The Secretary of State for Health (Alan Johnson): Guidance has existed for more than 20 years. I have today asked Professor Mike Richardsthe national clinical director for cancerto review policy relating to patients who choose to pay privately for drugs not funded on the NHS. Terms of reference have been placed in the Library.
Mr. Baron: I very much welcome the Secretary of States announcement, as will many campaigners up and down the country and in the House. The ban on co-payments was cruel, because, as we know, it took NHS care away from patients who were dying, and it was illogical because co-payments existed in other parts of the NHS. Will the Secretary of State assure the House that the review will not have the effect, however inadvertently, of kicking the issue into the long grass, because, as the case of Linda OBoyle proved, patients want and need the change in the policy now, not in a years time?
The hon. Gentleman has represented his constituent, Mrs. Linda OBoyle, vociferously in the House and, indeed, on a non-party political basis, and many other Members on both sides of the House have raised the issue. It is time that someone with the expertise of Professor Mike Richards looked at the issue. It will hardly go into the long grass; I want Mike Richards to report in October. When the hon. Gentleman has had a chance to read the terms of reference, he will see that I am asking Mike Richards to look at very complex issues. I am not saying that he should come down one way or the other; I am saying that he needs to review the issue, given the need, which hon. Members on both sides of the House understand, to protect the principles of the NHS as a service free at the point of need and the very understandable concerns of Mrs. OBoyles family and many others involved to find out whether we can ensure that we get guidance that is up to date and
related to what is happening now in the NHS, that is fair to everyone and that resolves some of the problems that the hon. Gentleman and others have raised.
Mr. Frank Field (Birkenhead) (Lab): May I welcome the Secretary of States statement? Many Labour Members welcome it, as well as Opposition Members. I am grateful for his emphasising that this is not a new policy; it is one that the Government inherited. May I add that, by in a sense time-limiting the review, he will increase support in the country for the outcome of the review, whatever it is?
Alan Johnson: I thank my right hon. Friend. He, too, has raised the issue in various debates in the House. The guidance goes back at least to 1986 and probably before then. I have no need to ask Professor Mike Richardshe will do this anywayto talk to Members, such as the hon. Member for Billericay (Mr. Baron), my right hon. Friend and others who want to raise specific issues. That can be done in the time scale that has been setcertainly, Professor Richards thinks that it canand, as I say, that will ensure that I do not stand at the Dispatch Box merely repeating guidance that has existed for 20 or 30 years. We can determine what we need to do now in the NHS to resolve some of these very difficult and complex problems.
Dr. Richard Taylor (Wyre Forest) (Ind): I also welcome the review that the Secretary of State has announced. Will he ensure that, in the deliberation, the needs of the silent voicesthose who cannot afford the extra paymentsare not forgotten?
Alan Johnson: The hon. Gentleman raises a very important issue. The scenario that many in the NHS feared, which has led to the guidance over the years, is that a patient in the first bed on a ward would be treated completely differently from the one in the second bed, because of their ability to pay. That is not the argument that has been raised by hon. Members in the House. I understand very clearly the fundamental points that are being made, particularly about Mrs. OBoyle, who did not know that there was an obligation to pay for treatment until she had received it. But the hon. Gentleman, from his experience in the NHS, raises the fundamental, key issue, which I hope he will accept is very clearly set out in the terms of reference.
Clive Efford (Eltham) (Lab): Will the Secretary of State give an assurance that the review will not result in a lottery system in the NHS, whereby people who can afford to pay can buy better treatment than people who cannot afford to do so? Most hon. Members on both sides of the House would be concerned if that inequality were introduced into the NHS, because it could become the thin end of the wedge for things such as top-up payments for other treatments. Will he assure us that the review will not open up that avenue?
the importance of enabling patients to have choice and personal control over their healthcare; and the need to uphold the founding principle of the NHS that treatment is based on clinical need not ability to pay, and to ensure that NHS services are fair to both patients and taxpayers.
