The National Health Service (Right to Treatment) Bill 2011, introduced as a Private Member’s Bill by Hugh Bayley MP just before Christmas, is expected to have its second reading in the House of Commons on 30 March 2012.
The Bill is designed to make provision:
- to ensure that medical treatment, prescribed as necessary by a doctor or other medical professional, is made available unless it is not approved by the Secretary of State for Health or NICE;
- to establish a national register of cases where such prescribed treatment is refused; and
- to introduce an appeal mechanism for such decisions.
Introducing the Bill, Mr Bayley observed that the NHS was becoming a postcode lottery, where resource allocation decisions were taken locally, leading to differential availability, and not by ministers accountable to Parliament. The Bill he said would “restore equity by giving patients a legal right to treatment recommended by their doctor”.
In many ways however, the Bill would not change the status quo. Certainly where treatment is already mandated by a NICE technology appraisal, there should be no question of the treatment not being commissioned. Where treatment is not approved by NICE, the patient will still have to apply for funding through an individual funding request process and, in the event of refusal, can challenge by appeal.
Where this Bill would make an impact however, is in the area of “low priority treatments” and the patchy provision, for example, of cataract surgery, despite its known efficacy and considerable potential for improvement of life quality and consequent health and social care savings.
Controversially, the Bill would require the Secretary of State to “come to Parliament to seek approval for explicit rationing decisions”. It is unclear how exactly this would work, given that healthcare must, by virtue of the bleak fact that demand will forever exceed supply, be rationed in some way, albeit in a reasoned way through the medium of prioritisation.
In Parliament, Mr Bayley warned against the incipient creep of both wholesale rationing and postcode lottery foreshadowing a loss of public confidence and a return to the dark days before the creation of the NHS. For those engaged in priorities work on a daily basis and those involved in delivering on cost improvement plans however, the suggestion that we might somehow be on the verge of a return to Beveridge’s five giant evils is hyperbole of the most unhelpful kind.
We will watch the progress of the Bill with interest.