Top-ups


The issue of private top-ups to NHS care has been in the news lately with particular cases highlighting the requirement for patients to pay for NHS care when they have paid privately for drugs not available on the NHS. The Secretary of State for Health, Alan Johnson, announced in June 2008 that a review into the policy was to be carried out by Professor Mike Richards, National Clinical Director for cancer.

Professor Richards' report (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089927) and the Government's response (http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_089926) were published on 4 November.

The report spells out the policy options as:
1. The integrated solution
Patients would receive “core” services and would pay the NHS for any additional treatments which the NHS (through NICE, the National Institute for Health and Clinical Excellence) considered as not cost effective.
2. Richards' preferred option
A patient may pay for additional drugs while continuing to receive NHS care, as long as the private and NHS elements are provided separately.
It should be noted that Richards seeks to reduce to a minimum the number of patients wanting to purchase additional drugs, by increasing the range of treatments approved by NICE.

To these options we might choose to add:
3. The previous position
A patient choosing to pay for treatment not available on the NHS would have to pay for the cost of NHS care provided in the same “episode of care” or “single visit”.
4. Fully funded, equitable NHS
All medically effective care to be provided by the NHS, with medical effectiveness rather than cost effectiveness as the driving force. Critics of this stance view it as unsustainable.

The Government is conducting a consultation about its draft Guidance on NHS patients who wish to pay for additional private care. The NHS Support Federation will respond to the consultation, which closes on 27 January 2009, by giving our members' views on the policy of top-ups.

 

 

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