Thank you to Dave West of Health Service Journal for drawing attention on Twitter to Earl Howe's answers to questions in the Lords on the proposed changes to NICE.

At the top of the debate, you find that Baroness Sherlock asked Earl Howe, "To ask Her Majesty's Government which groups were consulted prior to the announcement that the National Institute for Health and Clinical Excellence was to lose the power to decide that some drugs may not be supplied by the National Health Service".

This is A Very Good Question Indeed.

It is also one to which Health Policy Insight readers already know the answer - not NICE themselves.

And does Earl Howe answer this question?

"My Lords, it is important to make clear that the National Institute for Health and Clinical Excellence does not have any powers to ban the use of drugs in the NHS, so suggestions that this is a role that will be removed from it are based on a misunderstanding of the position. Our NHS White Paper makes it clear that the role of NICE will continue and, indeed, that it will be extended".

That'll be 'nobody was consulted', then.

Baroness Sherlock tries again: "My Lords, I thank the Minister for that Answer. I am a little confused, but perhaps he can help me to understand the change. In the world that he envisages, is it intended that every single GP consortium will take its own decision about which drugs it is willing to fund? If that is the case, will it be about every single individual drug or treatment? And, if that is the case, can the Minister explain how he will protect patients from the uncertainty and confusion that must arise from a return to a postcode lottery of that magnificence?"

Earl Howe's response: "My Lords, currently the NHS is faced with the decision of whether to say in effect yes or no to a new drug at the price that is proposed by a pharmaceutical company. We want to change that so that the price of a drug to the NHS is based on an assessment of its value, rather than pharmaceutical companies being free to set whatever price they choose and expecting the NHS to pay. So value-based pricing, which is the term we have used, will ensure that licensed and effective drugs are available to NHS clinicians and patients at a price to the NHS that reflects the value that they bring. That should get rid of the postcode lottery."

That'll be a refusal to answer the question, then.

Scroll down a bit, and Earl Howe is asked Another Very Good Question Indeed by Lord Crisp (Sir Nigel Crisp, NHS CE and DH Perm Sec as was).

Lord Crisp asked, "My Lords, I declare an interest as I was in the Department of Health at the time that NICE was created. If the Minister accepts that the NHS, which spends upwards of £11 billion a year on drugs, is right to have a clinically led method of assessing whether they work satisfactorily, will he confirm-there seems to be some confusion-that that will not be replaced by some hundreds of separate ways of doing the same thing? Will he also confirm that, whatever new arrangements he has in mind, the Government will speed up the process, which is sometimes a complaint about the NICE process at the moment?"

Earl Howe replied, "My Lords, we have been very clear that NICE, which enjoys international pre-eminence in the evaluation of drugs and health technologies, will continue to have an important expert advisory role, including the assessment of clinical benefits for new medicines. The noble Lord will know, I am sure, that in recent years NICE has done a lot to speed up its evaluations of new medicines and has introduced end-of-life flexibilities, for example, which have meant that patients have had increased and improved access to those new medicines".

That 'll be a further refusal to answer the question.

Either the Government ministers do not know whether each commissioning consortia will negotiate price separately, or they are not willing to tell us. Neither of which is a good option.

Sometimes, a refusal to answer the question says an awful lot.