Top-up ban on NHS drugs lifted

5 November 2008

Patients in England and Wales who choose to top-up their healthcare by paying for drugs privately will no longer be denied NHS care, the government has confirmed.

The health secretary Alan Johnson said that denying patients NHS treatment if they paid for drugs privately was both unfair and led to essential treatments being unduly denied.

The decision follows the findings by national cancer director Mike Richards, who was asked to investigate whether patients should be allowed to pay to top up their basic NHS treatment, which found that the current system was inadequate.

Johnson said: “We need a fair system that doesn't deny people essential treatment unduly. But we must ensure we don't undermine the basic principles of the NHS, which is treatment available to all, free at the point of use and irrespective of your background".

Mike Izzard, chairman of the Association of Medical Insurance Intermediaries (AMII) applauds the move.

“In our society, choice is so fundamental and if an individual wishes to top-up their healthcare treatment either by paying for it direct themselves or through an insurance policy then they should be able to do so without fear of there being any impact on their NHS care,” he says.

However, critics have accused the government of creating a two-tier system of healthcare, where patients that can’t afford to pay for private drugs are excluded from effective treatment.

Ian Beaumont, spokesman for Bowel Cancer UK, explains: “In the longer term, the concept of 'separate care' will act as a disincentive for the National Institute for Health and Clinical Excellence and Primary Care Trusts to approve future new treatments - including the 69 bowel cancer drugs currently in the pipeline - which will, in turn, force more patients to pay privately for treatments that should be available to them on the NHS.

"[...] this will result in a two-tier system based on ability to pay, not on clinical need, which will further undermine the NHS and its underlying principles.”

Strict rules will apply for those supplementing their NHS care privately. Patients will have to cover the cost of any staff time, blood tests and scans associated with private treatment. In addition, to avoid patients in the same ward receiving different quality of care, all treatments will have to take place away from NHS hospitals.

The new rules have been welcomed by the insurance industry.

A statement by the Association of British Insurers said: “The insurance industry has a key role to play in helping to ensure that access to the very best healthcare and drugs becomes a realistic choice for most people, not just the very few who can afford to pay for cancer drugs that can cost many tens of thousands of pounds.“

The health secretary is now working with drug firms to agree flexible pricing arrangements for drugs, with the option of a higher prices if their value is proven – such as if clinical trials were successful.

Alex Bennett, head of healthcare benefits at Aon Consulting, says the decision could pave the way for more employers to offer relevant benefits to workers. 

“Employers would welcome the possibility of linking future increases in their investment in health benefits to salary, not only to escape the prospect of ‘runaway’ medical inflation, but also to promote engagement and choice,” he explains. “For employees, there are likely to be new benefit designs that provide clearer choices between choosing cover for high cost cancer treatments and low cost therapies, in the knowledge that they could top up cover if they needed to.”

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