Guidance has existed for more than 20 years. I have today asked Professor Mike Richards—the national clinical director for cancer—to review policy relating to patients who choose to pay privately for drugs not funded on the NHS. Terms of reference have been placed in the Library.
I very much welcome the Secretary of State’s announcement, as will many campaigners up and down the country and in the House. The ban on co-payments was cruel, because, as we know, it took NHS care away from patients who were dying, and it was illogical because co-payments existed in other parts of the NHS. Will the Secretary of State assure the House that the review will not have the effect, however inadvertently, of kicking the issue into the long grass, because, as the case of Linda O’Boyle proved, patients want and need the change in the policy now, not in a year’s time?
The hon. Gentleman has represented his constituent, Mrs. Linda O’Boyle, vociferously in the House and, indeed, on a non-party political basis, and many other Members on both sides of the House have raised the issue. It is time that someone with the expertise of Professor Mike Richards looked at the issue. It will hardly go into the long grass; I want Mike Richards to report in October. When the hon. Gentleman has had a chance to read the terms of reference, he will see that I am asking Mike Richards to look at very complex issues. I am not saying that he should come down one way or the other; I am saying that he needs to review the issue, given the need, which hon. Members on both sides of the House understand, to protect the principles of the NHS as a service free at the point of need and the very understandable concerns of Mrs. O’Boyle’s family and many others involved to find out whether we can ensure that we get guidance that is up to date and related to what is happening now in the NHS, that is fair to everyone and that resolves some of the problems that the hon. Gentleman and others have raised.
May I welcome the Secretary of State’s statement? Many Labour Members welcome it, as well as Opposition Members. I am grateful for his emphasising that this is not a new policy; it is one that the Government inherited. May I add that, by in a sense time-limiting the review, he will increase support in the country for the outcome of the review, whatever it is?
I thank my right hon. Friend. He, too, has raised the issue in various debates in the House. The guidance goes back at least to 1986 and probably before then. I have no need to ask Professor Mike Richards—he will do this anyway—to talk to Members, such as the hon. Member for Billericay (Mr. Baron), my right hon. Friend and others who want to raise specific issues. That can be done in the time scale that has been set—certainly, Professor Richards thinks that it can—and, as I say, that will ensure that I do not stand at the Dispatch Box merely repeating guidance that has existed for 20 or 30 years. We can determine what we need to do now in the NHS to resolve some of these very difficult and complex problems.
I also welcome the review that the Secretary of State has announced. Will he ensure that, in the deliberation, the needs of the silent voices—those who cannot afford the extra payments—are not forgotten?
The hon. Gentleman raises a very important issue. The scenario that many in the NHS feared, which has led to the guidance over the years, is that a patient in the first bed on a ward would be treated completely differently from the one in the second bed, because of their ability to pay. That is not the argument that has been raised by hon. Members in the House. I understand very clearly the fundamental points that are being made, particularly about Mrs. O’Boyle, who did not know that there was an obligation to pay for treatment until she had received it. But the hon. Gentleman, from his experience in the NHS, raises the fundamental, key issue, which I hope he will accept is very clearly set out in the terms of reference.
Will the Secretary of State give an assurance that the review will not result in a lottery system in the NHS, whereby people who can afford to pay can buy better treatment than people who cannot afford to do so? Most hon. Members on both sides of the House would be concerned if that inequality were introduced into the NHS, because it could become the thin end of the wedge for things such as top-up payments for other treatments. Will he assure us that the review will not open up that avenue?
I can give my hon. Friend that assurance. I shall quote the terms of reference, which state that the review should take into account
“the importance of enabling patients to have choice and personal control over their healthcare; and the need to uphold the founding principle of the NHS that treatment is based on clinical need not ability to pay, and to ensure that NHS services are fair to both patients and taxpayers”.
