How far would you travel for your health’s sake?
Would you be prepared to pack your bags and jump on a plane to seek out the medical treatment you or your family needed? Frustrated with the limitations of the NHS and the expense of private healthcare, 70,000 people travelled overseas to receive medical treatment in 2007, according to government figures, and this is expected to rise to almost 200,000 by the end of the decade.
Whether it be a trip to Poland for fertility treatment or to Hungary for dental work, or even moving to get access to life-saving drugs, more and more patients are pushing the boundaries o get the medical treatment they need.
“Where we live increasingly determines what’s available to us on the NHS,” says Alison Hope, managing partner at StatMedica, which provides access to private healthcare in Poland. “And, with the expense of private healthcare in the UK, people are faced with the decision of either simply not having the treatment or seeking it elsewhere.”
Although the development of more life-saving drugs is a positive step, there’s growing frustration that the very people for whom these drugs are intended don’t have access to many of them on the NHS.
The term ‘postcode lottery’ couldn’t be more apt when it comes to the availability of life-extending treatment.
“There are 15 cancer drugs available on the NHS in Scotland that aren’t available in England,” explains Charlie MacEwan, communications director at Western Provident Association, a not-for-profit health insurer. “There’s a great deal of inequity and inconsistency in the UK health service.”
The government’s drug-rationing body, the National Institute for Clinical Excellence (NICE), is responsible for approving drugs and choosing – from an increasingly expensive list – those that should be available on the NHS.
Many cancer drugs are not available on the NHS even though they have been proven effective. This is because NICE is either taking its time to approve them or it believes that they are not cost-effective.
Once approved, the decision to fund such drugs lies with individual primary care trusts, which means a patient’s access to these drugs depends where they live. “Some PCTs will supply and administer the drugs, whereas others refuse to,” explains Charlie MacEwan.
Can i buy my own drugs?
If a PCT refuses to fund certain drugs, the government says patients cannot buy their own drugs and have them administered as part of their treatment on the NHS.
“We have choices in life, and the ruling to refuse a patient the choice to top up the NHS where it has insufficient funding to meet their needs is fundamentally flawed,” says MacEwan.
This controversial issue has been brought to light by an increasing number of cases, including that of 57-year-old Debbie Hirst from Cornwall. Her breast cancer had spread, yet the NHS would not provide her with Avastin, which is licenced and widely used in the US and Europe, to halt the growth of tumours.
A course of the drug costs £60,000 and Hirst’s oncologist told her that she could pay for it herself, so she started saving and decided she would put her house on the market. However by the time Hirst had £10,000, the health department told her GP that, if she paid for the Avastin, she would have to pay for all her cancer treatment – which she couldn’t afford.
The government is adamant that patients should not be allowed to dip in and out of the NHS. It says the rules are black and white – either you are treated through NHS and it’s free, or you go private and pay for everything.
Alan Johnson, the health secretary, has told Parliament: “[Patients] cannot, in one episode of treatment, be treated on the NHS, and then allowed, as part of the same episode and the same treatment, to pay money for more drugs. That way lies the end of the founding principles of the NHS.”
The government says allowing patients to top up NHS treatment would lead to a ‘two-tier’ system, because it would lead to patients in the same NHS ward receiving different drugs, based solely on their ability to pay.
Doctors say this already happens where private and NHS patients are treated at the same NHS unit.
In an ironic twist, as she was appealing against the department ruling on her case, Hirst was told that her condition had deteriorated so much that she could have Avastin on the NHS after all.
With even more life-saving drugs in the pipeline that the NHS is unlikely to fund, this distressing situation is likely to be experienced by increasing numbers of patients who could stretch themselves to pay for additional life-extending drugs, but not the entire cost of private care. In many cases the only people who will be eligible for these drugs will be the super-wealthy with private medical insurance.
This issue is highly contentious because legal experts say there is nothing in the law to bar patients from buying their own drugs and having them administered by the NHS. Think tank Doctors for Reform pointed out, in a report published in 2007, that top-up payments are routine in the NHS, ranging from dentistry and audiology to physiotherapy and diagnostics.
