Health: Cancer

Lord Crisp Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Crisp]

My Lords, I, too, congratulate my noble friend on securing this debate, with its focus on patient experience, and on her forensic presentation of the risks of fragmentation. I am sure that we are all looking forward to hearing the Minister’s response.

As many Members of your Lordships’ House will know, I was the chief executive of the NHS for some years. However, I want to use these few moments to talk about the experiences of people with private health insurance who are seeking treatment for cancer. It is clear that the NHS is the priority, and it is important to get it as good as possible for everyone. Where drugs are proven as effective, they should be available to everyone, and I absolutely take the point about early diagnosis. However, this is not the whole story. I understand, too, that private medicine or insurance have their place for some patients, and any debate about cancer care needs to take account of this.

I have learnt about some of the practices of some insurers thanks to the sad experiences of a friend who has cancer. In a nutshell, people who thought they had bought complete cancer care funding find out, sometimes in the worst of all possible circumstances, that they have bought partial cover at best. I was shocked when my friend told me that his insurer was setting limits on his treatment options which were not referred to in his policy documents and, even worse, proposing to change the terms of their agreement after he had started to claim. My friend is a lawyer, who has great determination and a very loving and supportive family. He decided to fight, and got his MP and me involved. We met the insurers and won some concessions which have prolonged his treatment. It should not be like that.

Having made some inquiries, I find that my friend is not alone. I have spoken to a number of consultants who have told me of patients faced with similar problems who are now paying their own way or have given up. I know of one woman who has to make that decision this week.

These would be sad stories but understandable if it had been clear at the outset what their policies covered. It was not. The fundamental problem is a lack of transparency. Insurance policies are all too often vague and confusing. They do not tell people precisely what they have bought or give them the certainty they need at the time they need it most. Patients find themselves in a negotiation where the insurers hold all the cards. The vagueness of the policies allows the insurers to make decisions entirely on their own terms. I have heard some say that this allows them to exercise compassion and to cover treatments that are not really covered. I am sure that they are compassionate people but they also have a financial bottom line, and such vagueness also allows them to be less compassionate.

The Association of British Insurers has a mandatory code of conduct which sets out the information patients should be given. However, even on its publication it was subject to criticism in the industry, with one source saying that it is very difficult to get any clarity over what is and is not covered. It is not just a question of picking up the policy document; we have to consult the medical advisers and heads of claims in each insurer, and even then it is not clear.

Private health insurance is a financial product, and individuals can complain to the Financial Ombudsman Service. By all accounts, this service works well although of course it can be very difficult for patients to pursue lengthy complaints when they are ill. Nobody, however, appears to be looking at complaints or problems which affect groups of patients or the whole industry. The Financial Services Authority has the power to do that, but has not looked into this in any depth, and I believe that the regulatory system is not working.

Cancer research is developing rapidly, with many new diagnostics and therapies. They offer hope but often bring extra costs. I can see that this makes it difficult to provide cover, but it also makes it all the more important that NHS and insurers’ policies develop equally rapidly.

When I was NHS chief executive, I was very familiar with the criticisms that we did not pay for new and expensive cancer drugs and that patients were subject to a postcode lottery, with access to treatment depending on where they lived. We tried to deal with these problems by setting up the clinically led National Institute for Clinical Excellence to assess scientifically how effective the drugs were. Decisions were made in public; NICE is accountable to the public.

More recently, I have campaigned with others for patients to be able to pay for additional drugs which did not meet NICE’s criteria on the understanding that this field is developing very fast and new treatments are being introduced. In 2008 I was delighted and honoured to co-author a piece to this effect in the Lancet, along with the noble Baroness. I am delighted that the previous Government agreed to do this, and I congratulate the current Government on increasing funding for cancer drugs.

The NHS continues to develop its policies and to improve. It could go further, but what about the private insurers? Let me be clear that not all insurers are as bad as those of my friend; when I talk to consultants, they name the same two or three which they believe are very good and the same two or three which they believe are very poor. But the reputation of all of them is damaged. The industry needs to get its act together. The Financial Services Authority needs to act and the Government need to ensure that they review this whole area.

In the mean time, I would advise any patients in this situation to do the same as my friend—to get their MP involved and to fight. I know that this is not the Minister’s responsibility and that he will refer this matter to his colleagues. However, the Department of Health has a responsibility for looking across this whole territory—we have been given wonderful voluntary sector examples of hospices—and at the impact on the NHS of private insurance and private healthcare. My complaints about clarity also apply to the NHS. It is very important that the NHS spells out what treatment people can expect and therefore, by implication, what space may be available for private insurance.

My experience is that people want clarity and certainty. Whether they are NHS or private patients, they do not want to wait around for decisions. The private insurance industry is failing on this, and I believe that the Government and the NHS could do more.