Top-ups - response to policy change

Responding to the Government's announcement on co-payments, the BMA said it offered a "practical way of balancing the rights of individual patients with the values of fairness and equality on which the NHS is based". The avoidance of the creation of a two-tier system is recognised as a key aim, with the treatment of top-ups as separate from NHS care and staff being welcomed by Hamish Meldrum. A wider public debate on the scope of a publicly funded healthcare system is also called for.


The NHS Confederation welcomed the rule change, particularly in relation to the speeding up of NICE decisions, risk sharing with drug companies and 'exceptional case' drug funding. Policy director Nigel Edwards says "Patients must be reassured that this is not the thin end of the wedge - no one wants a two speed NHS". However he goes on to say, "practical difficulties remain on how patients who choose to pay privately can be moved into private facilities, how these drugs should be priced and what form new guidance on exceptional funding panels will take".


The King's Fund was also supportive of the change in policy with chief executive Niall Dickson welcoming the decision not to withdraw NHS care from patients paying privately for top-up drugs. Clarity was called for on whether the new policy will extend beyond drugs to devices and other therapies.


A Guardian editorial on 5 November broadly supports the policy change. However, while welcoming the speeding up of NHS drug provision and an overhaul of rationing procedures, it also notes that, "with top-ups allowed, big pharma can peddle pricey products of limited efficacy without worrying about the rigours of the NHS rationing process. That could make it easier to exploit the desperation of patients - as well as the natural desire of doctors to offer them some hope".


The HSJ reported that just over half of NHS managers surveyed in a snap poll on 4 November supported the change, although a similar proportion (54%) thought it would make the NHS "less equal".


The BBC reported on 7 November that a leading insurance firm has said the market in insurance policies for health top-ups could be bigger than the private medical insurance market. Market analysts Laing and Buisson describe the ruling as a "pivotal point" while Unison has said, "we risk losing the very essence of the NHS - a health service which is free and equal for everybody".


The Times on 8 November asks whether we are "missing the real lesson of this story - that no NHS patient should ever have to pay for a cancer drug". Ian Beaumont, of charity Bowel Cancer UK, is quoted saying "The bad news is that, longer term, the concept of 'separate care' will act as a disincentive for NICE and primary care trusts to approve future new treatments, including the 69 bowel cancer drugs in the pipeline". The article also notes that Mike Richards' report calls on drug companies to lower the cost of cancer drugs to be made available on the NHS. In summary, the article concludes, "let's not get too excited about top-ups. As the experts Mike Richards and Geoff Martin remind us, they are perhaps a symptom of failure, rather than success".



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