My hon. Friend should be reassured that we are reviewing how the system works in the 21st-century NHS, and that the outcome is not predetermined. Professor Mike Richards is a respected clinician: he led the development of the cancer plan and cancer strategy, and until recently he was chairman of the National Cancer Research Institute. All the cases that I have examined, including Mrs. OBoyles, relate to cancermainly bowel cancer and kidney cancer. Professor Richards has spent his whole life in the NHS, so he is the perfect person to review the situation very quickly. The report will be published, so hon. Members will have the chance to see the results.
David Taylor (North-West Leicestershire) (Lab/Co-op): Desperately ill patients and their families are often vulnerable to the false hope provided by miracle drugs, which are sometimes touted in the media. What consumer adviceit is almost consumer protectionwill be given to those people so that they do not waste their time and money or expend their hope on what are cul-de-sacs so far as treatment is concerned?
Alan Johnson: My hon. Friend raises another dimension to the issue. Professor Richards led on the cancer strategy, which was published in December and pointed out the need to get cancer drugs through the process much more quickly. Consumers who are considering drugs that are available on the internet should, first, take the advice of their clinician; secondly, check whether the drug is licensed; and, thirdly, if it is licensed, ensure that they know where it sits in relation to the NICE process. We can speed up the NICE process, and we will comment on that in the next-stage review, which will be published shortly. The internet contains a range of drugs, some of which are licensed and some of which are not. We must be vociferous in ensuring that consumers get the right advice, and we must do what we can to ensure the proper regulation of such drugs.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am sure that the House is grateful to the Secretary of State for initiating the review. The Secretary of State will also appreciate that we have not had access to the terms of reference. It would be helpful if the Secretary of State, taking account of the case made by my hon. Friend the Member for Billericay (Mr. Baron) on behalf of Mrs. OBoyle and her family, were to agree that we need to examine two principles. First, if patients access private treatment beyond the boundaries of NHS care, it should not mean that they lose their entitlement to NHS care. Secondly, NHS care itself should continue to be both comprehensive and free based on need, not ability to pay. I gather from the terms of reference that the Secretary of State has included the latter principle, but has he included the former?
I appreciate that the hon. Gentleman has not had a chance to see the reviews terms of reference, but that sounded like an attempt to pre-empt the outcome. We are clear that someone who has had private treatment can return to the NHS for treatment, and we are also clear that people who have had NHS treatment are perfectly entitled to obtain private treatment. The ambiguity occurs over the term an episode of care and whether someone can buy a drug that is not available on the NHS and ask the NHS to pay for its
administration as part of their treatment. I want Professor Richards to examine that area, and I do not want to predetermine the review. Professor Richards is well aware of the problems experienced by Mrs. OBoyle and others, because he deals with such issues all the time. When the hon. Gentleman sees the terms of referenceI will not take up the Houses time by reading them all out, because there are quite a few wordsI hope that he will be assured that that point has been addressed. If not, the issue is not party political, and he is welcome to come and see meindeed, I am sure that Mike Richards would be keen to talk to him.
Mr. Lansley: I look forward to discussing the matter with Mike Richards. The Secretary of State will appreciate why I mention comprehensive care. The review particularly relates to many of the new cancer drugs. Mike Richards and the NHS also need to address how patients who rely on the NHS for their treatment can be sure that they will get comprehensive treatment. For example, I have a list of 20 European countries where Erbitux, the brand name for Cetuximab, which was privately provided for Mrs. OBoyle, is routinely made available for patients with colorectal cancer. In the NHS, Mrs. OBoyle was told that that drug was not available. Surely we must address that question, too.
