It was a no-win situation for the health secretary. On the controversial issue of top-up fees, Alan Johnson knew he would be upbraided by the unions if he said ‘yes’ and pilloried by patients, not to mention the Daily Mail, if he continued to say ‘no’.
This week, in accepting Professor Mike Richards’ recommendations, Johnson decided that patients in England can pay for private drugs without losing their right to free NHS care. To minimise the need for such co-payments, however, a wider range of medicines will be freely available on the NHS.
The National Institute for Health and Clinical Excellence will speed up its appraisal process for new drugs and look more favourably on higher-cost treatments for terminally ill people. Meanwhile, the Department of Health is negotiating more flexible pricing deals with the pharmaceutical companies.
This is a practical and shrewd alternative to a policy that all sides accept has been applied in a cruel and sad way. It maintains the NHS’s guiding principle – of being free at the point of need – while not penalising people who choose to pay privately in the hope of extending their lives by weeks or months.
But it doesn’t come without some cost and additional complexity. The extra funding necessary will be in the region of tens of millions of pounds, according to Nice. This might be a relatively small figure but still has to be found in these belt-tightening days.
There are also complications involving the requirement for the NHS to ensure that any private treatment takes place in a separate facility. And, of course, specialist cancer hospitals such as the Royal Marsden in London will inevitably breach the current private income cap on foundation trusts. Clearly, there is still work to do over the three-month consultation period to ensure that a two-tier system – with patients obtaining better care simply because they can afford it – does not ensue.
Johnson and Richards have proposed a structure that appears sound and sensitive. The department will need to monitor developments closely to make sure that it works in practice.
