Health Bill [HL]

My Lords, I applaud the commitment of both noble Lords to this issue, but I am afraid I am not going to satisfy at least one of them. Possibly I might give some comfort to my noble friend, but it is not favouritism: there is an argument here. The noble Lord, Lord Palmer, has added the words, ""actual cost if over £10"" to the amendment he tabled in Grand Committee. His intention in adding these words is that it will be very clear to patients what good value for money they are getting from the NHS, including those who pay £7.20 for their prescriptions. My noble friend Lord Campbell-Savours has the shared intent of making provision for adding a label to medicines and appliances dispensed to patients by community pharmacists, to indicate the cost of the product. While both of these approaches raise practical implementation issues, our primary objection is the impact these amendments might have on patients. As noble Lords know, further to this issue being debated during the passage of the Health Bill in 2006, we commissioned a piece of research on medicine labelling. The findings of this research provided clear evidence to support our case—to reject this proposition. The research, entitled Medicine Labelling Research, was published in 2007, and looked specifically at the effects of pricing information appearing on medicine labels, and addressed the question: would people continue to waste such high levels of medicine if they were aware of the actual cost of these products? The key outcome of this research is that labelling medicines with prices has a much more complex impact on patients’ attitudes toward their medicines than may be expected. Both amendments would present a risk to patients who need their medicines to treat their condition effectively, because higher and lower prices on medicines are linked by patients to the quality of the drug, the seriousness of the illness, the importance of the condition and the patient’s own self-worth. The research indicates that, for expensive medicines over £10, labelling may deter patients—probably the elderly—from taking their medicine, because of the uncertainty about the price or fear of being a burden to the NHS if the price is particularly high. These and other findings contributed to a conclusion in the report that, given the various routes of wastage, there seemed to be little possibility of reducing wastage by including pricing information, and that other ways had to be found. The patient’s perspective, we believe, must come first on this issue, and therefore I cannot support these amendments. In addition, there are several significant practical concerns. It was clear in Committee that a number of noble Lords recognised such issues. Let us take the practical considerations. While it might be possible in most cases to provide an indicative cost by using the drug tariff reimbursement price, this will still, as my noble friend Lord Campbell-Savours recognises, be of limited value, because the drug tariff reimbursement price list is affected by such factors as out-of-pocket and broken bulk expenses that pharmacists can claim. It is also affected, conversely, by the amount that is deducted from pharmacists to compensate for the discounts they have received when purchasing items from suppliers. There are many other practical considerations. In reality, implementation would be very complex. Dispensing contractors’ IT systems would need to have increasing functionality to put a price on a dispensing label; pricing databases would need to be up-dated, and dispensers would need to discuss the price with patients. For the amendment of the noble Lord, Lord Palmer, such changes would be required in a wide variety of NHS settings and the complexity would be increased by the intention to exclude prescriptions with a retail cost of less than £10, although some might come in and out of that band. Furthermore, it would be difficult to justify such an approach in relation to EU single market law—I appreciate that that may not go down terribly well with the noble Lord, Lord Palmer—which describes the primary purpose of packaging and labelling as the identification and safe use of medicines. The noble Baroness, Lady Barker, rightly recognised in Committee that the waste of medicines in the NHS has a resonance with the public. The department shares the very valid concerns of the noble Lords and others on this issue and is taking action. Medicines use reviews and repeat dispensing are in place. The department has also commissioned a very broad piece of research to establish the scale and cost of medicines that are not used and hence wasted, and to determine the varied and complex reasons why people do not take their medicines as intended. The outcome of this research, available later this year, will inform future policy development in an attempt to influence both health professionals and members of the public to reduce waste. I listened very carefully to what my noble friend Lord Campbell-Savours said about reimbursement. I will study carefully the detail of the noble Lords’ comments in relation to pharmacies, remuneration, reimbursement and medicine-labelling, and will provide a briefing on this. In the light of those comments, I hope that the noble Lord will feel able to withdraw his amendment.