Alan Johnson: I do not believe that that is about the terms of reference. The issue is how we deal with the NICE process. Cetuximab was a specific issue and it had not been through the NICE process. The PCT decided that the circumstances were not exceptional and, therefore, the treatment was not given. There is a whole different dimension to the issue under discussion. The fundamental problems that Professor Richards will look at are confined not to cancer drugs but to drugs per se. There may be many other issues and unintended consequences, because we have been concentrating so closely on the understandably controversial issues surrounding Mrs. OBoyle and others. But Professor Richardss remit will be to look right across the range. The worst thing that could happen to the review would be if he were to concentrate on one particular area and on a few particular drugs, and then miss the fact that unintended consequences apply to other illnesses and to other drugs.
The Minister of State, Department of Health (Dawn Primarolo): Data on newly acquired HIV infections are not available, but an estimated 5,817 people were reported as newly diagnosed with HIV infection in 2007, compared with 6,769 in 2006. The figures include people with long-standing infections, including many who were infected outside England but who were subsequently diagnosed in this country.
I thank my right hon. Friend for her answer. She will know that there is a serious problem not only with the overall numbers, which, although coming down, were recently still up on the 1997 figure of, I think, 3,000. She will also know about the problem
of late diagnosispeople being diagnosed six or seven years after becoming infected, by which time they have become highly infectious and less likely to respond to treatment. She will be aware that Londons strategic health authority has highlighted that big problem and is trying to address it with a target to halve the number of people who are diagnosed late. Will she seek to use her influence to spread that target and practice throughout all health authorities in the country?
Dawn Primarolo: My hon. Friend raises a very important point. He will know that the prevalence of HIV in England is one of the lowest in Europecomparable to that in Sweden, the Netherlands and Denmark. Nevertheless, he is quite correct: about 31 per cent. of those who are infected are unaware of the fact. The steps that the Department has been taking have been, first, to focus on publicising the importance of early testing and on providing extra resources; secondly, to improve timely access to NHS testing, particularly in a variety of settings, not just in genito-urinary medicine clinics; thirdly, to look very specifically at where the highest risks are and to ensure that information and support are provided to those groups to encourage them to come forward for testing; and, finally, to undertake work with those in the voluntary and third sectors, as well as with local health authorities, to try to remove the stigma and the perceived discrimination that many people fear in order to encourage them to come forward.
Mr. David Heath (Somerton and Frome) (LD): Has the right hon. Lady had any recent discussions with her colleagues in the Department for Work and Pensions about the growing concerns regarding medical assessments of people with HIV infections, in respect of disability allowances and of fitness for work? It is a growing concern, and it would be very useful if she were to have appropriate discussions with the DWP to ensure that it applies the right tests.
Dawn Primarolo: I have not had any discussions recently about that point, but if the hon. Gentleman has specific issues and experience in his constituency I would be very happy if he sent them to me, because clearly we must ensure that medical assessments are conducted correctly, particularly with regard to that very vulnerable group.
Mr. Neil Gerrard (Walthamstow) (Lab): I am sure that my right hon. Friend recognises the risks to public health from the greater number of new infections and from people who are undiagnosed. Given that, will she look again at including HIV in the list of infections that are exempt from NHS charges? We must have a balance between the public health risks and the financial costs, recognising that the risks outweigh the costs.
All people who are ordinarily resident in England are entitled to free national health service treatment, including for HIV. My hon. Friend will be aware that that is qualified by exempting categories of individuals from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended. He will also be aware that asylum seekers are exempt from charges for all hospital treatment, including for HIV, and will remain exempt for courses of treatment that continue if and when their applications
for asylum are rejected. All the points with regard to the threat to public health that he correctly identifies are addressed in the strategies that we use.
Mark Pritchard (The Wrekin) (Con): The Minister will know even from the Governments own data that many of the at-risk people to whom she referred are from sub-Saharan Africa. What consideration have the Government given to selected pre-screening of people who apply to move to the United Kingdom through work visas or student visas, or, indeed, as asylum seekers?
Dawn Primarolo: The hon. Gentleman will know that the Government have announced that they are investing an extra £2 million, in addition to the moneys already committed to prevention work, to look specifically at groups of highest risk, including gay men and people from African communities. Working through the African communities and the African HIV project, we are addressing particularly the issues that the hon. Gentleman mentions. It is important that people come forward for early testing. It is not necessary to have compulsory testing. We are seeing that testing through the various clinics and measures has increased dramaticallyin some cases, by up to 85 per cent.
