Health: Drugs 12:06:00 Lord Naseby asked Her Majesty’s Government: Why NHS patients lose their treatment rights if they supplement their treatment with a special drug at their own expense, when such restrictions do not apply to NHS dentistry, hearing aids, glasses and medical equipment aids. Baroness Thornton My Lords, legislation provides for charges for specific NHS services, including dentistry, optical appliances and wheelchairs, but not hearing aids. This system is different from allowing people to pay to top up NHS care with treatment that is not offered by the NHS. However, there is no question of anyone losing any treatment rights. No Government have ever allowed the mixing of NHS treatment and the private funding of treatment. Lord Naseby My Lords, the Minister refers to the founding principles of the NHS. During the Second Reading debate on the National Health Service Bill in 1946 Mr Aneurin Bevan referred to the gold-capping of teeth, pay beds and other treatments—two-tier medicine. Since then, numerous Governments have expanded that list, as the noble Baroness has just said, to include glasses, hearing aids and medical equipment. Would it not be fairer, better and more humane to allow these terribly ill patients, all of whom have paid for the NHS, to supplement their treatment, provided a medicine is licensed and provided it is at no cost to the NHS? How can it possibly be fair to take away their existing NHS treatment? Is it not all just a bureaucratic health nightmare? Baroness Thornton My Lords, more treatments than ever before are available on the NHS and more are coming on stream every day, but a founding principle of the NHS is that it is free at the point of use. The issues that we face today are issues of success: people live longer; they survive more illness; and we are inventing new and ground-breaking treatments every day to treat conditions that people did not expect to survive in the past. Most of what is done now was not available in 1948. Over the years, we have expanded what the NHS does and the challenge we face is to ensure that the very best treatment is free at the point of use and is not dependent on one’s ability to pay. Lord Walton of Detchant My Lords, at a time when the Government have embarked on many public/private partnerships in health, such as the creation of independent assessment and treatment centres, is it not illogical to suggest that people already being treated for a terminal condition by the NHS should not be allowed to purchase additional drugs? That seems to me to be totally illogical. It could even be construed by some as being a breach of their human rights. Baroness Thornton My Lords, people are not being denied the right to have the drugs that they need. The legal obligation of the NHS is that care must be provided free, based on clinical need and not on the ability to pay. Most arguments about top-up payments, which often centre on cancer, are for drugs which 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 that is for local decision, and whether they provide drugs that are awaiting approval or have been rejected is down to local decision. Lord Anderson of Swansea My Lords, I accept what my noble friend says about the success of the NHS, but does she not at least concede that there is some perversity in the fact that one can top up for wheelchairs but not for medicines? Baroness Thornton My Lords, it is easy to see why some confusion might arise. I promise the House that there is a clear distinction between charges for medical equipment and top-up payments for drugs, although I confess that possible confusion is not helped by the different charging regimes. Even for some drugs there is a grey area. For example, GPs may give private prescriptions for certain listed drugs—currently, flu vaccine and Viagra—for patients whose condition is not regarded as serious enough to qualify for an NHS prescription. On the other hand, the optical voucher scheme is not the same as top up because it represents a subsidy; for example, for those who may not be able to afford spectacles. Hearing aids, their maintenance and the batteries are free from the NHS, but if a patient chooses to go private they must bear the whole cost. Dental charges are banded, but NHS dentists can, if patients agree, provide treatment privately, but the two are paid for separately. Wheelchairs are provided and maintained free of charge, but a PCT has to set its own standards there. I promise the House that there is a logic here. Earl Ferrers My Lords, does the noble Baroness realise that while she has given some very good, defensive arguments for the NHS, she has failed to answer the original Question asked by my noble friend. Why should a person lose their treatment rights if they supplement their treatment? That is a fairly straightforward question and, with the greatest respect, it requires a fairly straightforward answer and not a diverse one. Baroness Thornton My Lords, perhaps I may explain why it is not possible to provide private treatment alongside NHS treatment within one episode of treatment. If there are two episodes of treatment, one NHS-funded and one privately funded, that is fine and up to the clinician to organise. You cannot do both together because you would be creating a two-tier system. Baroness Masham of Ilton My Lords, some people have to pay for social services. What is the difference? Would it not be useful for research if people topped up their treatment with new drugs? Baroness Thornton My Lords, social services charges and NHS charging for equipment are two separate things provided by two separate bodies, although they may, as the Baroness will know, be provided to the same person. It is our policy to bring those two things together, which is what the new Bill coming to us next week is about. Lord Tomlinson My Lords, does my noble friend agree that there is great value in the old adage that when you are in a hole you should stop digging? Baroness Thornton My Lords, the NHS is not in a hole. It provides exceptional treatment and care. My parents are both living longer today than they would have lived in the past, before the NHS existed, and we should celebrate that success. Baroness Finlay of Llandaff My Lords, do the Government intend to introduce direct payments in healthcare, as was recently broadcast in the media? If so, would that be for long-term conditions? What restrictions would there be in a direct-payment system for people to pay for top-up drugs? Baroness Thornton My Lords, I do not have a detailed answer to that question. I shall have to write to the noble Baroness. Lord Patel My Lords, does the Minister agree that the direction given is wrong and that the whole issue needs to be reviewed? Baroness Thornton My Lords, the NHS and my right honourable friend the Secretary of State keep these matters under constant review.