My hon. Friend should be reassured that we are reviewing how the system works in the 21st-century NHS, and that the outcome is not predetermined. Professor Mike Richards is a respected clinician: he led the development of the cancer plan and cancer strategy, and until recently he was chairman of the National Cancer Research Institute. All the cases that I have examined, including Mrs. O’Boyle’s, relate to cancer—mainly bowel cancer and kidney cancer. Professor Richards has spent his whole life in the NHS, so he is the perfect person to review the situation very quickly. The report will be published, so hon. Members will have the chance to see the results.
Desperately ill patients and their families are often vulnerable to the false hope provided by miracle drugs, which are sometimes touted in the media. What consumer advice—it is almost consumer protection—will be given to those people so that they do not waste their time and money or expend their hope on what are cul-de-sacs so far as treatment is concerned?
My hon. Friend raises another dimension to the issue. Professor Richards led on the cancer strategy, which was published in December and pointed out the need to get cancer drugs through the process much more quickly. Consumers who are considering drugs that are available on the internet should, first, take the advice of their clinician; secondly, check whether the drug is licensed; and, thirdly, if it is licensed, ensure that they know where it sits in relation to the NICE process. We can speed up the NICE process, and we will comment on that in the next-stage review, which will be published shortly. The internet contains a range of drugs, some of which are licensed and some of which are not. We must be vociferous in ensuring that consumers get the right advice, and we must do what we can to ensure the proper regulation of such drugs.
I am sure that the House is grateful to the Secretary of State for initiating the review. The Secretary of State will also appreciate that we have not had access to the terms of reference. It would be helpful if the Secretary of State, taking account of the case made by my hon. Friend the Member for Billericay (Mr. Baron) on behalf of Mrs. O’Boyle and her family, were to agree that we need to examine two principles. First, if patients access private treatment beyond the boundaries of NHS care, it should not mean that they lose their entitlement to NHS care. Secondly, NHS care itself should continue to be both comprehensive and free based on need, not ability to pay. I gather from the terms of reference that the Secretary of State has included the latter principle, but has he included the former?
I appreciate that the hon. Gentleman has not had a chance to see the review’s terms of reference, but that sounded like an attempt to pre-empt the outcome. We are clear that someone who has had private treatment can return to the NHS for treatment, and we are also clear that people who have had NHS treatment are perfectly entitled to obtain private treatment. The ambiguity occurs over the term “an episode of care” and whether someone can buy a drug that is not available on the NHS and ask the NHS to pay for its administration as part of their treatment. I want Professor Richards to examine that area, and I do not want to predetermine the review. Professor Richards is well aware of the problems experienced by Mrs. O’Boyle and others, because he deals with such issues all the time. When the hon. Gentleman sees the terms of reference—I will not take up the House’s time by reading them all out, because there are quite a few words—I hope that he will be assured that that point has been addressed. If not, the issue is not party political, and he is welcome to come and see me—indeed, I am sure that Mike Richards would be keen to talk to him.
I look forward to discussing the matter with Mike Richards. The Secretary of State will appreciate why I mention “comprehensive care”. The review particularly relates to many of the new cancer drugs. Mike Richards and the NHS also need to address how patients who rely on the NHS for their treatment can be sure that they will get comprehensive treatment. For example, I have a list of 20 European countries where Erbitux, the brand name for Cetuximab, which was privately provided for Mrs. O’Boyle, is routinely made available for patients with colorectal cancer. In the NHS, Mrs. O’Boyle was told that that drug was not available. Surely we must address that question, too.
I do not believe that that is about the terms of reference. The issue is how we deal with the NICE process. Cetuximab was a specific issue and it had not been through the NICE process. The PCT decided that the circumstances were not exceptional and, therefore, the treatment was not given. There is a whole different dimension to the issue under discussion. The fundamental problems that Professor Richards will look at are confined not to cancer drugs but to drugs per se. There may be many other issues and unintended consequences, because we have been concentrating so closely on the understandably controversial issues surrounding Mrs. O’Boyle and others. But Professor Richards’s remit will be to look right across the range. The worst thing that could happen to the review would be if he were to concentrate on one particular area and on a few particular drugs, and then miss the fact that unintended consequences apply to other illnesses and to other drugs.