Why NHS patients lose their treatment rights if they supplement their treatment with a special drug at their own expense, when such restrictions do not apply to NHS dentistry, hearing aids, glasses and medical equipment aids.
Baroness Thornton: My Lords, legislation provides for charges for specific NHS services, including dentistry, optical appliances and wheelchairs, but not hearing aids. This system is different from allowing people to pay to top up NHS care with treatment that is not offered by the NHS. However, there is no question of anyone losing any treatment rights. No Government have ever allowed the mixing of NHS treatment and the private funding of treatment.
Lord Naseby: My Lords, the Minister refers to the founding principles of the NHS. During the Second Reading debate on the National Health Service Bill in 1946 Mr Aneurin Bevan referred to the gold-capping of teeth, pay beds and other treatmentstwo-tier medicine. Since then, numerous Governments have expanded that list, as the noble Baroness has just said, to include glasses, hearing aids and medical equipment. Would it not be fairer, better and more humane to allow these terribly ill patients, all of whom have paid for the NHS, to supplement their treatment, provided a medicine is licensed and provided it is at no cost to the NHS? How can it possibly be fair to take away their existing NHS treatment? Is it not all just a bureaucratic health nightmare?
Baroness Thornton: My Lords, more treatments than ever before are available on the NHS and more are coming on stream every day, but a founding principle of the NHS is that it is free at the point of use. The issues that we face today are issues of success: people live longer; they survive more illness; and we are inventing new and ground-breaking treatments every day to treat conditions that people did not expect to survive in the past. Most of what is done now was not
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Lord Walton of Detchant: My Lords, at a time when the Government have embarked on many public/private partnerships in health, such as the creation of independent assessment and treatment centres, is it not illogical to suggest that people already being treated for a terminal condition by the NHS should not be allowed to purchase additional drugs? That seems to me to be totally illogical. It could even be construed by some as being a breach of their human rights.
Baroness Thornton: My Lords, people are not being denied the right to have the drugs that they need. The legal obligation of the NHS is that care must be provided free, based on clinical need and not on the ability to pay. Most arguments about top-up payments, which often centre on cancer, are for drugs which do not yet have NICE approval, have been rejected by NICE or have not yet been licensed. NHS bodies must provide drugs that have NICE approval, but that is for local decision, and whether they provide drugs that are awaiting approval or have been rejected is down to local decision.
Lord Anderson of Swansea: My Lords, I accept what my noble friend says about the success of the NHS, but does she not at least concede that there is some perversity in the fact that one can top up for wheelchairs but not for medicines?
Baroness Thornton: My Lords, it is easy to see why some confusion might arise. I promise the House that there is a clear distinction between charges for medical equipment and top-up payments for drugs, although I confess that possible confusion is not helped by the different charging regimes. Even for some drugs there is a grey area. For example, GPs may give private prescriptions for certain listed drugscurrently, flu vaccine and Viagrafor patients whose condition is not regarded as serious enough to qualify for an NHS prescription.
On the other hand, the optical voucher scheme is not the same as top up because it represents a subsidy; for example, for those who may not be able to afford spectacles. Hearing aids, their maintenance and the batteries are free from the NHS, but if a patient chooses to go private they must bear the whole cost. Dental charges are banded, but NHS dentists can, if patients agree, provide treatment privately, but the two are paid for separately. Wheelchairs are provided and maintained free of charge, but a PCT has to set its own standards there. I promise the House that there is a logic here.
Earl Ferrers: My Lords, does the noble Baroness realise that while she has given some very good, defensive arguments for the NHS, she has failed to answer the original Question asked by my noble friend. Why should a person lose their treatment rights if they supplement their treatment? That is a fairly straightforward question and, with the greatest respect, it requires a fairly straightforward answer and not a diverse one.
Baroness Thornton: My Lords, perhaps I may explain why it is not possible to provide private treatment alongside NHS treatment within one episode of treatment. If there are two episodes of treatment, one NHS-funded and one privately funded, that is fine and up to the clinician to organise. You cannot do both together because you would be creating a two-tier system.
Baroness Thornton: My Lords, social services charges and NHS charging for equipment are two separate things provided by two separate bodies, although they may, as the Baroness will know, be provided to the same person. It is our policy to bring those two things together, which is what the new Bill coming to us next week is about.
Baroness Thornton: My Lords, the NHS is not in a hole. It provides exceptional treatment and care. My parents are both living longer today than they would have lived in the past, before the NHS existed, and we should celebrate that success.
Baroness Finlay of Llandaff: My Lords, do the Government intend to introduce direct payments in healthcare, as was recently broadcast in the media? If so, would that be for long-term conditions? What restrictions would there be in a direct-payment system for people to pay for top-up drugs?
Lord Sheldon: My Lords, I thank my noble friend for that reply. In the Budget Statement, the Chancellor of Exchequer said that he was meeting the first fiscal rulethe golden rulewhich is that the current Budget will be in surplus over the economic cycle. Can my noble friend give the date of the beginning of this cycle and the length of the economic cycle?
Lord Davies of Oldham: My Lords, the Government watch trends in the development of the economy but do not give an end date for the economic cycle. Forecasting that is the pursuit of fools gold. Since 1997, the Government have set out to follow the two golden rules. We have been successful in that. The growth of the British economy, the control of debt and the substantial investment over the past decade are proof of the Governments strategy and our observance of the golden rule.
