05 September 2008
NHS leaders and experts have warned that the question of whether to change the health service's policy on 'top-up' payments is 'hideously difficult'.
At present, NHS patients who want to 'top up' their care by privately paying for drugs not approved by the health service must pay for the full costs of their treatment. But following increasing controversy, the government has asked cancer czar Mike Richards to review the policy.
NHS Confederation policy director Nigel Edwards told Public Finance that responding to the consultation was 'hideously difficult'. In a letter to Richards, he wrote: 'The view of most of the members we consulted was that they would rather there were no top-ups at all allowed in the NHS.'
The reasons included fears that equity could be compromised if a two-tier system was created. But the letter added that confederation members also recognised that this position was 'almost certainly not sustainable'.
Edwards told PF: 'It is a slippery slope. The question is how you make it less of a slope and less slippery.'
The confederation's submission to the review raises a series of issues about how a top-up scheme could be made to work. Edwards warned: 'Some of the practical issues could make it impossible to implement.'
There was little consensus among NHS organisations about how to proceed, Edwards admitted. He urged that top-ups be limited to as narrow a range of drugs as possible, 'and only in situations where the drug has to be administered at the same time as NHS treatment'.
Edwards also argued that any top-up payment scheme should be priced 'so that it doesn't disadvantage the NHS – it must cover the full costs of treatment, including monitoring'.
The King's Fund's draft response said retaining the current policy was 'untenable'. But the think-tank also took a cautious line, saying: 'This is undoubtedly a complex and divisive issue... If the government does permit top-ups, it should identify and specify the circumstances in which top-ups are allowed; calculate the associated costs... and examine whether it is possible to enable those who cannot afford to pay for top-ups in full to have access to such drugs.'
The Royal College of Nursing's submission called for top-up payments to be allowed alongside free NHS care 'for a time limited period in order to publicly work through the wider implications' of such a change.
PFsep2008
