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National Health Service (Right to Treatment)

Volume 579: debated on Tuesday 8 April 2014

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to ensure that medical treatment prescribed as necessary by a doctor or other medical professional must be provided unless the type of treatment is not approved by the Secretary of State or the National Institute for Health and Care Excellence; to establish a national register of cases where such prescribed treatment is refused; to introduce a mechanism for appeal against decisions about provision of medical treatments; and for connected purposes.

It is widely recognised that the national health service has become a lottery in which access to treatment no longer depends solely on a patient’s clinical needs but on where they live and on the state of the local NHS budget. That problem is made worse because Ministers, who decide how much money NHS England and the 211 clinical commissioning groups receive, deny all responsibility for how that money is spent, and because of the lack of transparency and accountability of the decision makers who control the postcode lottery and decide which patients will get treatment and which will not.

My Bill addresses the postcode lottery in three ways. First, it will require the Government to set up a public register of all individual funding requests—or IFRs— made to NHS England and CCGs, together with the decision on whether the NHS will pay for treatment. That will improve transparency by allowing patients and clinicians to see whether a treatment banned by the NHS in their locality is available on the NHS elsewhere. It will lead clinicians and the Government to make more consistent decisions in future. After all, we are all liable for the same taxes, wherever we live, so we should all get equal access to treatment from a tax-funded public health service. Indeed, on 26 March the Minister of State for care and support, in a letter to me about a constituent’s lack of access to treatment, said:

“We are aware of variation across the country in prosthetic services, and we will be working with NHS England to determine what needs to be done to address this, in line with the key objective in the NHS Mandate 2013-15 to expose variation and unacceptable practice to help people learn from best practice.”

I cannot see how the Government can possibly turn down my proposal.

Secondly, my Bill seeks to introduce a presumption in favour of treatment where a treatment is recommended by a qualified NHS clinician, unless the procedure or medicine is not approved by the National Institute for Health and Care Excellence or is designated in a statutory instrument proposed by the Government and approved by Parliament as a treatment no longer available on the NHS. We as politicians at national level determine how much money to make available to the NHS, so we ought to take responsibility for decisions on access to treatment within the budget that is available.

The NHS has always rationed treatment, through waiting times and other opaque devices, but now equity of access to treatment—one of the founding principles of the NHS—is so compromised by postcode rationing, we need an open and transparent system for reviewing decisions. Transparency is not enough. The people who control the NHS purse strings need to be accountable for their decisions.

Thirdly, I propose that patients whose treatment is supported by their doctor but turned down by the NHS should have a right of appeal to an independent tribunal. This would be consistent with the Human Rights Act 1998; it already applies to people whose benefits or immigration application is turned down. So surely there should be a similar right to challenge a public sector decision maker when someone’s health and well-being is at stake.

Let me mention briefly a few examples of my constituents who have had to fight for treatment. Zoe Bounds is a woman in her 30s with two children. She had ovarian cancer in her teens and recently developed breast cancer. Her consultant recommended a double mastectomy to reduce the risk of the cancer spreading. The care commissioning group agreed to pay for one breast to be removed, but NHS England, which is responsible for funding preventive surgery, refused to pay for the other half of the operation. On appeal, however, the CCG agreed to the double mastectomy.

Rebecca Beattie was badly beaten by a former partner and suffered multiple fractures to her face and nose. She needed surgery to enable her to breathe properly, but initially funding was refused. It was only after appeal and exposure in local and national newspapers including The Sun that funding was made available.

Emma Willets needs a permanent catheter to empty her bladder. A temporary operation at Pinderfields hospital to stimulate her sacral nerve greatly improved her condition. Her individual funding request for a permanent operation to stimulate the nerve has been turned down by the CCG. Her consultant points out rightly that the cost of permanent catheterisation—including the cost of hospital admissions each time she gets a urinary tract infection—will be much greater than the cost of the operation to improve her condition. These cases illustrate the need for accountable decision making and for a patient’s right of appeal.

Two and a half years ago, I introduced a similar Bill. I predicted that the Government’s NHS reforms and the squeeze on NHS funding would make the postcode lottery worse. NHS expenditure per person is down in real terms from £2,043 in 2009-10, to £1,999 this year and is due to fall again next year to £1,986, according to figures prepared for me by the statisticians in the House of Commons Library.

I asked parliamentary questions in 2012 and again this month about the number of individual funding requests. I was told:

“The data requested is not collected centrally.—[Official Report, 3 April 2014; Vol. 578, c. 793W.]

I have, however, conducted my own survey of primary care trusts, 109 of which replied—a 72% response rate. The number of IFR approvals in 2009-10 was 51,661. The number of approvals in 2011-12 had fallen almost by half to 26,076. There is enormous variation in approval rates. In 2011-12, 10 out of 109 PCTs approved 75% or more of IFRs; seven approved 25% or fewer. This is simply unacceptable. The postcode lottery is unfair. It contradicts the founding principles of the NHS. Each time the NHS says no to a patient a little more public confidence in the NHS drains away. This needs to change, and quickly. I commend my Bill to the House.

Question put and agreed to.


That Hugh Bayley, Frank Dobson, Kevin Barron, Ms Gisela Stuart, Sir Bob Russell, Barbara Keeley and Grahame M. Morris present the Bill.

Mr Hugh Bayley accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 6 June, and to be printed (Bill 199).