asked Her Majesty’s Government:

Whether they will introduce co-payments for specialist NHS drug treatments; and under what circumstances co-payment is now permitted in the National Health Service.

My Lords, it is difficult to give a full answer to the Question now because Professor Richards, the National Cancer Director, is reviewing the issue. I can, however, tell the noble Baroness that he will report to the Secretary of State at the end of the month, and his findings will be published shortly thereafter.

My Lords, I thank the Minister for her reply, which was of course unsatisfactory, because everyone wants a solution. Does she agree that, although we would all like to see equity in the health service, such equity cannot and does not exist? We read today that new heart treatments will be available for those who live near a big hospital, and we know that one’s recovery from a stroke depends on whether there is a stroke unit in the local hospital. There already is great inequity. Enabling people to buy life-saving drugs would not add to the degree of inequity that already exists.

My Lords, the noble Baroness points to the fact that there is variation in how individual trusts are applying current guidance. Some trusts are allowing patients to buy additional private drugs and retain their entitlement to NHS care while others are not. That is why the Secretary of State asked Professor Mike Richards to lead a review into that difficult issue. Since June, he has sought views from a wide range of people and organisations, including patients, clinicians, academics and NHS organisations. As I said, the results of that deliberation will be before us very soon.

My Lords, did not the British Medical Association suggest setting up a royal commission on this very subject? What is the Government's view of that idea?

My Lords, the British Medical Association has indeed written to the Secretary of State asking for a royal commission on this issue. However, the Secretary of State has deliberately set a tight deadline for the review, while allowing time to consider what are difficult and complex issues. I am sure that the House will appreciate that we want to minimise the period of uncertainty for patients. That is why the review is not a royal commission and why we are asking for it to be completed within three months.

My Lords, is it not extraordinary that a year ago the Minister told the House that co-payments did not form part of the basic principles of the NHS? Now we discover that a number of NHS trusts have been carrying out co-payment, presumably without the knowledge of the Department of Health, which is in itself extraordinary. The Minister says that the review is urgently to be announced. The original promise was September; that has gone and we are nearly through October; presumably we may get something in November. Would not the whole issue be solved much better if NICE got on and reviewed all the cancer drugs and gave some results urgently to patients of the NHS to ensure that all those modern drugs are available for all NHS patients?

My Lords, as he often does, the noble Lord asked many questions at the same time; I will try to answer them all. One of the recommendations of the review conducted by my noble friend Lord Darzi last year was that NICE should be asked to speed up the process; that is what is being considered and implemented at the moment. There is no suggestion that trusts are breaking the current national guidelines; the problem is the interpretation of that national guidance. That is why the review is taking place now. I think that I can assure the House that it will be reported to the Secretary of State before the end of this month and that, at the beginning of next month, a Statement will be made to the House.

My Lords, under the system of co-payment being worked on by the Department of Health, will the ability to pay mean that patients have quicker access to diagnosis and treatment?

My Lords, the whole point of the review is that the principle of ability to pay is not taken into account in people's access to drugs. They should be able to get the appropriate drugs they need when they need them. The Government have increased the drugs budget enormously in the past 10 years or so. The question really is: how can we ensure that we do not have different things going on in different parts of the country? I am sorry that I keep repeating myself, but the review is taking place and it will be reported on very soon.

My Lords, the Minister has not answered the point made by my noble friend Lord Naseby: she told this House some time ago that the practice was to cease paying NHS costs when a patient went to get private drugs. This clearly has not been happening in certain areas. Why was that? Was she not aware of the fact that it was going on in certain parts of the country; or did she not know what was going on at all?

My Lords, that may be slightly unfair of the noble Lord. The interpretation of the guidance is being implemented in different ways in different localities. I have said that three times; I shall say it again. That is why we are having the review: so that that interpretation can be made fairer across the country.

My Lords, will the devolved health administrations in Scotland, Wales and Northern Ireland be included in this review?

My Lords, because the administrations are devolved, particularly in Scotland, they operate on a different basis. However, I am assured that discussions are taking place at the same time so that they are fully informed and involved in the review. They will then have to decide how they react to it.