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National Health Service Co-Funding and Co-Payment Bill

Volume 708: debated on Friday 4 February 2022

Second Reading

I beg to move, That the Bill be now read a Second time.

It is a great pleasure to introduce the Bill. Its proposals are not really novel, because co-funding and co-payment within our national health service already exist. Indeed, the NHS website, under the heading “When you need to pay towards NHS care”, states:

“Patients often need to pay towards the cost of:


dental care

eye care

wigs and fabric supports”.

It goes on to say:

“The money raised helps fund the NHS.”

The payments in respect of those items are co-payments. Sometimes they are fully funded by the individual, sometimes partially funded, and sometimes there are exemptions, but the money raised from the co-payments then goes into co-funding, and it helps to fund the NHS. Of course, other items could be added to that list.

It is necessary to pay towards NHS care when it is described by some bureaucrat as social care and not healthcare. We know that an enormous amount of bureaucratic time is taken up with trying to argue that people are not in receipt of continuing healthcare, but are actually in receipt of social care. If they were in receipt of continuing healthcare, they would not have to pay for it—it would be free—but because it is deemed to be social care, they have to pay towards it either in full or in part under the system that is in place. The Government have now said that they wish to bring together the health and social care sectors. If they are to do that, then surely they need to be thinking through the issue of means testing and co-funding and co-payment as it relates at the moment to social care.

If we are to have this system, let us make sure that it works. This NHS document makes it clear that a person is not allowed to pay towards the NHS in various other sectors. Why are they are not allowed to pay towards the NHS? Our NHS is, by all accounts, still short of resources. Why do we not do everything in our power to encourage more contributions towards healthcare in this country from private individuals? Is that not a reasonable objective? It seems as though the NHS policy is to prevent people contributing towards their own NHS costs unless they fall into the categories to which I have referred. That is really the essence of this debate. I will not be able to get this Bill on the statute book in the next quarter of an hour, but I hope that I will be able to open up a debate that has been closed for far too long.

No, I will not give way. I just want to make my point.

Today is World Cancer Day. This morning, the Secretary of State launched a new document, talking about a 10-year plan for cancer. That reminds us that the NHS is free at the point of delivery, but it is not often free, or even available, at the point of need. Those are two separate propositions. Often, when people talk about how wonderful our NHS is, they omit to point out that, very often, the NHS is not available at the point of need. That is highlighted by the fact that there were 50,000 fewer cancer diagnoses across the UK during the pandemic, and that, during that time, NHS cancer treatments fell by some 6%. We have information now that compares OECD figures, and it shows that, in the United Kingdom, in 2019—before the pandemic—the rates of fatalities from cancer were 216 per 100,000 people. In the United States, which has a very different system from ours, it was 178 per 100,000 people. In Australia, it was 180 per 100,000 people, and, in Mexico, it was 118 per 100,000 people. The OECD average across 38 countries was 191, so we are an outlier in this country with our NHS in having much higher death rates from cancer than comparable economies and, indeed, much higher death rates than economies that are much less successful economically than our own.

We also have a pretty poor show in terms of diagnostics. We have fewer diagnostics with computerised tomography, magnetic resonance imaging and positron emission tomography scanners—CT, MRI and PET scanners—than the average OECD country, by which I mean the 38 countries to which I have referred. The average in the OECD is 45 scanners per 1 million population. In this country, it is only 16 per 1 million population. Is that not a scandal? When we look at the gargantuan waste within certain aspects of the NHS machine, it brings home the gravity of those figures and why we need to draft more resources into the NHS, including resources from the private sector.

Wait a moment.

That could include, for example, all those facemasks with ear loops that had been ordered at a cost of £155 million. If the NHS did not want them, because it insists on having better-quality facemasks with head loops, surely it could have sold them off to try to get some income from the private sector, but it did not: it just wrote that money off. Similarly, because of an official error in drawing up the specification for hospital gowns, it wasted £70 million on them.

There is no reason to be complacent about the state of our NHS. That is not to say that there is not some fantastic work carried out by people who work in the NHS across the country. In many respects, the NHS is a centre of excellence.

No—I am just coming on to a constituency case, and my hon. Friend may be able to intervene on this point.

I do not know whether the person in question knew I was raising this matter in the House, but at 8.19 am today I received a letter from a lady whose mother is one of my constituents. She says,

“My mother has avoided Covid for two years by staying home, she is going to be 81 tomorrow.

She had urgent surgery on Monday on her spine. She now has COVID. Everything I have heard about her treatment by all at the hospital is dreadful. She is currently sharing a ward with people who are all being sick.”

