it is far harder to deliver high-quality services that are integrated on the ground. That is why the Government are right to resist putting too much detail into legislation. However, I do support the change proposed by the Government, which makes it clear that the purpose of ICSs is not to have private providers on the board. I can confirm that, as the Minister said, it never was. Mischievous rumours were put about, some of which have been repeated today, that that was the intention, and I am glad that the Government’s amendment puts that matter beyond doubt.

I am attracted to amendments 89 and 90 and, in another group, amendments 91 to 98 and amendment 23, tabled by my hon. Friend the Member for Broxbourne (Sir Charles Walker). I was going to say this before I knew that I would be sitting next to him in the debate today, and I hope that the Government will look on these amendments kindly. The parity of esteem between mental and physical health is incredibly important, and I commend the amendments to the House.