My Lords, I welcome these amendments, which relate to the National Institute for Clinical Excellence—NICE. I thank all noble Lords for tabling these amendments and for their contributions today, which certainly expanded my knowledge of the subject, as I am sure they did across the Committee. The debate has shown that there is a need for change, as I am sure the Minister has heard, to better equip the National Health Service to provide the patient what they need when they need it.
The noble Baroness, Lady McIntosh, spoke clearly about hurdles that must be overcome, whether they are bureaucratic, process, budgetary or administrative. All these hurdles get in the way of the end result: meeting the needs of patients. That, I believe, is what this debate is focused on.
NICE is well recognised as a partner to our NHS. Its objective approach and evidence-based analysis rightly gain respect. However, as my noble friend Lord
Hunt said—he can now be called the first Minister for NICE—although the National Health Service is full of innovation, it is also slow to pick up on it; that point was emphasised by the noble Lord, Lord Warner. That begs the question: what kind of partner should NICE be to the NHS? Is it going to be an enabling partner, or will it frustrate at times? Of course, we all want to see NICE in that fully enabling capacity.
However, beyond what NICE approves in terms of treatments, pathways or otherwise, there must be procedures for it to implement and connect effectively to patients’ needs. We know that no system or set of procedures will ever be perfect; we have heard that today. Understandably, therefore, as the Minister has heard, pressure and a will for change—in a positive sense—is contained in these amendments. The noble Baroness, Lady Finlay, spoke about how important it is to have evidence-based healthcare and to have known guidelines and see them complied with, as is right and proper.
There are cautionary considerations to note in this debate; we have heard some of them. One is whether it is wise to put what in some cases appear to be operational requirements in the Bill. I am sure the Minister will address this. The new world is certainly paying a lot of attention to flexibilities. We want to make sure that anything contained in the Bill does not inadvertently work in another direction.
My understanding is that NICE guidance is mandated, in effect, with the guidelines somewhat less so. Amendment 54 contains a proposal to reinforce the intention that, once a treatment has been properly assessed and recommended, all patients should be able to gain the benefit. We know, and we have heard in this debate, that this does not always happen, and that clinical commissioning groups follow different policies. However, in considering the amendment at face value, it is important that we consider what impact this latitude might have. I am sure we are all keen not to accidentally invoke some kind of fallout, such as taking away all leeway from commissioners. At present, they can depart if they can set out an objective case for doing so; for example, with requests for certain drugs and therapies through individual funding requests.
Similarly, it would be unfair if a patient could cross an integrated care board border and receive a treatment that was not available in another ICB area. That would seem inadvertently to achieve what we do not want to achieve: the worst of a postcode lottery. Equally, if we have locally based approaches, the reality is that some localities will differ in their priorities and services. I know that we will return to this topic many times in our consideration of the Bill because the care that patients receive should certainly be equitable and fair and not based on where they live.
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At this point I refer to the contribution of the noble Lord, Lord Stevens, who reminded your Lordships’ Committee that what we are dealing with is not a new problem but was considered over the matter of lime juice many years ago. It is right that the noble Lord, Lord Stevens, raised questions about the terminology
in the amendments. If they are to advance, I am sure that your Lordships’ House would want to look at how the terminology is set out and what the wider impact of the amendments would be.
On Amendment 74, the intention for information to be promoted is sensible, as is a process to report on usage of online information sources. Again, I expect—I hope—that the Minister will at least find favour with this amendment, but he may question whether it is straying outside the legislative territory. That is a matter we should also consider about Amendment 97.
Amendment 97 is about a timeline for the updating of the systems of integrated care boards and healthcare providers to make NICE-approved medicines or devices available. I certainly support the intention here. However, if this is a direction to take, we need an examination as to whether a deadline of 28 days would actually provide for the intention of this amendment, and whether this is something of concern for primary legislation.
I had assumed when looking at Amendment 163 that the inspections referred to were by the Care Quality Commission. I am grateful to the noble Baroness, Lady Finlay, for confirming that. It makes sense for the CQC to look at many aspects of compliance and the amendment would ensure that focus is directed at ensuring equitable access to technologies and treatment.
In closing, I hope that the Minister will have felt the mood of this debate, which is supportive of NICE in all its excellence but also in a wish to see perhaps a nimbler and more responsive partner to the NHS so that we can see benefits for patients on a fair and equitable basis.