Dr Paul Charlson, a GP in Yorkshire and member of Doctors for Reform, told Moneywise: “There’s absolutely no legal reason why this shouldn’t be allowed, but nothing is clear, so it all comes down to political dogma. It really is farcical. The reasons given by the government do not stand up to scrutiny or common sense.”
Charlson claims that the government’s two-tier argument is laughable because the NHS system has been multi-tiered for a long time. “About half of the patients at my practice have made co-payments at some stage. With NHS waiting lists so long, patients often go private for an initial consultation, then return to the NHS for scans,” he says.
A helping hand
While the NHS top-up debate continues, help is at hand with a unique insurance policy that funds a range of cancer drugs not available through the health service.
The policy, called Mycancerdrugs, is provided by WPA and requires customers to pay an annual premium equal to their age – for example, £60 at age 60. If policyholders develop cancer, they will have access to £50,000 of treatment with licensed drugs that are often not obtainable through the NHS.
“The aim of Mycancerdrugs is to compliment the NHS and fill a gap that enables customers to take control of their own healthcare,” says MacEwan. The drugs will not cure cancer but can extend life.
There are a number of caveats to the policy. These include whether you have, or have had, cancer and whether either of your parents, or any siblings have developed cancer under the age of 60. There is an initial 90-day deferment period and it is only available to the under-65s.
Considering that people who claim under the policy could have a problem getting the NHS to administer the drugs, WPA has sought legal advice from Nigel Giffin QC, who insists there is nothing in law to bar
Since the introduction of Mycancerdrugs, Charlie MacEwan says he has taken many phone calls from medical consultants. “They’re saying ‘it’s great what you’re doing, but do you realise it is illegal?’ They’re surprised to hear that it is not illegal at all.”
And while some claimants have had difficulties getting PCTs to allow them to use their insurance to pay for top-up treatment, those that have appealed have been successful.
When it is such a struggle to get treatment, it’s not surprising that an increasing number of people are travelling overseas for medical and dental treatment. More than half a million people in England have lost access to NHS dentistry since the government introduced reforms in April 2006, according to recent figures from The Information Centre.
“With limited NHS provisions and the expense of the private sector, many people find themselves with no alternative,” says Alison Hope. “While cost is a major factor, so is receiving higher quality treatment and care.”
Diagnostics, scans, fertility treatment, cosmetic surgery, ophthalmology and cardiology are among a long list of treatments available in continental private clinics at a fraction of the price of private treatment in the UK. However, referring to healthcare as cheaper can be misleading, says Hope.
“This can imply a substandard service. But patients have access to top specialists, so the healthcare is simply better value for money.”
This is certainly what Roger Standley found – he was one of 45,000 people who went abroad for dental treatment last year.
Of course, travelling abroad for treatment is not a decision to be taken lightly. “As with anything, you get very good and very bad consultants and hospitals, so we urge people to carry out extensive research first,” says Hope. It’s advisable to seek English-speaking clinics and those that arrange for you to meet, or a least talk to, the consultant before you arrange the treatment.
Personal recommendations are also a good guide.
The feasibility of travelling abroad also depends on the type of treatment and whether you’ll need to make follow-up visits. “Fertility treatment, for example, requires a lot of planning because it needs to take place at a certain time in a woman’s cycle,” says Hope.
You’ll need to research journey times and costs because, while private elective surgery such as hip and knee replacement in Australia is around half the cost of that in the UK, the cost and convenience of travelling such a long distance could make you think twice. You will also need to know whether you’ll be fit to fly after your treatment and the cost of insurance.
It’s important to get the total cost of your treatment in writing before you travel, and confirmation of what’s included in the price.
The Foreign Office advises patients to be clear about who is responsible for the cost of extras, such as additional medical or emergency treatment in case of complications, medicines and dressings, and any extended stay for friends or family accompanying you. You should also find out if medical repatriation to the UK, correctional treatment in the UK, and follow-up treatment are covered.
Where to go for advice and info
• Foreign & Commonwealth Office (travel health section)
Private medical insurance
PMI allows you to skip the NHS waiting list and arrange treatment at a time you choose. With most PMI policies, you pay a monthly premium (the older you are, generally the higher premium) and the policy will then pay out, up to specified cover limits and after an agreed excess, for any treatment you might need. Not all conditions are covered by PMI and you get what you pay for: the more cover you want, the higher your premium will be.