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NHS: Private Medicine

Volume 700: debated on Wednesday 19 March 2008

asked Her Majesty’s Government:

Whether they intend to change their policy of withdrawing National Health Service care from patients who choose to buy their own private prescription drugs.

My Lords, there is no question of withdrawing NHS care from anyone. However, no Government have ever allowed—indeed, none of the main political parties supports—an individual simultaneously being an NHS and a privately funded patient within the same episode of care.

My Lords, is the Minister not embarrassed that the National Health Service threatened to withdraw treatment from a woman who wanted to spend £15,000 of her own money on cancer treatment that might have saved her? The reason given by the Minister in another place was that this would create a two-tier health service. At the moment, the taxpayer spends £96 billion on the National Health Service. Private individuals spend £30 billion on help for the aged, dentistry, private treatment, private drugs and over-the-counter drugs. If that is not a two-tier health service, what is it?

My Lords, I realise that this issue has been in the news recently and I understand why noble Lords would want to raise it, as these cases are highly emotive. Many arguments about top-up payments centre around cancer drugs that do not yet have NICE approval, have been rejected by NICE or have not yet been licensed. NHS bodies must provide drugs that have NICE approval, but it is for local decision whether they provide drugs that await approval, have been rejected or do not have a licence.

My Lords, is consideration being given to setting up a cross-party working party to look at top-ups or co-payments? This extends beyond cancer drugs to the new biologic drugs, which can be potent disease modifiers, and to aids and appliances—high-tech ones such as different types of cardiac defibrillator and low-tech ones such as different types of wheelchair wheels, which are not available on the NHS but which patients are not allowed to pay the top-up for.

My Lords, a founding principle of the NHS enshrined in every code of practice—most recently in the 2003 code of practice—is that someone is either a private patient or an NHS patient. Patients can be private patients and decide to resume their treatment as NHS patients but they cannot in one episode of treatment be treated on the NHS and then as part of the same episode be allowed to pay money for more drugs. I would be surprised if those on the opposition Front Benches felt differently from the Government about this matter because it is a fundamental principle. We need to think carefully about any suggestion of moving from that principle.

My Lords, the noble Lord, Lord Lawson, tried to get in earlier. I think that it is his turn, after which we will take my noble friend.

My Lords, thank you; I will be brief. Will the Minister take a look at the French system, which is a mixed system and which works a great deal better?

My Lords, my noble friend talks about fundamental principles, which are all about lifesaving activity. Under the National Health Service a person is entitled to have treatment. If the National Health Service refuses to provide the particular medicines required to ensure that that person’s life will continue, is it not legitimate that that person should be able to buy those medicines outside the National Health Service and still be a National Health Service patient?

My Lords, it is important to clarify this. Mixing private payment with NHS treatment is not only inconsistent with the founding principles. If a private patient arrives at an NHS facility, of course they will not be refused treatment; they will be treated in exactly the same way. Also, PCTs have a statutory duty to fund the use of drugs that are recommended by NICE. If, however, a patient opts to have private treatment, they cannot have it within the treatment that they are already receiving from the NHS. I am sure that my noble friend will understand that that would mean that there would be a subsidy. However, in terms of drugs—

My Lords, I am sure that the Minister would agree that a child would not be denied state education if their parents were also giving them private tuition and paying for it. I cannot understand why she is arguing in the way that she is about private prescriptions for health service patients. Could she admit that it is perhaps a Stalinist leftover from the days before new Labour embraced the market?

My Lords, would the Minister be kind enough to set out for me in a letter the legal basis on which the NHS refuses to treat any British citizen who is entitled to universal treatment under the NHS, and will she put a copy of that letter in the Library?

My Lords, I would be happy to do that. The noble Lord needs to understand this. NHS patients indeed have the right to expect high-quality healthcare, and it is the responsibility of their PCTs to ensure that they get it. The decisions about their treatment are taken locally, and ultimately the resources available to the NHS are limited. In a system that offers universal care free at the point of need, there can be no absolute right to treatment, but that has always been the case.