National Health Service (Right to Treatment)
Debate between Hugh Bayley and Phillip Lee
Hugh Bayley (York Central) (Lab)
I beg to move,
That leave be given to bring in a Bill to make provision to ensure that medical treatment prescribed as necessary by a doctor or other medical professional must be provided unless the type of treatment is not approved by the Secretary of State or the National Institute for Health and Clinical Excellence; to establish a national register of cases where such prescribed treatment is refused; to introduce a mechanism for appeal against decisions about provision of medical treatments; and for connected purposes.
The NHS is becoming a lottery. Decisions about the treatment people receive depend not on their medical needs, but on where they live. These decisions are unfair to patients, inefficient because inconsistent resource allocation decisions are not cost-effective, and unaccountable because responsibility for the decisions is not taken by Ministers who are accountable to Parliament for how the NHS spends its money and because patients have no right of appeal if NHS treatment is denied.
This Bill seeks to restore equity by giving patients a legal right to treatment, when it is recommended by their doctor, so that all patients have access to the same range of NHS services. The Bill also seeks to strengthen accountability by requiring the Secretary of State—whom I am pleased to see on the Treasury Bench—to come to Parliament to seek approval for explicit rationing decisions. The Bill seeks to improve transparency by creating a national register of all treatments for which NHS funding has been withdrawn. Finally, it seeks to empower patients by giving them a right of appeal if they believe they have been denied a clinically necessary treatment.
There cannot be a single Member who has not been approached by a constituent who has been denied treatment. The following cases are just some of the problems I have encountered this year. A constituent with cystic fibrosis needs antibiotics to prevent lung infections. Nine out of 10 people with cystic fibrosis die from respiratory problems. She cannot use the two most commonly prescribed antibiotics because she is intolerant to them, so her consultant prescribed a different drug, but the North Yorkshire and York primary care trust decided not to pay for it. Haxby health centre in York recently told patients that eight common procedures would no longer be available to them on the NHS. Patients were referred to a private clinic charging, for example, £146 for treating in-growing toenails and £243 for removing benign lesions such as moles. Obese people can generally have bariatric surgery—the fitting of a gastric band—if their body-mass index exceeds 40. In York, however, treatment is limited to much more extreme cases where the patients have a BMI greater than 50. In vitro fertilisation—test-tube baby treatments—are available to infertile couples in Hull and Leeds, but not in North Yorkshire and York. Yesterday, the hon. Member for York Outer (Julian Sturdy) and I went to see our local PCT about its decision to stop paying for facet joint injections prescribed by NHS pain consultants to people in our area with chronic back pain. Patients forced to go private as a result of this decision expect to spend between £800 and £1,000 a year for the treatment.
This problem of postcode rationing is likely to get worse, because responsibility for health commissioning will soon be transferred from 150 PCTs to about 300 GP-led care commissioning groups and greater fragmentation will lead to greater variation in treatment decisions made locally, and also because of the tight squeeze on NHS funding. This year, PCT recurrent revenue funding increased by 2.2% while the retail prices index in the year to date is running at 5.2%, so there is a real-terms cut of some 3%.
The NHS has a cash-limited budget of course, and I therefore accept that there will be limits to the services it can provide. Indeed, in the 1992-97 Parliament, I was a member of the Select Committee on Health, which produced two reports on NHS rationing, or “priority setting” as it rather coyly called it. I contend, however, that if there has to be rationing, it is essential to ensure that those with the greatest needs always get treated. The rationing decisions must be rational, in that they must be based on clinical evidence—
Hugh Bayley
I do not think it is customary to take interventions while introducing a ten-minute rule Bill.
As I was saying, if rationing decisions have to be made, they must be both rational—based on clinical evidence—and fair, so that all patients are treated on an equal basis. If we are forced for cost reasons to say that, for example, tattoo removal or breast augmentation or in vitro fertilisation will no longer be provided, that should be a national decision made by a Minister and approved by Parliament, and applied on an equitable basis to all patients. It is patently unfair that in vitro fertilisation is available to patients in Hull and Leeds but not to patients in York.
Piecemeal local decisions undermine public confidence in the national health service. When a man in pain is told he must pay hundreds of pounds a year for the injections his NHS pain consultant prescribes, or when a woman is told she must pay to have her in-growing toenails attended to or an unsightly mole on her face removed, they naturally ask what will be struck off the NHS treatment list next. Every time the NHS says no to a patient, a little piece of public trust leaks away—a crack appears through which doubt and fear seep into the public consciousness about the reliability of the NHS in our time of need.
Nye Bevan chose the title of his political testament, “In Place of Fear”, with a purpose. Before the creation of the national health service, people lived in fear of the catastrophic consequences of illness or incapacity, and we do not want to return to those pre-NHS times. It is fortunate that all parties in this House are committed to the future of the NHS, so the Government, I believe, should act decisively to stem the leakage in public trust and to prevent it from turning into a torrent.
It is for those reasons that I propose my Bill, and I commend it to the House.
Question put and agreed to.
Ordered,
That Hugh Bayley, Frank Dobson, Mr Kevin Barron, Ms Gisela Stuart, Andrew George, Malcolm Wicks, Barbara Keeley, Mr Virendra Sharma, Valerie Vaz, Bob Russell, Grahame M. Morris and John Healey present the Bill.
Hugh Bayley accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 30 March 2012 and to be printed (Bill 266).