We hope to make an announcement shortly on the setting up of a committee to keep the selected list under review, and to ensure that it continues to meet all clinical needs at the lowest possible cost to the National Health Service.
Does my right hon. and learned Friend agree that in view of the anxious letters that many hon. Members have received about the operation of the limited list it is essential that the independent body starts its work as quickly as possible? Will he assure me that the British Medical Association will be fully co-operating in it? Will he ask the group to study the position of oral mucolytics as a matter of urgency? Finally, will he assure me that the group will contain a Scottish representative, as we have a separate list in Scotland?
We are receiving some representations, but I think that the introduction of the selected list is going remarkably smoothly. I am glad to say that the bulk of the medical profession is co-operating in its introduction, as it promised to do. There is a genuine difference of medical opinion about Mucodyne and other similar preparations. The unanimous opinion of our experts was that it had no established clinical value in the treatment of glue ear and other conditions, but that is the first issue that our new committee will examine when it reviews the present list. We are about to consult on the exact membership. I shall bear in mind the needs of other countries.
We have not removed from the list any drugs for which, according to the best expert advice that we can obtain, there is no alternative. The point of having the new committee is to take that advice and keep it up to date.
Is my right hon. and learned Friend aware that I do not want to have to write to him and wait weeks for a reply, or table parliamentary questions about this matter? What we need is an early and efficient system that will deal with the matter as quickly as possible at local level.
My hon. Friend tends to press me in letters and in every other way on whether we need an appeals system for individual cases. The fact is that we immediately consulted the BMA when it asked for such a system. We made an extremely reasonable offer, which was described as a climb-down by some of its representatives. However, the climate of medical opinion has changed. My latest information is that it is likely to say that there is no need for such an appeal system. The matter is not in my hands.
I have to wait for the formal response from the committee which represents general practitioners, with which I negotiated the arrangements, but I repeat that in the substantial body of medical opinion some have never seen the need for such a system, and that a growing number do not see the need for such a system now. We have to be guided in those matters by the best expert medical and scientific advice that we can obtain. We have to be influenced by the votes cast by the representative committee, representing all GPs.
Mr. John Mark Taylor:
Will my right hon. and learned Friend reassure me that when the independent review group gets to work — we hope as soon as possible—if it finds that there are reductions that can still be made in the list it will recommend them, and they will be proceeded with?
I entirely accept my hon. Friend's point. The point of continuing the review will be to make sure that we have everything that the patients need on the list, and that we continue to provide those drugs in the most cost-effective way. I think that our estimates of savings will go up in future years as more generic alternatives to some of the branded products that are on the list at the moment come on to the market.
In view of the general uncertainty in the profession about the appeals procedure, will the committee examine the possibility of having an across-the-board generic substitution, with the general practitioner having the right to say that there is to be no substitute, which would preserve the best of both worlds?
As I have not yet had a final response from the General Medical Services Committee I am not sure whether it is right to describe the present position as uncertain. No doubt I shall eventually get a certain response to the reasonable offer that we have made. I know that there are still advocates in the House of full-scale generic substitution, particularly in the Opposition, but it would have a ruinous effect on a wide range of the pharmaceutical industry and, in the end, could cost the country the introduction of valuable new drugs of genuine therapeutic value.
Is my right hon. and learned Friend aware that the delay in implementing a review and appeal procedure is doing great damage to the limited list policy, which most of us support?
I am concerned by my hon. Friend's views, but the moment that we were asked to consider the possibility of an appeals system we entered into urgent discussions with the BMA, and my officials and I had meetings in rapid succession with the representatives of the general practitioners. They were unable to give me an answer to the offer until they had had the conference of local medical committees. They still have not given me a final answer. I think that the people with whom I negotiated feel that a reasonable suggestion was made by the Government. It is up to the doctors to decide whether patients need it.
Is the Minister aware that I am surprised at his use of the word "smoothly", when I have not had a letter answered about the matter for some months, except for a single letter from Baroness Trumpington, saying that letters would be answered in the future? If the right hon. and learned Gentleman came to my constituency surgery he would realise how much distress the limited list is causing, not only to my constituents, but to doctors, who are now asking me for appointments because they are against it, too.
My noble Friend's letter is similar to one that I am sending out, too. I hope that it explains to hon. Members the difficulty, which I know everybody is feeling, about answering letters. I hope that people will understand that there are serious practical problems in answering correspondence about individual patient's symptoms, drugs, and treatment. I also note what the hon. Gentleman said about the number of cases with which he has to deal. A great deal depends on the policy adopted by individual practices. Where the doctor advises that a change of drug is called for, little seems to happen to the patients in consequence. In some practices the patients are being told that Parliament has done this or the Government have insisted upon that, and the result is that some patients start to feel uneasy the moment they are subjected to such lobbying.