Lord Forsyth of Drumlean: My Lords, on the subject of fools gold, can the Minister tell us how much less the deficit would be had the then Chancellor not sold our gold reserves at the bottom of the market? Can he also explain how this country, uniquely, has allowed borrowing to increase during the good times while our competitor nations have used the good times to reduce borrowing and are therefore better placed to deal with the current economic turbulence?
Lord Davies of Oldham: My Lords, on those two points, I notice that the Conservative Partys ability to forecast consists of reflecting accurately what happened in 1997. It is easy to be wise after the event on gold prices. At the time, other countries were pursuing a similar strategy to ours with the rate of gold as it was; we all recognise the changes that have been effected more recently. On the more general issue, the strength of the British economy is such that we are best placed to face what we all appreciate is a very difficult international climate. All economies are being forced to rein in their projections for growth. The Budget indicated that we had scaled back our projections for growth, but I emphasise that they are projections for growth.
Lord Howarth of Newport: My Lords, could we be in danger of refighting the last war rather than the one that may lie ahead of us? While the consequences of high inflation are undoubtedly extremely damaging, would not the consequences of recession or even depression be at least as damaging? Would it therefore be wise dogmatically to seek to balance the budget over the cycle, especially as no one knows what the cycle is, while allowing demand to collapse in the economy?
Lord Davies of Oldham: My Lords, the Government would of course be concerned if demand collapsed in the economy and we were not able to fulfil our projection of growth, albeit more limited than we would have anticipated had not the international crisis occurred. Nevertheless, growth will occur. My noble friend is absolutely right: it is important that we avoid recession. The British economy is well placed to avoid it and the Government intend to pursue all measures that will help in that respect.
Lord Dykes: My Lords, is the Minister aware that the Government are officially still, it surprises some people to learn, in favour of joining the euro? It is now over 10 years since that assertion was made with the famous five conditions written on the back of an envelope by Ed Balls. Are the Government aware that they cannot avoid this issue any longer? The euro has become the most successful currency in the world. If
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Lord Davies of Oldham: My Lords, I cannot satisfy the noble Lord in that respect. He will appreciate that over the past decade the comparison between the growth of economies in the eurozone and the growth of the British economy reflects favourably on the decision that we took not to enter the eurozone when that opportunity presented itself. He will also recognise the folly of reading too much into potentially short-term perspectives when we all recognise that there is a difficult year ahead of us and that economies may respond to it in different ways.
Lord Lang of Monkton: My Lords, regardless of the Prime Ministers notions of moveable economic cycle start and finish dates, is it not the case that this country has enjoyed 15 years of economic growth? However, the inheritance of the incoming Labour Government was coloured by binge borrowing on a massive scale and encouragement to the private sector to do the same, so that we now have an economy disfigured by debt, burdened by the highest tax burden ever and facing a turn in the economic cycle. How can the Minister square those facts with the Chancellors claim of economic stability?
Lord Davies of Oldham: My Lords, the country is not burdened by debt. It is the case, of course, that debt for households has increased, but the assets of households have increased by 70 per cent in the past 10 years and therefore people are borrowing against clear and advanced assets over the period when we first came to power. On the more general issue of government finances, as we have indicated all along, the Government will borrow only to invest. The country enjoys the fruits of that investment over the past 10 years. The Conservative Opposition purport to be involved in no investment on the scale of this Governments. Where would our health service and schools be had they been in power over that period?
Lord Davies of Oldham: My Lords, from my distant vantage point I seemed to detect that the visit of President Sarkozy was a considerable success. He was certainly very accurate in his judgment in that respect.
Lord Davies of Oldham: My Lords, the Olympic Delivery Authority and its delivery partner have processes in place to maintain registers of the physical assets and intellectual property rights. The London Organising Committee of the Olympic Games will procure and manage an asset-tracking system. The intellectual property of the 2012 Games is protected by the London Olympic Games and Paralympic Games Act 2006, and the Olympic Symbol etc. (Protection) Act 1995.
Lord James of Blackheath: My Lords, I thank the Minister for that Answer. Does he share with me a shiver down the spine to hear that the ODA has processes in place, which does not say that the asset registers exist? As for the asset-tracking system, when it is has done its job, will it turn its radar on to the Dome to see if it can find its assets, which were never found because there was never an asset register since the Government did not know how to hold one?
Lord Davies of Oldham: My Lords, the noble Lord often receives from me the reply that we have learnt lessons from the Dome. I cannot promise him that we will return to those Elysian fields. There are four years before the Olympic Games are due to be mounted. We have in place exactly those systems that he recommended should be put in place and that he thought ought to have been in place for the Millennium Dome. Of course, the development of the Dome was somewhat rushed in its later stages, as he will appreciate. The preparations for the Olympic Games are on timetable and working satisfactorily.
If it is correct that a town the size of Hastings is going to be built on the Olympic park, how many hectares of land will be left for green space? If that number is not correct, where will all those homes be built in the Lower Lea Valley and by whom?
Lord Davies of Oldham: My Lords, the intention is to leave two prominent elements as the Olympic legacy: first, the development of homes in east London, partly on the Olympic sitethe future use of parts of the Olympic villageand partly in the surrounding boroughs and areas; and, secondly, the creation of the largest park and public open space in Europe in many years.
Lord Addington: My Lords, can the Minister assure us that the Government are absolutely content with the record-keeping about the assets of this process? Would the Government care to suggest a reasonable timeframe in which we can look back and see if it has been successful? As the noble Lord, Lord James, has raised this point, at least then we would have a definitive answer and know when we should go and get it.
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