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NHS: Primary Care Trusts

Volume 739: debated on Tuesday 17 July 2012


Asked By

To ask Her Majesty’s Government what action they will take to prevent primary care trusts inappropriately restricting access to patient treatments.

My Lords, it is inappropriate for a primary care trust to impose blanket bans on treatments, or to restrict access to treatments on the basis of cost alone. The department will ask strategic health authorities to investigate any examples of such behaviour, and appropriate action will be taken.

My Lords, in thanking the noble Earl, I remind the House of my health interests in the register. The noble Earl will be aware that there is now abundant evidence that some primary care trusts are restricting treatments that are deemed appropriate, in some cases against the guidelines issued by NICE. Given that, will he go further and seek to ensure that he and his ministerial colleagues intervene in the NHS where this is happening so that we can be satisfied that the NHS will still provide a comprehensive service?

My Lords, yes, we will intervene if ever it is demonstrated that primary care trusts are restricting treatments on a blanket basis or on a cost basis unrelated to clinical need. Any arbitrary restriction on access to treatment of that kind is unacceptable. We have made that clear repeatedly, as has Sir Bruce Keogh, the NHS medical director, on a number of occasions. However, that is not the same as saying that the NHS should be unconcerned about value for money. It should be very concerned about it. It should not spend money on treating a patient when that patient is unlikely to derive clinical benefit from the treatment. Therefore, we need to distinguish that kind of case from the kind cited by the noble Lord.

My Lords, will the noble Earl find out to how many cases the PCT in North Yorkshire has denied treatment in the past year? Is he aware of how distressing it is for very ill patients to have to appeal?

My Lords, I do not have the figures for North Yorkshire in front of me but, as the noble Baroness is aware, there is a process for patients to make an exceptional case application to their primary care trust where the circumstances are deemed to be exceptional. We had a short debate about this matter the other day. However, there will inevitably be variation around the country in the extent to which treatments are seen as a priority for the local population in a given area.

My Lords, it is a question not just of treatment but of investigations for treatment. Only last week, I saw a couple complaining of long-standing infertility who were refused a laparoscopy or an X-ray of the uterus on the grounds that they were not permissible as investigations under the National Health Service. It was limited by their primary care trust. Would the noble Earl care to comment on that?

My Lords, if that case was a consequence of the primary care trust taking a blanket decision over a clinically valid investigation process then I would be very concerned and should be interested to hear the details from the noble Lord.

My Lords, given that there is no consistency in the name that PCT committees are calling themselves to make these judgments about treatments and pathways, and often these matters are reported or hidden in longer performance reports, can my noble friend ensure that PCTs are open and transparent in their decision-making on these treatments, including referencing how their decision reflects NICE guidelines, and also insist that the appeals process is equally accessible?

Yes, my Lords, we emphasise this principle at every opportunity. Indeed, transparency is a central principle, as my noble friend will be aware, in the way that the NHS constitution instructs the health service to make decisions rationally and transparently so that patients can see the basis on which those decisions have been arrived at. Again, if that is not happening in any area I should be very glad to hear about it.

My Lords, in relation to the point made by my noble friend Lady Masham, is the Minister aware that the particular primary care trust in North Yorkshire has refused the funding for an operation for a bright young lady doctor who is enrolled on a training scheme in that area and who turns out to have a rare hereditary form of pancreatitis? Three surgeons, two in Newcastle and one in Leicester, have agreed as a team to operate on her, otherwise the condition will be progressive and eventually fatal, but the primary care trust has refused funding for the procedure on the grounds that it is somewhat experimental, even though it has been carried out successfully on a number of occasions before. Is this not a case that ought to be referred to the Advisory Group for National Specialised Services?

My Lords, we had a debate about that very case the other day, as the noble Lord will be aware, and as I said then, this matter is under close scrutiny at the Department of Health. I am hopeful of a happy outcome.

Thank you, my Lords. This is an unfortunate Question in that it tends to imply that this system is widespread. However, my experience, admittedly only in one hospital in Cambridge —Addenbrooke’s Hospital—is quite the contrary. I do not know just how much my noble friend can comment on whether access for patients has been restricted nationally, but I would very much like to ask him to make sure that this Question is not a common reflection on the National Health Service and hospital service. I do not think that it is.

My Lords, I agree with the noble Lord. The Co-operation and Competition Panel undertook a review of restrictions on patient care last year, and although it uncovered quite a number of examples of arbitrary rationing, those were cases that took place under the previous Government. We have banned all such cases. We do not believe that this kind of arbitrary restriction is at all widespread, and we have yet to receive any firm evidence that it is taking place at all.

My Lords, I wonder if the Minister is aware of the widespread feeling of disgust and disappointment at the Government’s decision to close the ECMO cancer unit for children at the world-renowned Glenfield Hospital in Leicester. Is he aware that the quality of work done at that hospital has been praised internationally, and that many thousands of people in Leicester, Leicestershire and beyond are just appalled at the Government’s insensitive and brutal decision?

My Lords, I am aware of the concern that the noble Lord has reflected in his remarks, but I think that it would be wrong of me to comment. That particular decision flowed directly from a review which was conducted by the NHS, quite consciously at arm’s length from Ministers. The matter is currently under scrutiny and I would not wish to pre-empt any decision that my right honourable friend the Secretary of State wishes to take.