House of Commons Speaker Lunch

The PM Society's fourth House of Commons Speaker lunch was hosted this year by Dr Evan Harris, the Liberal Democrat MP For Oxford West and Abingdon, who promised to deliver an interesting talk on 'Rational rationing, not polite politics' to the 100 plus Society members who attended this event. Society Chair, Sandy Thomson, introduced Dr Harris to the delegates thanking him for his agreement to talk and briefly summarising his career to date.


Dr Harris qualified as a doctor from Oxford University Clinical School in 1991 and trained in emergency hospital medicine in Liverpool and at the Oxford Radcliffe Hospital. In 1994 when he took up an honorary public health post with the Regional Health Authority tasked with reducing the long and unsafe hours worked by junior doctors. During the mid 1990s he was an active trade unionist and BMA representative, and was elected to represent doctors in the region on the National Council of the BMA between 1992-1994.

Following his election in 1997, he began his political career as junior health spokesman and following re-election in 2001 he was appointed the Liberal Democrat Shadow Secretary of State for Health. His interests continue to include medical ethics and civil liberties issues as well as being an active campaigner for antiracism and refugee rights.

On the subject of rationing medicine - Dr Evans asked 'how should we deal with it?' He believes Politicians do not do rationing well, as patients don't get what they want and providers don't get a fair look in either. The key point is that the NHS needs to be properly resourced and the Liberal Democrat policy supports this notion. If the NHS doesn't have the funding to provide specific treatments, this has a huge impact on the poor who have no access to private healthcare and do not get the treatments they need from our health service.

The gap between what the NHS provides and what is demanded from both the healthcare profession and patients is growing. Doctors need to be able to make a judgement call when it comes to treatment options and this needs to be about what is good for the patient - not just about government policy, targets and budgets.

On the subject of NICE, he said that NICE was established to try and help the situation of overspending and to look at cost effectiveness of drugs available. When Labour Ministers stated that 'no treatment wouldn't be available', Dr Evans said this was not true. NICE has been used to tackle the postcode lottery for treatments - however, he believes this is insulting. He thinks there does need to be rationing as there is variation regionally and not everyone can have or in fact wants the same. In politics, local authorities have local voting to adapt to this, but unfortunately PCTs don't with the Health Service - the Liberal Democrats believe there should be more local accountability.

He believes the introduction of NICE was a good thing, as it has worked quite well, however the Government has used it for their own political agenda. The question is, are we looking at effectiveness or cost effectiveness? For a product to be licensed companies have had to prove its efficacy but proof of cost effectiveness can be hard to show in newly launch products and he believes that the Government shouldn't hide behind NICE for the political decisions, they need to be responsible for, such as the Statins example.

Also, products reviewed by NICE sometimes get preferential funding, with those not looked at being penalised. The decision needs to be made whether to ring fence funds or for NICE to decide which products to look at rather than being persuaded by what Dr Evans calls the 'Daily Mail Factor'.

He believes NICE should be expanded to fast track cost effective treatments (such as those for smoking cessation which have a huge impact on the NHS). He thinks the general population needs to have their expectations managed and each household to receive a list of what is not available on the NHS due to low levels of taxation. A tax that is fair (unlike a council tax) that would support a better funded NHS, which can offer a much wider range of treatments is, he believes, what is needed.

The Courts are certainly not the place to decide on commissioning issues - for example when the unavailability of an expensive drug such as Herceptin for cancer treatment is seen as a Human Rights issue, rather than being assessed purely on the evidence for its use.

When questioned about the independence of NICE appeals by a member of the audience, Dr Evans stated that he had sat in on NICE and was very impressed with the rigorous process used. In fact, he stated that it was a much more rigorous process than anything that went through the House of Commons and in his personal view doesn't' think there are any issues of bias and as appeals are held in public he feels they are robust and independent.

The question of whether SMC (Scottish Medicines Consortium - the Scottish equivalent of NICE - which has approved some products which NICE has not) is better than NICE was posed. Dr Evans believes there should be a Parliamentary debate. When it comes to the cost of affording a particular treatment, the media does not understand cost of 'quality of life years'. NICE have a ration but what is it? Does the figure need adjusting? We don't have a set amount of money for treating people - but perhaps we should?

The cost of the Health Service is ever increasing, but are increases in staff costs (quoted to be an extra £1.7 billion in the past year) a wise investment or are they to pay for agency staff?

Dr Harris said that although he believes rationing staff is an important issue, paying nurses a proper wage cannot be seen as a waste of money.

The GMC contract with payment by results has resulted in GPs consistently exceeding targets - so he believes that if things need doing in the health service, put it into the GP Contract and the GPs will deliver. Paying GPs to do things will pay rewards in the future.

The final question from the audience about the heavier demand from non tax payers on NHS services, due to the ageing population was met with the response that those people had paid taxes in the past and particularly those who were from the War generation deserve to have an adequately funded NHS now. If the better off, middle-classes were encouraged to stay within the NHS system rather than looking to private medicine, then they would be more willing to help to fund it through higher taxes and benefit from what they have already paid for.

Held on: 27/10/2006