NHS top-up fees row continues

1 September 2008
Scottish patients will learn this week whether or not they will continue to be excluded from state care if they choose to purchase drugs that are not available on the NHS.

Existing rules state that you cannot mix and match NHS care with private care because it breaks with the fundamental principle of the NHS - that it is free at the point of need. However, the expectation is that the Scottish National Party will continue this practice, as it fears that allowing ‘co-payments’ would lead to a mixed economy of healthcare.

The issue has provoked fierce debate this year after cancer patients in England were banned from receiving NHS care after topping up their treatment privately. Back in June, the health secretary Alan Johnson asked the government’s national cancer director, Mike Richards, to review the policy for English patients by October, but Scottish health minister, Nicola Sturgeon, will clarify the position in Scotland later this week.

However, the majority of doctors believe that patients should be allowed to pay for drugs that are not available on the NHS and continue to receive treatment. The British Medical Association (BMA) and Royal College of Nursing point to the practice of topping-up healthcare in areas such as long-term care, social care and dental treatment.

The BMA has therefore called for a royal commission to review all the evidence and implications of permitting top-up payments. One proposal includes the drugs companies themselves paying for top-up treatments that either the NHS or patients cannot afford.

Last week, drugs company Novartis, which supplies the sight-saving drug Lucentis, announced that it would pay to top up patients’ treatment when the level of care paid for by the NHS was not enough.

Currently, the NHS will only pay for 14 injections at a cost of £10,000 – enough to save the sight in one eye. If a patient needs additional injections, Novartis has agreed to supply the drug - overruling draft guidance by the National Institute for health and Clinical Excellence (NICE), which claimed that it was not cost-effective and that patients should have to go blind in one eye before receiving any treatment.

Novartis’ move also paves the way for other new drugs which may require top-up doses to be funded in the same way in the future. However, reforming the system could lead to separate rules in England and Scotland if Richards’ review breaks with the current rules.

“We are meeting with Mike Richards today to discuss our recommendations for topping-up NHS healthcare,” said Ian Beaumont, a spokesperson for Bowel Cancer UK. “He has been open-minded so far, but we hope his report takes into consideration the views of patients, carers and industry bodies alike which would help to make the system better, fairer and more workable.”

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