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Andrew Lansley on health top-ups

The text of the Shadow Secretary of State for Health's speech to the Commons earlier.

"I am grateful to the SoS for advance sight of his statement. I am sure the House will also wish to thank Professor Mike Richards for his report.

I regret that the SoS statement, far from clarifying the issues, leaves them as unsatisfactory as ever.

Professor Richards’ report says on page six that, “I believe that the option of NHS top-ups should be rejected”. But the SoS says that if patients are denied access to cancer drugs by the NHS, they can pay for them without losing their entitlements to NHS care. 

So, contrary to past guidance, and in a U-turn on its policy, patients will be able to be both a private patient and an NHS patient in relation to the same course of treatment.

So is the SoS in favour of top-ups or against them?

The Government has jumped from the frying pan and into the fire.

From denying cancer patients their NHS entitlements, to forcing patients to pay and creating a two-tier NHS.

This has happened because the SoS has not satisfactorily answered the key question: why are NHS patients in England not receiving clinically effective, life-extending cancer treatments which are routinely available in other European countries?

An OECD report on pharmaceutical pricing last week showed that the UK spending on medicines per capita is below the OECD average.

The Government have admitted that the uptake of new cancer drugs in this country is slower than across Europe; and that we spend 5.6 per cent of our NHS budget on cancer services, when the French spend 7.7 per cent.

Why has the SoS not understood that the heart of this issue is to enable clinicians in this country to provide the cancer treatments that they believe are necessary for their patients?

Why has he not followed our advice, taking Ministerial referral out of the NICE system and thereby getting the appraisals done within 3-6 months?

Despite the talk of more flexible pricing, Why has he not implemented value-based pricing for new medicines, through the PPRS, so patients can access treatments and the price paid reflects the therapeutic and innovative value?

Why can’t he simply say that the NHS will provide the best clinical care?

Instead, the SoS still seems to be prepared to contemplate cancer patients paying thousands of £s for their medicines, administered as ‘separate care’ by the NHS.

If so, is the SoS planning new primary legislation, to introduce a new power to charge for treatment?

Is he preparing legislation to remove the private income cap on Foundation Trusts, because specialist cancer hospitals like the Royal Marsden or The Christie would otherwise hit the cap?

How will he stop these new rules becoming a bureaucratic nightmare?

How will he prevent the NHS becoming a ‘core service’, with increasing numbers of top-up treatments?

How will he stop patients being exploited, pressured to pay for more and more treatments or services?

Will he confirm that his proposal for “separate care” will often mean private healthcare provided by NHS bodies?

Based on his proposals today, how can the SoS still argue that treatment by the NHS is available based on need, not ability to pay?

Let us take the case of a patient who has bowel cancer, whose consultant recommends ‘Erbitux’, a life-extending treatment. 

We currently have some PCTs providing it, others not. 

We have some hospitals paying for it, others requiring it to be administered at home with the patient paying.  Still others are requiring it to be administered entirely privately, with all the associated treatment costs being paid for.

After listening to this statement, only the latter case appears to be ruled out.  And so it should be.  It should have been stopped as soon as Ministers understood that this was happening; it was always morally repugnant to make cancer patients pay for their continuing NHS care. 

It is equally unacceptable for cancer patients still to be put through months of delay, whether through NICE appraisals or local exceptional case panels, not knowing whether their treatment will or will not be provided by the NHS, even if their consultant says it is the best – sometimes the only – option for them. 

And this, when they know that if they were a cancer patient in France, Germany or Greece, they would get the treatment. 22 European countries provide Erbitux for bowel cancer treatment; but not in this country. And it isthe drug Linda O’Boyle from Billericay needed and had to pay for. (John Baron).

The Government are planning to stop cancer patients having to pay £7.10 for a prescription; but is prepared for a cancer patient to pay £11_k for Erbitux to treat their bowel cancer. What kind of madness is this?

The Rarer Cancers Forum estimates the cost of extending access to new cancer drugs at £175 million a year.  The NHS surplus last year was £1.7 billion. 

This summer, the Secretary of State announced that his price cut on the Pharmaceutical Price Regulation Scheme would cut the cost of the drugs bill by £300 million a year.

So where is that money going?  Why is the money voted by Parliament to provide care for patients not providing the cancer services which our constituents need, and which other countries provide?

We have to look at this issue from the patient’s perspective. If a patient has cancer, they would expect the NHS to provide the treatments which they need, including those which will extend their life.

If I want something different, and pay for it privately, then I don’t expect the NHS to penalise me for doing so.

Those are two simple principles. Why will the Government not make it that simple and respect the values of the NHS?"


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