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House of Lords

Wednesday, 29th March 1995.

The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.

Prayers—Read by the Lord Bishop of Worcester.

NHS Trusts: Refusal of Treatment

Lord Dean of Beswick asked Her Majesty's Government:

    Whether they have issued guidelines to the newly formed national health trusts under what, if any, circumstances cost can be the main factor in refusing treatment to a patient.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, the Government have made clear that it is not acceptable for a health authority to refuse treatment solely on the grounds of cost.

Lord Dean of Beswick: My Lords, I am grateful to the Minister for that reply. However, within the guidelines referred to in the Question, if there are two centres of excellence, such as exist in a part of Manchester—for example, the Wythenshawe Hospital with its expertise in heart and lung surgery and the world famous Christie Hospital that treats cancer patients—and those two trusts find themselves running short of money, which results in a diminution in the number of people or cases they can treat, is there any way they can make a special appeal to the department for more funding to enable them not to decrease their workload?

Baroness Cumberlege: My Lords, we expect trusts to balance their books at the end of the year but there are areas in which we put some transitional funding when we feel it is essential.

Lord Ashley of Stoke: My Lords, is the noble Baroness aware that I have written evidence that some totally deaf people who could have their hearing restored have been denied cochlear implants solely on the grounds of cost when those people desperately want the treatment? The doctors have said they are willing to give the treatment but the cash simply is not available. Is it possible for the Minister to tell the House whether this is government policy and, if it is not, what can she do to help?

Baroness Cumberlege: My Lords, I think it is accepted now that the health service cannot fulfil every demand that is made of it. That is not only true of this country; it is true of every country in the world. It is up to health authorities to set their priorities. I am sure that the particular cases which the noble Lord has mentioned are taken into account but maybe they have to wait a little longer until funds are available.

Baroness Gardner of Parkes: My Lords, will the Minister confirm that there are many choices which

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have to be made which are not made on a cash basis at all but which are governed by a shortage of items such as kidneys and bone marrow that are available for transplants? We need more donors to come forward. The health service will always be faced with choices.

Baroness Cumberlege: My Lords, my noble friend is absolutely right, in that there are a number of constraints but it is interesting to see that in 1979 there were three heart transplants and in 1994 there were 342. I think that illustrates how the National Health Service is trying to keep up with new demands and with increasing technology, which of course is very expensive.

Baroness Jay of Paddington: My Lords, can the Minister comment on the use of the drug beta-interferon which is an example of a new type of treatment to which she has referred? I understand that, although this drug is now regarded as being clinically effective for some people with multiple sclerosis, there are many health authorities in the country which are not using it because it is expensive. Do the Government agree with that policy?

Baroness Cumberlege: My Lords, with regard to beta-interferon, a licence application has been made to the European Medicines Evaluation Agency and certainly our guidelines to health authorities are that, with regard to licensed drugs, costs should not be a factor.

Lord Skelmersdale: My Lords, does my noble friend accept that there has always been rationing in the health service? It used to be rationing by waiting lists and now it is rationing by treatments, which is much more apparent to the general public.

Baroness Cumberlege: My Lords, of course there have to be priorities set but I think the important thing is that it is clinicians who should set the priorities when they are faced with individual patients before them. Our policy is very strongly that that should be the case and it should not be politicians, central planners, economists or whoever who should take those individual decisions.

Baroness Gardner of Parkes: My Lords, can the Minister tell me whether beta-interferon, which has been mentioned, is a drug that even in the United States will be subject to a ballot process because it is such a rare and costly drug and it cannot be produced in sufficient quantities?

Baroness Cumberlege: My Lords, I am afraid I cannot answer my noble friend but I shall certainly write to her.

Lord Ashley of Stoke: My Lords, I hope I can be forgiven for coming back. Will the Minister bear in mind that in the case of deaf children if the treatment is delayed after the age of five it is too late in some cases

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for the implant? Therefore delays really mean no treatment. Will that be borne in mind by the Government?

Baroness Cumberlege: My Lords, I am sure that would be borne in mind by the health authorities who commission these treatments and also by the clinicians. I do not think that is an issue for the Government.

Lord Rea: My Lords, I of course accept that the National Health Service cannot offer every treatment, however expensive, to everyone. However, what I think is causing dissatisfaction is that some purchasing and some providing authorities can provide certain treatments and others cannot but there is an uneven situation pertaining in different parts of the country. What has happened to the slogan that the money will follow the patient that was very much part of the reason for bringing in the 1990 Act?

Baroness Cumberlege: My Lords, priorities have to be set. In fact, the Select Committee in the other place has been doing a study on this subject. On Friday the Government will give their response to the Select Committee's report, which reflects the Government's policy that priorities are best set locally. It is inappropriate that we should try to do that centrally from Whitehall. We cannot be sufficiently sensitive to local situations.

Lord Hughes: My Lords, on a simpler matter, can the Minister say why it is that when a patient was discharged from hospital and was attended by a district nurse she was refused the size of dressing which was used all the time she was in hospital?

Baroness Cumberlege: My Lords, that is an extremely technical question. I shall do my best to answer it. The interesting aspect is that in October last year we introduced a new scheme under which district nurses can prescribe. That includes dressings and a whole range of medication. That will overcome some of these problems because it will give district nurses more flexibility.

Lord Hughes: My Lords, to follow up that point, the district nurse does prescribe. The matter was referred to Aberdeen, where the pricing bureau refused the request on the grounds that the dressing was too large. It was not too large in hospital, but it became too large when the matter came to Comrie. It is obvious that if the prescription was refused by the pricing bureau it was refused on grounds of cost.

Baroness Cumberlege: My Lords, this sounds seriously like a Scottish Question. I am aware that in Scotland they have not introduced nurse prescribing.

Lord Dean of Beswick: My Lords, can I take it from the Minister's reply to my first Question that the doctors have the final say, and that in the case of an over demanding patient who wishes to go over the doctor's head to the chief executive of a trust the request will be met by a firm "no"?

Baroness Cumberlege: My Lords, treatment depends very much on the consultation between the doctor and

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the patient and the trust between them. I am aware that some patients are over-demanding. We launched a campaign last year entitled "Help us to help you" under which we suggest to patients that there are ways in which they can help GPs especially, in terms of call-out and not being over demanding.

Works of Art: French Auction Procedures

2.45 p.m.

Lord Boyd-Carpenter asked Her Majesty's Government:

    Whether it is the case that France prohibits the sale by auction of works of art in France outside its state system of Commissaires Priseurs; whether this is contrary to the Treaty of Rome and the practice of other member states of the European Community; and, if so, what action they propose to take to ensure that France complies with its obligations.

The Minister of State, Department of Trade and Industry (Earl Ferrers): My Lords, in France all sales of works of art must be undertaken by Commissaires Priseurs. That is an unacceptable restriction on the ability of British auction houses to operate in France. The Government have made repeated representations on this matter both to the French authorities and to the European Commission. The European Commission has told us that it will take legal proceedings against the French Government under the treaty.

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