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NHS Patients (Access to Medicines)

I am grateful to the Secretary of State for advance sight of his statement. I am sure, too, that the House will wish to thank Professor Mike Richards for his report. I regret, however, that the Secretary of State's statement, far from clarifying the issues, leaves them as unsatisfactory as ever. Professor Richards's report says on page 6:"““I believe that the option of NHS top-ups should be rejected””." However, the Secretary of State says that if patients are denied access to new cancer drugs by the NHS, they can pay for them without losing their entitlement to NHS care. So, contrary to past guidance and in a U-turn on policy, patients will be able to be both private patients and NHS patients in relation to the same course of treatment, even if the Government dress it up as separate care, with patients being wheeled to another ward in the hospital to have their cancer drug administered and then a bill sent to them by the NHS. I refer Government Members to page 6 of the report, where the Secretary of State requires strategic health authorities to say where private drugs are going to be administered, which includes designating an area of an NHS hospital for the delivery of privately funded treatments, and to page 51, where the proposed option for separate care says that patients will receive different care from the NHS and the private provider, although this will often be the NHS, so the NHS will be the private provider. The Secretary of State has not really answered the question: is he in favour of top-ups or is he against them? In reality, the Government have jumped out of the frying pan and into the fire, from, on the one hand, denying cancer patients their entitlement to NHS care, which has rightly been abandoned, to, on the other, requiring patients to pay for their cancer drugs and thereby creating two-tier access to NHS care. That has happened because the Secretary of State, after we have asked him time and again, has not answered the key question: why are NHS patients in England not receiving clinically effective life-extending cancer treatments that are routinely available in other European countries? An OECD report published last week on pharmaceutical pricing said that UK spending on medicines per capita is below the OECD average. The Government admitted last year in the ministerial industry strategy group that the uptake of new cancer drugs in this country was slower than across Europe. We know from the Minister's reply that we spend 5.6 per cent. of our NHS budget on cancer services, whereas France spends 7.7 per cent. Why does the Secretary of State not understand that the heart of the issue is about enabling clinicians in this country to provide the cancer treatments that they believe are necessary for their patients? There are many steps that we could take on that. Why has the Secretary of State not followed the advice that we have published on NICE and taken ministerial referral out of the system? That would take six months out straight away and speed up NICE appraisals. Despite the talk from the Secretary of State about more flexible pricing—frankly, for two years I have been urging this on Ministers—why did he not implement a fully value-based pricing system for new medicines in the review of the pharmaceutical price regulation scheme this year, so that patients can access the treatments through the NHS and the price paid will reflect the therapeutic and innovative value? Instead, the Secretary of State still seems to be prepared to contemplate cancer patients paying thousands of pounds for their medicines, just as long as they are administered by the NHS in another ward, as separate care. If so, is he planning new primary legislation to introduce a new power for NHS trusts to charge for treatment? Is the Secretary of State preparing legislation to remove the private income cap on foundation trusts, which specialist cancer hospitals such as the Royal Marsden or the Christie would otherwise breach? How will he stop the new rules from becoming a bureaucratic nightmare? How can his rules be applied if patients exercise choice and go to an independent hospital or even go abroad in future, using the cross-border health care directive? How will the Secretary of State prevent the NHS from becoming a core service, with increasing numbers of top-up treatments or patients being pressurised to buy more treatments and services privately? Will he confirm to the House that separate care will often mean private health care provided by NHS trusts? Based on the Secretary of State's proposals today, how can he still argue that treatment through the NHS would be available based on need rather than on the ability to pay? Let us take the case of a patient with bowel cancer, whose hospital consultant recommends Erbitux, a life-extending treatment. At the moment, some primary care trusts provide that treatment, while others do not. Some hospitals pay for it themselves, while others require it to be administered at home with the patient paying. Still others require it to be administered wholly privately, with all the associated treatment costs being paid for. In today's statement, only that last case has been ruled out, and rightly so. It has always been morally repugnant to make cancer patients pay for their continuing NHS care. We made that clear months ago, and the Secretary of State could have made this decision months ago. It is equally unacceptable for cancer patients still to be put through months of delay—whether as a result of NICE appraisals or exceptional case panels—while not knowing whether their treatment will be provided by the NHS, even if their consultant says that it is the best, and sometimes the only, option for them. Those patients might also be aware that Erbitux will be provided for bowel cancer treatment in every other country across Europe, but not here. Indeed, it was Erbitux to treat bowel cancer that Linda O'Boyle needed to pay for. Hers was one of the central cases that gave rise to the review. I pay tribute to my hon. Friend the Member for Billericay (Mr. Baron), who represented Linda O'Boyle, her family and her interests assiduously in the House. The Government are planning to stop cancer patients having to pay £7.10 for a prescription, yet they are still prepared for those patients to pay £11,500 to acquire Erbitux for their bowel cancer treatment. 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 10 times that amount. This summer, the Secretary of State imposed a price cut on the pharmaceutical price regulation scheme, saying that that would save £300 million a year. Where is this money going? Why is the money voted by Parliament to provide care for patients not providing the cancer services that our constituents need, and which they know other countries provide? Let us be clear about this. There are two principles involved: if a patient has cancer, they expect the NHS to provide the treatments that they need and that are recommended for them, including those that will extend their life; if they want something different, and pay for it privately, the NHS should not penalise them for doing so. Those are two simple principles. Why could not the Secretary of State have made it that simple today? Why could he not have got up and said that those would be the principles that we would work to, while respecting the values of the NHS?