She then makes some rather rude, disparaging remarks about the NHS, which I will not share with the House, and says:

“I know there is an option to go private, but let’s face it that’s for the wealthy upper class”,

and asks why we do not give people more choice without having to bankrupt them. She goes on to say:

“Is anyone in the UK seriously looking at the state of the NHS and working to make real, positive change?

Thanks and Regards”.

She is saying that we must not be complacent. We must start addressing those very real concerns.

I am conscious of time, so I will refer to an answer I received on 2 February from my right hon. Friend the Minister for Health. The question was:

“how many staff in his Department will be permitted to work from home after 1 February 2022; and if he will make a statement.”

I think there is a lot of concern that some staff in the NHS are not at their posts and are working from home when they should not be.

What answer did I get?

“The Department is transitioning to a new model of hybrid working. Staff are expected to work partly in the office and partly from home, with a minimum of four days a month in the office unless there is a business or wellbeing reason not to do so.”

A minimum of four days a month in the office? I thought at first I had misread it, and they were talking about a maximum of four days a month working from home. How is it that our NHS, which we are told is the envy of the world, can manage with so many of its staff working from home rather than from their workplace?

What is this new model of hybrid working and why are we transitioning to it? Why has nothing been done before? If we had had action before, perhaps so many of my questions to the Department of Health and Social Care would not have gone unanswered—for example, a question due for answer on 5 January. I am delighted to see the vaccines Minister on the Front Bench. The question was:

“To ask the Secretary of State for Health and Social Care, how many (a) deaths and (b) adverse reactions have been officially recorded against covid-19 vaccinations; and how many have been examined to establish the cause and/or trigger.”

That is a fundamental question to which the Government should have an answer. Now, however, a month later, on 4 February, the question that should have been answered on 5 January has still not been answered. If some of those staff had not been working from home, perhaps they might have got round to answering that question.

Another question that was due for answer on 5 January was:

“To ask the Secretary of State for Health and Social Care, for what reason his Department has taken over responsibility from covid-19 vaccine manufacturers for negligence claims arising from their vaccines causing serious illness or death; and when he plans to return producer liability to those manufacturers.”

Again that is an example of where, if the responsibility is taken away from the manufacturers, the taxpayer will end up footing the bill. Have we had an answer to that question due on 5 January? No, we have not.

My final example of the consequences of too many people working from home and not answering questions from parliamentary colleagues is:

“To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 21 December 21 to Question…on Coronavirus: Immune Thrombocytopenic Purpura, what steps his department is taking to investigate the 427 suspected cases of major thromboembolic events with concurrent thrombocytopenia; and if the Government will make it its policy to those affected by those suspected cases of the availability of the Vaccine Damage Payment Scheme.”

I have not had an answer to that either, even though it was due on 13 January and is directly relevant to all the issues about vaccine confidence that many hon. Members take very seriously.

Not long ago, an article was published in the British Journal of General Practice, “Patient co-payment for general practice services: slippery slope or a survival imperative for the NHS?”, that asks:

“Is universal zero cost at point of general practice care a time-expired and unaffordable NHS sacred cow? Is it time to question the unquestionable?”

In a sense, that is what the Bill does: questions what has, hitherto, been unquestionable.

The article continues:

“International observers of the NHS note increasing despondency within the general practice workforce,”—

and not just within the workforce, but among their patients—

“with much talk of a broken system tracking an unsustainable trajectory. The increased patient demand is exacerbated and compounded by the burdensome opportunity and transaction costs of a powerful, centrally orchestrated, and financially-incentivised framework. This framework is designed to drive (or buy) ‘quality’ through a complicated and time-consuming matrix of accountability measurements. As the columns of this Journal and many others…have detailed, the combination of increased demands from patients and an onerous system of accountability has led to widespread and serious workforce stress, demoralisation, and flight to early retirement.”

The article then describes the situation in New Zealand, where it says:

“There is strong support from general practice to retain co-payments both as a mechanism to manage demand and as a way to encourage self-management of minor ailments.”

Why are we not considering that in the United Kingdom? We know that GPs are under enormous stress and that people feel deterred from going to the GP or that their GPs refuse to see them, which is contributing to the examples of undiagnosed cancer that I referred to earlier.

I will not, because I am afraid that there are only 30 seconds left. I hope that this short speech will open up a proper debate on a really important issue. We cannot keep ducking it.

It is a pleasure to talk about my love for the NHS. I was born with a cholesteatoma in the right ear. Thanks to the NHS, I was able to be seen at the age of seven, which meant that the bones that had deteriorated in my inner ear—

The debate stood adjourned (Standing Order No. 11(2)).

Ordered, That the debate be resumed on Friday 25 February.