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NHS Constitution

Volume 501: debated on Tuesday 24 November 2009

1. What recent assessment he has made of the effectiveness of the NHS constitution; and if he will make a statement. (300139)

The NHS constitution was based on extensive consultation and has widespread support. It gives real power to patients by describing their rights. The Health Act 2009 gives the constitution its legal underpinning and requires a report on its effectiveness to be published every three years.

Last month Milton Keynes hospital acquiesced to the demands of a pregnant woman by providing an all-white staff for the delivery of her baby. Does the Secretary of State think that this was the correct decision by the hospital, or can we sometimes put patients’ wishes too much to the fore in thinking of hospitals’ actions?

I cannot be alone in finding uncomfortable the situation that the hon. Gentleman describes. I should have thought that it was so for the NHS staff who were on the receiving end of such a request. I know that the trust concerned is conducting an investigation into the request and its handling. I shall be happy to update him when further information is available.

Does my right hon. Friend expect that when the patient consultation on the new constitution has been completed, the wait of 18 weeks or less for a referral from a GP to a consultant or the two-week wait for GP referral for somebody suspected of having cancer will be one of the most popular things that has happened in the national health service in our lifetime? Will he make sure that that is reinforced so that people will expect it for many years to come?

My right hon. Friend the Chairman of the Select Committee is right to say that the outstanding progress the NHS has made on waiting times in the past decade should never be lost. We should lock in that progress and the NHS should not slip back below those standards. The patients charter published on 3 March 1995 gave an 18-month guaranteed waiting time for in-patient treatment. That is the measure of how far the national health service has come in recent times. I expect patients to endorse the proposal on that new right, but the NHS constitution will need to be updated in line with public expectations about the national health service.

The draft NHS constitution includes a right to drugs approved by the National Institute for Health and Clinical Excellence, yet we are witnessing a growing crisis with patients unable to get hold of vital drugs for breast cancer, epilepsy and many other conditions. There is a long list of drugs that are currently unavailable because people are exporting them and profiting from the exchange rate. Is this not a despicable trade? What are the Government doing to stop it?

I understand the concerns that the hon. Gentleman expresses about parallel exports. The medicine supply chain is crucial and we are taking steps in the Department to guarantee the security of crucial medicines. He mentions the right in the constitution to

“treatments . . . recommended by NICE . . . if your doctor says they are clinically appropriate for you.”

We believe that that is an important right for patients. Obviously NICE has a difficult job to do in judging the cost-effectiveness of treatments, but we think it is the right guarantee to make so that, just as we will not see waiting times slip back, there will never be a return, under this Government at least, to the postcode prescribing that we saw in the 1990s.

The right hon. Gentleman is right that there should be an entitlement, yet every day drug companies are reporting 300 to 500 calls from people who cannot get hold of vital medicines. I have a letter that has been circulating to community pharmacists; it includes a price list, with very attractive offers to pharmacists to buy their drugs for export, thereby denying patients in this country vital drugs. What are the Government doing to stop this unethical practice?

On Friday, the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), published clear guidance to primary care trusts. The issues that the hon. Gentleman raises are crucial. It is vital that patients have access to the medicines that they need. We are taking a range of steps to secure the medicines supply chain, but I understand the points that he is raising. We have taken action and I will continue to work with him to ensure that there is no problem in the supply of medicines.

I declare an interest as someone who suffers from type-2 diabetes. Will my right hon. Friend assure the House that the NHS constitution will properly protect those who have diabetes by giving them an assessment to determine whether they have the illness? It is better to prevent than to treat once somebody has an illness.

I agree entirely that the challenge for the national health service is to become truly preventive—to become a national health service, with the word “health” underlined. My right hon. Friend will know that as well as consulting on the proposed maximum waiting times, we are asking the public whether people aged between 40 and 74 should have a right to an NHS health check every five years. That would take the NHS into new territory. It would take it squarely into preventive territory, and I look forward to hearing whether he and his constituents think that is the right step to take.

The NHS constitution says that patients should have access to NICE-approved drugs. What does it offer a patient with primary liver cancer, for example, who has only one drug as an option for treatment and is told that the NHS will not provide it?

I described the right very clearly in my answer to the hon. Member for North Norfolk (Norman Lamb): it is a right to drugs as approved by NICE. The hon. Member for South Cambridgeshire (Mr. Lansley) should accept—indeed, I think I have heard him say before—that NICE has a very difficult job to do in judging the cost-effectiveness of new treatments. I do not want to return to a situation in which people have different access to drugs and treatments according to where they live. NICE brought order to the system, and has an international reputation for rigour in the assessment of new medicines. I am proud of the difficult job that it does, and when it has made its deliberations, that right carries its recommendations to patients throughout the country.

The Secretary of State did not answer my question, but the answer that he should have given, according to his view, is that the constitution offers patients in those circumstances nothing—they will not have access to that drug. Why will he not follow the policy, which we pressed on him and his predecessors, of a value-based pricing system for new medicines, so that patients are provided with treatments that are clinically best for them, so that the reimbursement price through the NHS then reflects the value of the drug, and so that the Government, the national health service and the drug companies get together to ensure that patients have access to treatments that are clinically effective and best for them? Why will the Government not accept that they should have a policy that puts patients first?

Let me answer the direct point about NICE’s provisional decision on treatments for liver cancer and Nexavar. It is a provisional decision, so every patient in the country has the opportunity to comment on it and the breadth and range of views can be heard. That is everybody’s right—to make their views known. I do not think that the hon. Gentleman could sit in my position and basically say that every new treatment that comes along can be afforded. We have to have some rigour in the system, and in the way that decisions are made. Experts—I stress that word—should advise Ministers on how best to take forward those decisions, and that is what we have in NICE. It does an extremely important job for the Government and, I might add, for the taxpayer, and I should expect the hon. Gentleman to show it a little more support.

About 10 or 12 years ago, I regularly had complaints from constituents who were waiting 18 months, two years and, in some cases, three years for an operation. On the patient guarantee, it is absolutely right that we reaffirm our commitment to waiting list times, and we should laud what we have done to reduce them, but will my right hon. Friend similarly guarantee that we will continue to press as hard as we can to get waiting lists down?

I agree entirely with my hon. Friend, and the whole thrust of the constitution is to translate those targets into permanent rights so that there is no slipping back. My father has just had a heart bypass operation, and he was treated within a matter of weeks. I looked at the patients charter that the Conservative party introduced in 1995, and there was a 12-month standard for an artery bypass graft. How many unlucky people died on those waiting lists for heart bypass operations? That is a world away, and I assure my hon. Friend that under this Labour Government we will never go back to such a situation in the national health service, with people dying waiting for hospital treatment.