Annual Statements of Healthcare Costs
Oral Answers to Questions — Prime Minister
Phillip Lee (Bracknell, Conservative)
I beg to move,
That leave be given to bring in a Bill to require the Secretary of State to instruct general practices to issue annually to each person eligible for care provided by the National Health Service an itemised account of the cost of his or her healthcare in the preceding 12 months, and for connected purposes.
It would appear that, by chance, I am the warm-up act for the Opposition day debate on the NHS risk register. That is purely coincidental, but it is timely and fortunate for me, because I am going to propose a serious policy suggestion that should be considered by Members from all parts of the House.
For decades, so-called informed political opinion has argued that significantly changing health care provision in Britain is not possible. “Don’t touch the NHS,” they have said, “It will be political suicide.” My political contemporaries and I do not have the luxury of that option. Health care costs, driven upwards by an inexorable increase in patient demand, have reached a tipping point. Any politicians who think that the current NHS model can be sustained in the medium to longer term under that onslaught are deluding themselves. Indeed, to think so betrays a remarkable ignorance of the realities of health-care demand in Britain today. For sure, changing the public’s mindset on the issue will be an extremely painful political process, with no short-term reward, but we have no choice, particularly those of us who want to protect the fundamental principle of access to all.
No doubt advocates of change, like me, will face professional and personal vilification: observe the recent treatment of health care reforms by vested interests—and those reforms are just about modifying the system of supply. However, I am not interested in a party political spat. First and foremost, I care about my country and its people, and I am determined to communicate the fact that there are other ways to provide and pay for health care, that there is life after the current NHS and that it could be better. For I want people to be free to choose any lifestyle, while understanding that the consequent health care costs are their responsibility. I want to give more to the truly deserving because we have spent less on those who were perfectly able to provide for themselves. Where is the implicit incentive to look after oneself in the current system? It is not there. In its place is a clever ruse to breed dependence on the state—an ingenious construct to support a command and control, tax and spend bureaucracy, headed by a wealthy elite who, ironically, often opt for private health care themselves.
Where is the long queue of nations lining up to replicate the national health service? If imitation is the sincerest form of flattery, the NHS is flattered not at all. For example, patients in Denmark, with very few exceptions, pay for their drugs at cost, and in Norway patients pay to see their GP. Those rich countries, and others, could see that the current NHS system was unsustainable in the longer term and implicitly based on rationing. We should remember that the NHS is predicated on the Bentham principle of the greatest good for the greatest
number, so if we need expensive new cancer drugs in the future, we should not hold our breath, because the system will not be willing or able to pay for them.
Clearly, securing public support for fundamental change is always imperative, and in order to do that, the true costs of health care must be known by all. That is why I am presenting this Bill to Parliament, calling for the introduction of an annual personalised statement of health care costs to be issued to everyone. Irrespective of age, the costs of GP and hospital appointments, drugs, surgery, vaccinations, diagnostics and treatment would be itemised. That would make the British public more receptive to NHS changes in the future, because the knowledge would be empowering.
I wish to move on to address the obvious questions and concerns that colleagues might have, particularly those who fear additional Government paperwork. My approach would not be bureaucratic for the patient, as I am talking about a simple itemised statement, with the attached NHS number, based on the health care provided, and most of the data exist. Indeed, they all should exist, and are generally in a form that can be easily extracted. Furthermore, the GPs I have spoken to would relish the opportunity to clarify the true costs of hospital interventions, so forcing that knowledge to the surface would attract widespread support in the primary care sector, particularly in the new age of commissioning. Believe me, GP support always matters when introducing something new to the NHS.
I shall now deal with the cost. On postage, GP practices issue correspondence to patients every day. They send letters to remind patients of flu jabs, cholesterol checks, medication reviews and chronic disease annual reviews, to name but a few things. Numerous interactions with patients take place already, so why not add a printed statement in the envelope? After initial modest start-up expenditure, the running costs should be minimal. On the basis of a simple internet search of data extraction software management charges, a pro rata administrative salary of £25,000 per surgery—[Interruption.]
John Bercow (Speaker)
Order. I apologise for interrupting the hon. Gentleman, but quite a lot of noisy conversations are taking place in the Chamber and that is unfair on him. He must be allowed to introduce his motion and get a hearing.
Phillip Lee (Bracknell, Conservative)
I might say, in response to some of the heckling coming from Labour Members, that this idea is to be shared with parties. Indeed, if there is a future Labour Government—God forbid—they may benefit from public understanding of the true costs of health care. I say that particularly given that Labour Members have in the past suggested co-payments as a solution to the current NHS difficulties.
As I was saying, after initial modest start-up expenditure, the running costs should be minimal. On the basis of a pro rata administrative salary of £25,000 per surgery, data extraction software management charges, additional printing costs and so on, my office has estimated a cost of approximately 50p per patient per year—a total annual expenditure for England and Wales of about £30 million, or 0.03% of annual NHS spend. Indeed, that figure could be lower, as part of the details of my Bill would make it in the financial interest of each GP practice to keep overheads to a minimum. Indeed, even
if it were more, the impact of the statements would be that fewer patients would attend out-patient appointments and fewer people would store drugs in their larder at home, thus saving the NHS money.
