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NHS: Private Patients

Volume 701: debated on Wednesday 21 May 2008

asked Her Majesty’s Government:

Under what circumstances the National Health Service may refuse treatment to a patient who has previously paid for private healthcare.

My Lords, if a private patient seeks help from the NHS, he or she is entitled to NHS services on exactly the same basis of clinical need as any other patient. Our guidance is quite clear on this. There should be no question of people ever being refused NHS care.

My Lords, I thank the Minister for that Answer. That cuts across what was stated in the paper on Sunday in the case I am sure she knows about. Is she aware that many people of limited means are prepared to spend their hard-earned money on private treatment? That is their choice. Yet if all but the richest people, who can more easily afford to pay fully for private treatment, transferred entirely to the National Health Service, would that not completely wreck the NHS by overburdening it?

My Lords, that is a very interesting point. It would be wrong for me to discuss individual cases, although I have some information about that one. I reassure the noble Baroness that our guidance is quite clear that, when a patient who has previously received private healthcare seeks help from the NHS, they should be treated in the same way as any other NHS patient and offered treatments based on their clinical need. Their previous status as privately funded patients should, as far as is practical, neither disadvantage them nor allow them to access NHS care in a preferential way.

Our 2004 code of conduct for private practice says that,

“any patient changing their status after having been provided with private services should not be treated on a different basis to other NHS patients as a result of having previously held private status”.

I understand from the South Gloucestershire PCT that the case to which the noble Baroness referred does not routinely fund the particular treatment that was referred to in the press case. However, NICE is currently reviewing the safety and efficacy of this treatment, and expects its guidance to be published in September. In the mean time, that PCT can review, and says that it will continue to review, any individual funding requests that are made.

My Lords, does my noble friend agree that the very essence of the NHS, of which most of us are extremely proud, is the fact that the service is free at the point of use? Does she further agree, therefore, that it is very important to avoid any perception or impression that one can in some way buy a premium treatment by somehow combining private care with NHS care?

My Lords, I agree with my noble friend that the fundamental principle of the NHS is that treatment is free at the point of use and is based on need and not on the ability to pay. That deserves to be celebrated and preserved, and is why the principle is supported by all the main political parties. If patients want to pay separately for private healthcare, of course they can. However, creating a premium NHS service by allowing people to pay the NHS for treatments that are not offered to all would indeed lead to patients receiving different NHS care, not because they had different clinical needs but because one person could afford to pay a top-up and another could not. This would make nonsense not only of the founding principles of the NHS but of the 10 core principles which the Opposition signed up to and are as vigorously in favour of as we are.

My Lords, the Government seem to be getting into rather a muddle about the interface between the National Health Service and private healthcare. In fact, they seem quite happy to encourage primary care trusts to involve private companies in healthcare provision. They also talk an awful lot of talk about patient choice, so when are we going to see the day when NHS patients can use private healthcare whenever they wish, perhaps funded up to a certain limit by the NHS?

My Lords, the NHS works with the private sector across many different provisions of its services. The point is that the service is available free to the user at the point at which they need it.

My Lords, is the Minister aware that it is now reported that in the charity-run hospices for the terminally ill, whether they are adults or children, drugs that are to be prescribed have to be paid for privately? I cannot believe that when Aneurin Bevan set up the National Health Service, he wanted those hospices and the patients in them to pay for their drugs, so will she look urgently into that situation?

My Lords, I would be very surprised if that was the case, but I certainly undertake to look into it.

My Lords, is the Minister aware that many IVF patients will be deeply grateful to her for the statement that she has made today? I know of a number of cases in which individual NHS clinics have unfortunately turned patients down on the grounds that they have had private care for IVF before, so her statement is entirely welcome.

My Lords, I thank my noble friend for that. The code of conduct for the private practice of NHS consultants is, as he will know, very clear.

My Lords, I, too, am grateful to the Minister for her clear statement of the principles of the NHS, with which the whole House will obviously agree. Although she told my noble friend Lady Gardner that she cannot comment on individual cases, will she please look into this case, as the South Gloucestershire PCT has said:

“If someone elects to privately fund a treatment that is not funded by the PCT and no exceptional grounds have been agreed in advance, the individual will remain responsible for funding any ongoing costs”?

My Lords, the noble Baroness raises an interesting point. Primary care trusts have a statutory duty to fund the use of drugs that are recommended by NICE. If a drug has not yet been recommended by NICE—and I indicated that there would be guidance on this treatment in September 2008—that does not mean that the primary care trust does not use it, but it does mean that it may come to that conclusion. However, I undertake to approach South Gloucestershire to ask it to reconsider the case, as per the Question.

My Lords, is the noble Baroness aware that quite a number of people pay for private care in private hospitals because they cannot stand the possibility that they might be treated on the NHS in mixed-sex wards? Would the Government reconsider the policy which was announced by the noble Lord, Lord Darzi, that it is impossible now for the Government to guarantee that people—particularly women, incidentally—would not be treated in mixed-sex wards?

My Lords, the noble Lord will be aware that the Government are determined that every patient should be treated with the dignity they deserve and we are working very hard to solve the problem of mixed-sex wards, making sure that people have the privacy they require.