Mr. David S. Borrow (South Ribble) (Lab): Does my right hon. Friend agree that there is a danger that as more and more people are living and working with HIV/AIDS, the perception of the disease as being life-threatening recedes, and that any prevention programme therefore needs to recognise that change in perception and to focus very much on the fact that being able to take drugs and in most cases live a long and productive life is not a reason to assume that one is not at risk?
Dawn Primarolo: My hon. Friend is absolutely right. With the development of therapies and treatments, it is particularly important that people understand that HIV is still a deadly disease. We particularly need to understandthe Department is taking this forwardwhich groups in the community may be less aware of the risk, or have a belief that they can live with it, and to target additional information and support to them to encourage them, first, to come forward for testing, and, secondly, to desist from activities that increase their likelihood of HIV infection.
The Parliamentary Under-Secretary of State for Health (Ann Keen): We are concerned about the increasing incidence of and mortality from liver disease. I congratulate my hon. Friend on his work in the all-party group on hepatology and on the many Adjournment debates that he has introduced on this issue. We are already taking action on a number of fronts to combat its primary causesalcohol misuse, which is the most common, viral hepatitis and obesity. We accept that there is strong support for developing a national plan for liver disease.
Unlike deaths from other major diseases, which are going down significantly, deaths from liver disease caused by viral infections, obesity and excessive
consumption of alcohol are, tragically, rising significantly. What more can my hon. Friend do to reverse that trend, and when will we see a national service framework established in the field of hepatology?
Ann Keen: We have engaged with a wide range of stakeholders in order to build a consensus on the issues that my hon. Friend has raised and on what we might do about them. We shall decide on our next steps in the light of that and of preliminary work on the evidence. Much of the evidence is being taken by Professor Ian Gilmore and Professor Eileen Kaner of Newcastle university. Problematic drinking is a key cause of liver disease. In our national alcohol strategy, we support a comprehensive approach, across and beyond Government, to address the consequences of harm caused by alcohol. We have a range of measures in place to tackle hepatitis B and C, such as a national hepatitis C action plan and awareness campaign. Our expert committee, the Joint Committee on Vaccination and Immunisation, is reviewing the national hepatitis B immunisation programme. Tomorrow, I shall meet some officers of the all-party group, and I hope to take the process forward as soon as possible.
Mr. Philip Hollobone (Kettering) (Con): Does the Under-Secretary share my concern at the growth in the instance of liver disease among younger people through the misuse of alcohol? What steps is she taking in conjunction with other Departments to target that age group to prevent the problem of binge drinking?
Ann Keen: Our national alcohol strategy has been rolled out along with, today, a Home Office initiative on the very subject that the hon. Gentleman rightly raises. Education on liver disease and its serious consequences, which sometimes do not come to light for many years to come, is difficult to get across to young people because they live for today, and serious consequences for the liver may not become apparent for 10, 15 or even 20 years. Much more can be done and I am happy to work with the hon. Gentleman on any initiative he wants to bring to me.
Mrs. Ann Cryer (Keighley) (Lab): Has my hon. Friend considered a requirement for a Government health warning on all tins and bottles of alcoholic beverages, similar to the warnings that we have on packets of cigarettes? A number of countries throughout the world use them.
Ann Keen: I am informed by the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that there is a voluntary system in place at the moment, but we can always look to do more because the consequences for young people are so serious and because the rate of deaths from liver disease in this country is rising.
John Bercow (Buckingham) (Con): What discussions has the Under-Secretary had with colleagues in the Department for Children, Schools and Families and the Ministry of Justice to ensure that there is some sort of co-ordinated action whereby the contents of the strategy can be rolled out in prisons in due course, and within young offender institutions in particular? Action is urgently needed there.
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