Health and Care Bill

Paul Bristow Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests.

I want to focus on two main areas of the debate: the role of patients in accountability and transparency; and tariffs—the way in which we pay for procedures and care. I support the Bill, but I hope that we have the means to address the deep-rooted cultural issue of regarding patients’ views as less valuable than those who work in our national health service. Before I was elected, I was often involved in advocacy campaigns. Patient groups would want to challenge NHS England’s commissioning policies or service specifications. These policies govern the technologies and procedures that are used to treat conditions, but the patient groups would find the decision-making processes totally impenetrable, as would the clinicians and health policy experts advising them. What chance do individual patients and relatives have to make their voices heard?

The same impenetrability applies to clinical commissioning groups. Patient access to established procedures and technologies is blocked by local policies, but people have to be dedicated to find these policies on convoluted websites or page 178 of a 256-page document. For example, CCGs regularly restrict patient access to hip and knee procedures for patients with a body mass index of over 30. Extraordinarily, some CCGs allow procedures only for patients who have a BMI of less than 25. I would confidently predict that that would disqualify the vast majority of hon. and right hon. Members, and we should call it out for what it is, which is rationing.

Such rationing was routine before covid created massive backlogs in NHS waiting lists in some CCGs. Transparency and openness is the solution to these problems. A formal role for patients on ICS boards, a formal role for patients in the development of commissioning policies and creating a national appeals board for challenging commissioning decisions are all ideas that I hope Ministers might consider as the Bill progresses.

Finally, on tariffs, national tariffs are not perfect but they do incentivise providers to treat as many patients as they possibly can. The Bill states:

“NHS England must publish…‘the NHS payment scheme’”—

a document “containing rules for determining” the prices to be paid in future, including, for example, for hip and knee procedures. Tariffs have led to hip and knee procedures and other procedures being done at volume and at scale, certainly, at least, when commissioners agree to pay for them. High volumes of elective procedures have been a good thing and the current elective backlog is probably the biggest challenge that the NHS faces coming out of the pandemic, so whatever ends up in that document, it needs to be clear, transparent and provide incentives for high-volume procedures to be carried out at pace and at scale.