A further concern that has been expressed to me is that the statements could upset patients. It has been suggested that those who receive most of the care—the frail and the elderly—might not appreciate receiving such a statement, and that it might be distressing and lead to an avoidance of health care. All I can say to that is that we cannot all be young all the time, so when would be the right time to introduce this policy? Those who are young now need to know how much they are going to cost when they are old. Why should the elderly benefit from a system that is unlikely to be there for the young when they need it? To be blunt, it is time to tell it as it is, not as we would wish it to be. Tough politics? Yes. Morally and politically right? Yes to both.
In presenting this Bill, I am not advocating any particular policy solution. Indeed, I encourage those on both sides of the House to come forward with different policies in response to it. I am merely suggesting that, having introduced the statements, an informed public debate about health care provision could begin. Such a debate is long overdue in this country. The challenge facing the NHS is not one of supply; the demands being placed on it because of ageing, obesity and changes in health-seeking behaviour mean that Governments of all political colours urgently need to bring forward plans that are truly sustainable in the longer term. For that reason, and for the other reasons that I have given, I respectfully submit that this Bill is timely, and I commend it to the House accordingly.
Anne Main (St Albans, Conservative)
And to oppose it. I have no doubts about the intentions of my hon. Friend Dr Lee, for whom I have great respect, as someone who works in the health service. I have serious doubts, however, about the impact of the Bill and the message that it will give to people who are extremely concerned about the future role of health services.
Not so long ago, certain things were routinely prescribed on the NHS that we would now find it ludicrous to prescribe. My mother used to work in an old-fashioned system called the pricing bureau, and people would routinely bring in “scripts” for zinc and castor oil cream or cotton wool. Now, we would find it amazing to see such things on an NHS prescription. We have moved on, and accepted that the NHS cannot provide for everything in our lives. I would welcome a debate on some of the services that people expect the NHS to provide, such as cosmetic surgery, tattoo removal, or even in vitro fertilisation cycles for people of certain ages. That would be a valuable debate, because, as my hon. Friend so wisely says, we have to think about the future and adopt a sustainable, affordable model for the NHS.
However, I believe that giving a person and their family an annual statement of their cost to the NHS could be profoundly divisive. I am concerned, for example, about the effect that it could have on people who have served in our armed forces and come back with life-shattering injuries. They might have had to make difficult decisions about their lives, having been made limbless in the service of their country. What mental effect could it have on them to be told every year what their treatment is costing their country?
Similarly, what mental effect could it have on people who feel that their lives are not worth living, and that they are being burdensome, to be told that there is a tariff associated with their ongoing care? What effect could it have on a family who have fought long and hard for a child with cystic fibrosis or another life-limiting condition, to be sent a bill or tariff, after the child had died, setting out what their child’s life had cost? I believe that such experiences would be unsettling and distasteful for some people.
I am also concerned—I am sure this is a leap that goes way beyond any of my hon. Friend’s intentions—about the Kafkaesque situation that might result, whereby we would start to look at people in the context of how costly they were to keep going, and whether their life was worth that expenditure. If people are made to feel that they are responsible for their own health, whether that is because of obesity, smoking or drinking, so be it, but I am not sure that presenting people with a breakdown of what it has cost to treat them will necessarily make them change their ways.
Having nursed somebody who died from cancer, I can tell hon. Members that people feel like a burden when their life is in a difficult place. They will often say, “I wish I wasn’t doing this to you, to the family, or to others. If I wasn’t around, perhaps you could collect on the insurance, or your life could move on in a different and happier way.” I feel that adding an extra burden for families in such a position, through sending them a breakdown of the annual cost to the NHS, would be unacceptable. That is not a voice that I wish to see coming from the Government, and I do not believe that this suggestion should ever become a Bill. I am comforted by the fact that most ten-minute rule Bills never get anywhere.
If I thought that this ten-minute rule Bill would get somewhere, I would go around soliciting support and testing the waters in Parliament to see whether anybody else shared my concerns. I accept that my hon. Friend simply wishes to ensure that people get the best treatment according to an affordable model, and that people who are being feckless with their own health should be made to face up to and be aware of that fact, but I do not think that having an individual statement of their health care costs that year will make those people change their ways. It might—this is why I oppose the Bill, although I do not intend to press it to a Division—[Hon. Members: “Oh!”] If other hon. Members wish to divide the House, that is up to them, but I have not made arrangements to do so.
I was concerned that the Bill might go unchallenged, because ten-minute rule Bills often are, and I thought through some of the possibilities that, although they are not necessarily implied in my hon. Friend’s plans for his Bill, could creep through if what he has been describing took effect. I was concerned enough to raise my worries
today, and to think that if the information locked in the NHS about individuals’ costs were made public, it could be used by the people who argue that we should not save seriously sick people, or treat people with complex needs, or value people with disabilities, because the tariff associated with them is higher than the cost for a healthy person. That is not a society that I wish to endorse, and that is why I wanted to raise my concerns.
David Hanson (Delyn, Labour)
On a point of order, Mr Speaker. Would it be possible for you to arrange the urgent deposition of the report by Her Majesty’s inspectorate of constabulary on police numbers in the Library? In answer to Question Q1 today, asked by my hon. Friend Mr Betts, the Prime Minister said that there were more police officers on the beat in the past year, when in fact there are 4,000 fewer. I would not wish the House to be inadvertently misled by the Prime Minister’s comments today.
John Bercow (Speaker)
What I would say to the right hon. Gentleman is that if the report in question is not available in the Library, I am confident that the Library will make good and ensure that it is. I am sure that is really all he was seeking from me.