07 November 2008
By Paul Dicken
Proposals to allow patients to pay privately for drugs not available on the NHS without losing their right to free care could cost tens of millions of pounds.
On November 4, Health Secretary Alan Johnson announced plans to allow all NHS patients in England to pay privately for drugs, after accepting all 14 recommendations in the review of 'top-up' payments by national cancer professor Mike Richards.
Johnson set out measures to ensure private treatment was received separately to NHS care and the number of cases was kept to a minimum.
The National Institute for Health and Clinical Excellence will next year introduce a new appraisal process for 'end of life' drugs 'offering demonstrable and substantial survival benefits'. This will recommend medicines for use with rarer conditions, which might extend dying people's lives. An announcement will be made next year on proposals to speed up the appraisal process for all drugs.
Nice chair Sir Michael Rawlins suggested the cost of funding extra drugs would run into the 'tens of millions of pounds, not hundreds of millions of pounds', but the potential cost of broadening the range of drugs freely available to patients remains uncertain.
Johnson said patients with terminal illnesses getting access to certain drugs was an issue 'causing uncertainty and distress'.
'All these measures will reduce the need for patients to fund drugs privately but there will always be a small number of cases where patients opt to buy drugs. In those cases, NHS care will never be withdrawn.'
One of the main aspects of the proposals is that private wings or hospitals will have to be used to provide care where patients are paying for medicines, and any additional costs should not be subsidised by the health service.
One result is that specialist cancer hospitals, such as the Royal Marsden in London, will breach the cap on private-patient income set for foundation trusts, but regulator Monitor is currently reviewing the income cap rules.
Nigel Edwards, policy director at the NHS Confederation, told Public Finance that there would be some financial impact, but 'it's not expected to be huge', he said.
He added that the proposals 'were not without some quite significant practical difficulties', such as issues arising from patients who paid for drugs that were ineffective and the need for consistency between primary care trusts on how exceptional cases panels operate.
Tony Harrison, research associate at the Kings Fund health think-tank, told PF there was a lack of data, which made it difficult to estimate what the measures would cost. A vital element would be bargaining with pharmaceutical companies, he added.
'There is a general feeling that there is mileage to that. I think the companies themselves realise they've got to come to the bargaining table about those expensive drugs.'
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