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Health Care Prioritisation

I thank the hon. Gentleman for that intervention, and I agree with what he says. I have, however, been circumspect in talking about NICE, and I am hoping that our inquiry and the report will address some of those questions, so I will not be drawn into addressing this matter further at present. I was about to explain a little in respect of the cancer reform strategy. In the section on community-based prostate health clinics, there is the following significant sentence:"““Improved support for men in making decisions about further investigation or treatment would not be a form of rationing, but rather a way of ensuring that men have the best possible information and support when making difficult decisions.””" There is rather a move to imply that a PSA—prostate-specific antigen—screening programme is not being rolled out nationwide because of financial difficulties, but that makes it clear that that is not the reason why, and that the reason is because the case for screening is not entirely proven as yet. All of this calls for great courage from the Government. To open an honest public debate about priorities, admitting that some treatments might fall off the bottom and get rationed out, will be difficult for the Government to consider. Vitally, however, this subject is also important the other way around, in respect of the £1.8 billion surplus. I know we keep on being told that it is only 2 per cent. of the whole NHS budget, but £1.8 billion is still a lot of money to anybody, and after the restoration of education budgets and the ending of the vacancy freeze on staff one would think there should be some left. I think that people should have a say in what the surplus is used on. For me, one of the high priorities would be to reduce the postcode rationing. I shall briefly consider what could be removed from health care provision and what could be given a low priority. I had hoped that we were still using lots of medicines that did nothing, but NICE told us in an open session of the inquiry that it had looked at this matter and found that few drugs that do nothing were still being used. That is sad, because I remember as a houseman writing up in dog Latin super things such as mist. ipecac. co. That was a delightful medicine whose very taste made one feel better. It was supposed to stop one coughing, but it rightly fell out of use ages ago. Should we provide cosmetic surgery in respect of tattoo removal or varicose veins? Should we provide travel immunisation or, more controversially, gender change operations, vasectomy reversal or surgery for obesity? What about surgery for some conditions if the patient continues to smoke or drink? That is just the start of a list. How should we take it on? Hospital Doctor, one of these widely circulated free newspapers for hospital doctors, recently reported on a survey of medical opinion, and it called for an urgent review of NHS rationing. Admittedly its evidence was mostly anecdotal evidence of deaths, suffering and complaints resulting from our higgledy-piggledy rationing by local availability of resources. Hospital Doctor called on the Government to commission an independent review of how treatment is rationed in the NHS. It specifically wanted:"““More transparency in how rationing decisions are reached and communicated; Stronger and wider-ranging guidance either from NICE or another independent source; Less political interference, from MPs campaigning for certain treatments to individual primary trust management decisions.””" Those are all reasonable aims. The Royal College of Surgeons has joined the debate. Recommendation 2 of its response to the British Medical Association's discussion paper, ““A rational way forward for the NHS in England”” referred to core services. It stated:"““There are difficult choices to be made regarding the deployment of NHS resources. This College believes that decisions on priority setting, like those on reconfiguring services, should be made primarily on the basis of clinical need and not in the interests of financial or managerial expediency. There must be an open and honest debate about the services which are freely available on a national basis, those which require some form of co-payment and those which cannot be provided by the state.””" The college goes on to draw attention to some of the obvious difficulties that we would encounter were we to embark on such a debate. My challenge to the Government is to accept that the NHS is potentially a bottomless pit, and that most people want a tax-funded service free at the point of delivery but that a fully comprehensive service is probably impossible. We thus need to have a debate on the top priorities—the core services—and the lesser priorities, some of which might fall off the bottom of the affordable scale. An open and honest debate on the issue might restore some confidence in the Government and show that they are prepared to listen. A debate would also give the Government the chance to demonstrate that they can take advice—something that was thrown into doubt by the treatment of the Home Office Minister in the House of Lords recently. If such a debate took place, headlines such as those in The Guardian today might no longer be possible. Two examples were, ““Prospect of moving to a care home frightens two thirds of Britons”” and ““NHS ignoring human rights of people with learning difficulties””. Perhaps the Minister could persuade his ministerial colleague in the House of Lords to add this dimension to his review of the NHS. His vision is of"““a world class NHS focused relentlessly on improving the quality of care””." I cannot argue with that, but I wish that we could add to the vision how that is to be achieved and how we can tackle the inequity that exists. We must recognise that we cannot afford everything, and the consultation must address the issue of prioritisation or rationing. I have demonstrated tonight how much support there is for doing so.