Health and Social Care Bill

My Lords, I know that NICE is held in very high regard by noble Lords in the Committee. The Government share that view. That is why we are putting NICE on a firmer statutory footing in the Bill, extending its role to cover social care as well as healthcare and public health, and putting NICE quality standards at the heart of quality improvement. NICE will continue to play a key role in helping to ensure that decision-making in the NHS is robust and evidence-based. The noble Lord, Lord Owen, said that the Bill gave the impression that NICE would turn into a kind of annex of the Department of Health. I can assure him that that is not the intention of the Government. A special health authority, as NICE technically is at the moment, is much closer in technical terms to the Department of Health than the non-departmental public body that we will set up. He also said that he felt that the additional responsibilities we were placing on NICE were inappropriate. When I have spoken to Sir Michael Rawlins, the chair of NICE, he does not take that view. He regards what we are doing as a vote of confidence in NICE, which is what it is intended to be. There has been some confusion throughout the passage of the Bill about the detail of NICE’s future role. This may underlie some of the discussion we have had in the debate around the incorporation of NICE’s technology appraisals into quality standards. First, I can confirm that NICE will continue to appraise new drugs and technologies at least until we implement our plans for value-based pricing from 2014. The Bill enables us to provide for NICE to continue this important work when it is re-established. As we develop our plans for value-based pricing of new branded medicines, NICE’s role in appraising drugs will inevitably evolve. However, we have been clear that we expect NICE to have a central role in the value-based pricing system, including in undertaking an assessment of the costs and benefits of different medicines. That is highly analogous to its current role. I very much agree with the noble Lord, Lord Owen, that we do not wish to lose—and certainly not downplay—the skills and scientific and analytical expertise that NICE undoubtedly has. We will make announcements on the precise shape of the value-based pricing model in due course but suffice to say for now that we believe that NICE is very well placed to fulfil the role of performing the pharmacoeconomic evaluation that will underpin the value-based pricing assessment. Alongside that, NICE may also need to continue to undertake some technology appraisal activity after 2014—for example, to review existing recommendations in the light of new evidence or to assess important new non-drug technologies. It is quite wrong to suggest that we will cease that activity within NICE. I also take the opportunity to reassure noble Lords that we will use powers in the Bill to replicate the effect of the funding direction which ensures that the NHS in England continues to fund drugs that have been recommended by NICE’s technology appraisal guidance. However, it would not be appropriate to place in the Bill such a requirement on clinical commissioning groups—as Amendment 344ZA would seek to do. That would leave no flexibility to alter the requirement in the event that there were clear practical barriers to implementation within three months of the final guidance. Amendments to the existing funding direction have only been made on a small number of occasions but it is important to retain that flexibility and secondary legislation supports this better than putting a requirement in the Bill. In our response to the Future Forum report, we also confirmed our intention to maintain the effect of the funding direction in the new value-based pricing arrangements from 2014 to ensure that the NHS in England consistently funds medicines with a value-based price. This means that NHS patients can be reassured that they will continue to have a right to clinically appropriate, cost-effective drugs and treatments as set out in the NHS constitution and handbook. Quality standards bring clarity to quality and are a resource that supports clinicians and commissioners in driving quality improvement locally. They serve a different purpose from the technology appraisal guidance that NICE provides on drugs and treatments. There has also been some debate around the promotion of innovation by NICE. It has been a recurring theme in the Committee. A few days ago we published Innovation, Health and Wealth, which recognises the key role that NICE guidance should play in supporting the adoption and diffusion of innovation and sets out a range of measures to support and improve implementation of NICE’s guidance, such as the establishment of a NICE implementation collaborative. There has also been discussion about whether it is appropriate for NICE to have a training function. I can reassure noble Lords that there is a clear need for this provision. I am looking here at Clause 236. Among its important functions, we intend that NICE will undertake work historically delivered by the National Prescribing Centre, which provides support for high-quality, cost-effective prescribing and medicines management across the NHS through the development of a range of tools and services. NICE, in its current statutory form, absorbed the NPC in April of this year. The Department of Health has previously commissioned from the National Prescribing Centre specific support and tools to support policy delivery, including training. The department or the NHS Commissioning Board may in future direct NICE to provide similar services. There have also been suggestions that we amend some of the provisions relating to the chair and non-executive directors in Schedule 17. I can understand why the noble Lord, Lord Hunt, suggested that the Health Select Committee should approve the appointment of the chair of NICE but this provision has not been made for the other bodies being established in the Bill and I do not believe it is necessary for NICE. Under the Bill, the Secretary of State will be responsible for appointing the chair of NICE, as is the case for NICE in its current statutory form. To require Health Select Committee authorisation would be to add a further layer to the appointments process for the NICE chair to little obvious benefit. I can also appreciate why noble Lords have asked me to clarify Schedule 17(3). It may at first glance appear to contain an unusual level of detail for primary legislation but I should point out that this provision is here for a serious purpose: to ensure that in the very serious but, we hope, unlikely eventuality that a non-executive officer of NICE is suspended there can be no argument about whether they have been properly informed of that decision. This provision is consistent across the arm’s-length bodies being established in the Bill. Finally, I briefly speak to the amendments that I will seek to move. They are all minor and seek to: clarify some of the wording around NICE’s additional functions; ensure that public consultation for quality standards produced now will be recognised as effective consultation following NICE’s re-establishment; and remove an amendment to Welsh legislation in the consequential provisions that is considered unnecessary. I hope that the noble Lord will feel reassured by my explanations of these issues and that he will withdraw his amendments.