Tuesday, September 09, 2008

Is Clegg right on Co-Payments?

Being diagnosed with a terminal illness is never good, and it's worst when the sufferer has young children. You can understand why the mother of a 2 year old might want to do anything it takes to find the money to provide herself with the drugs to extend her life, even for a few months. Those few months might make the difference between her child having memories of her or not. If she is stuck somewhere the NHS does not provide that life extending drug, then she has an awful and cruel choice - she either sells everything she owns to provide herself with the drug and plunge her family into financial uncertainty as she then foregoes the right to all NHS treatment, or takes her chances with the disease.

Nick Clegg has today said that he doesn't think that she should have to forego the NHS treatment if she buys the drug.

So far, we have managed to create the fantasy that everyone actually has this choice. Of course they don't. If the woman in question is a single mother on income support, or a school dinner lady, or, frankly, me, then she would have more chance of being named as a vice presidential running mate than being able to afford the drug.

This, therefore is a choice that is open only to the considerably wealthy, and in the land of the Credit Crunch, the number of people who could realistically opt for it is getting smaller.

Should a small elite be able to buy themselves advantage and still be treated on the State?

If they were enabled to do so, would this not ultimately reduce what was available on the NHS?

Let's take the elite argument first. Many parents supplement their child's state education by sending them to places like Kip McGrath. Should their children be expelled from the State education system? Other children at the same school might have the same learning difficulties except their parents might not be able to afford the around £20 per lesson cost of these places.

What about parents who opt for private education and then for example go through a redundancy or a divorce? Should we refuse to re-admit their children to the State system?

Come to think of it, I already purchase private health care, despite really quite disapproving of it - I don't have an NHS dentist. I would love to, but places on an NHS dentists' list are like hens' teeth round here. I take the view that, because we are able to afford more than the basics in life, although we are not rich by any manner of means, that I should not take up a scarce place on an NHS list. The £24 a month I spend on a private dental plan is a source of irritation to me, but, thankfully, not financial hardship. It also doesn't de-bar me from NHS treatment should my private dentist muck things up, or should complications arise.

We have already accepted the principle, even in the NHS, that co-payment is an option.

To me it is the compassionate thing to do to allow people to top up their treatment and continue to get the same as anyone else would get - treatment that is free at the point of delivery.

Nick mentioned some important safeguards: that the NHS should have to bear no cost as a result of the decision to purchase the extra drug - so if it causes an unexpected side effect you're on your own. To be honest, I would probably be inclined to let this one go, otherwise you could have lawyers arguing forever about whether it was the drug or the illness that caused the problem; that the treatment should have been recommended by your physician - very sensible; and nobody should be able to jump the NHS queue; that no PCT should use this as an excuse to reduce the number of treatments available. That is fairly easily policed and should be enshrined in law.

I think that Nick's ideas on co-payment are humane, compassionate and sensible. It actually means ultimately more people might have access to those life extending drugs which can be no bad thing - this means that the amount families would have to think about paying can be put in thousands rather than tens of thousands.

One of the things I do know about Nick is that he is very people-centred. He sees people as human beings and not numbers or statistics. He understands and empathises what life is like for people. He gets out there and talks to people, in his Town Hall meetings. This is the essence of Liberalism. The Tories aren't brilliant at society and community, and Labour have this appalling collectivist approach, even under new Labour, that really annoys me.

I am not wildly happy, to put it mildly, with his £20 billion cut in public services idea - we are only just recovering from the last Conservative Government's period of under-investment, for goodness' sake, but I still stand 100% behind my vote for him as leader. His Town Hall meetings were no nine day wonder election winning gimmick. Every few weeks I get an invitation on Facebook to one in some far flung part of the country. He's getting out and about, and not allowing himself to become immersed in the fantasy that only what goes on in Westminster matters.

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