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Landmark NHS top-ups decision due 'Distressing' top-ups ban lifted
(about 4 hours later)
Patients in England are due to hear whether they will be able to top up NHS care by paying for drugs privately. The bar on topping up NHS care by paying for drugs not available on the health service is to be lifted under plans drawn up by ministers in England.
People are currently excluded from the NHS if they pay for treatment not available on the health service, but practice varies from place to place. But strict rules are to be applied meaning patients will also have to pay for staff time and the scans and blood tests associated with the extra care.
It is widely expected that ministers will lift that ban, following a four-month review of the issue. The Department of Health said it was also looking to ensure more drugs were available on the NHS.
But the landmark decision will also set out how such a complex system can work alongside a universal health service. But critics accused the government of creating a "two-tier" system.
Top-up fees, or co-payments as they are sometimes called, have dominated the headlines this year. Current rules state that people should be excluded from the NHS if they pay for treatment not freely available, although practices do vary from place to place with some trusts ignoring the guidance.
Allowing private payments alongside NHS care cannot be allowed to become the thin end of the wedge - no one wants a two speed health service and this should not become a step in that direction Nigel Edwards, of the NHS Confederation Q&A: NHS top-upsA doctor's storySend us your comments This issue was causing distress to patients and their relatives - and none of us wanted the uncertainty and inconsistency to continue Alan Johnson, health secretary Q&A: NHS top-upsA doctor's storySend us your comments
The Department of Health announced the review in June, after an outcry from patients over what was considered a hard-line stance and mounting evidence of an inconsistent approach by individual NHS trusts. The government's proposals, which are being put out to consultation until the end of January, were put forward following a four-month review of top-up fees by cancer tsar Professor Mike Richards.
The national clinical director for cancer, Professor Mike Richards, was asked to look at the issue and has spent the last four months talking to patients, doctors, charities and NHS managers about what should happen. The review was announced after an outcry from patients over what was considered a hard-line stance and mounting evidence of an inconsistent approach by individual NHS trusts.
He handed his report to ministers at the end of October and the government is now ready to formally announce its verdict. Ministers accepted all 14 of Professor Richards' recommendations.
While it has been widely reported that the government will lift the top-ups ban, there is still much to be resolved over how such a move would work in practice. It means top-ups will be allowed, but only under strictly regulated conditions if the proposals are agreed to.
The package of measures has been designed to ensure everything from treating the side effects to carrying out extra tests relating to the top-up treatment is paid for by the individual.
This could run to tens of thousands of pounds depending on the treatment.
And patients paying for their own treatment will also have to have it done away from NHS wards - either in private centres or private wings of NHS hospitals.
'Two-tier NHS'
Ministers said this separation would avoid the creation of a two-tier NHS whereby patients lying next to each other were getting different levels of treatment.
They are also issuing guidance to local NHS managers about how to handle applications for funding in what are termed "exceptional cases".
Patients can apply - and 26,000 do each year - to have treatments funded that would not normally be.
Part of the anger about the issue in the first place was that there was a wide variation in how the NHS treated such cases with some trusts approving all of the applications, while others rejected each one.
PROPOSALS: AT A GLANCE Patients get right to pay for top-ups without losing their basic NHS package of careBut those paying for extra drugs will also have to cover the cost of any staff time, tests and scans associated with that treatmentTop-up care must be carried out away from NHS ward to avoid patients in beds next to each other getting different quality careArrangements do not apply to implants used during operations such as cataract, knee and hip surgeryNHS aiming to ensure more drugs available on NHS by raising the threshold it is willing to pay for treatments for rare terminal illnessesMinisters seeking to get better deal from drug firms through the use of risk-sharing pricing such as refunds when the drug does not work
But the proposals also suggested the top-up ban should remain in place for implants used during surgical procedures such as eye, knee and hip operations as these cannot be separated like the administering of drugs.
For example, the NHS only pays for single focus lens during cataract operations, which means patients may still have to use glasses for activities such as reading.
However, there are multi-focal versions available and if a patient wanted these to be used they would have to pay for both the lens and operation under the plans - rather than having the NHS pay for the operation and the individual covering the cost of the better lens.
The proposals also hinge on the NHS making more drugs available.
Ministers are seeking to agree more flexible pricing strategies with drug firms.
Talks are on-going but these could involve so-called risk-sharing models such as refunds if the drugs do not work on an individual or a sliding-scale of cost whereby the NHS pays more if the drug continues to be effective over time.
Exceptional cases
At the same time, the NHS drugs advisory body, the National Institute for Health and Clinical Excellence, is to carry out a five-week consultation on raising the threshold it is willing to pay for life-prolonging treatments for rare terminal illnesses.
The proposal would strengthen the right of NICE officials to go above the current limit in exceptional cases where it there were no other treatments available.
This could effect a batch of kidney cancer drugs that were rejected earlier this year.
Health Secretary Alan Johnson said these measures along with the steps to speed up the drug appraisal process which are currently being rolled out would ensure that only a "small number" of patients would be in a position where they wanted to pay for drugs themselves.
But he added where people did still want to fund their own treatment it would be wrong to deny them the NHS package of care.
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Issues raised during the consultation include what should happen if a patient runs out of money, who picks up the bill for side-effects of treatment and what can be done for those who cannot afford to top up their care. "This issue was causing distress to patients and their relatives - and none of us wanted the uncertainty and inconsistency to continue."
In total, 15,000 patients appealed to their local NHS trust last year after being denied treatment - and while not all of them would necessarily end up paying a top-up, it does illustrate the scale of the problem. Many charities welcomed the move as a sensible way forward over what was a "very complex issue".
Professor Richards' report is also expected to set out how the number of treatments available on the NHS can be broadened. Dr Hamish Meldrum, chairman of the British Medical Association, agreed the best solution had probably been reached.
In recent months there has been talk of altering the way the NHS appraises the drugs it uses, as well as encouraging pharmaceutical firms to offer more flexible pricing options, such as refunds if the drugs do not work. But he added: "In reality this whole debate is part of a much wider one about the future of healthcare provision.
How one patient tops up his NHS care "As new, expensive drugs become available, and the population ages, it is increasingly important that society recognises that there are very real limits to what the NHS can and cannot do."
U-turn But shadow health secretary Andrew Lansley accused the government of going against the founding values of the health service.
Administrations in the rest of the UK are known to be monitoring what the Department of Health decides, with Wales and Scotland already announcing they are carrying out their own reviews. "We have consistently argued that it is morally wrong for patients to have their NHS care taken away from them if they choose to pay for part of their treatment."
Liberal Democrat health spokesman Norman Lamb said: "A government U-turn on top-up payments will be a very welcome one. But he added: "They've gone from letting patients lose their NHS care to creating a two-tier NHS, where some patients will get better care simply because they can pay for it. And they're trying to dress it up by calling it 'separate' care."
"The NHS cannot provide everything without regard to cost, but that is not an excuse for the injustice and inhumanity of withdrawing all care from those that want to spend their own money on life-saving treatment." He suggested the most important step was to make more drugs available on the NHS, but this was far from certain under the proposals.
And shadow health secretary Andrew Lansley said it was paramount that the NHS was able to fund more drugs to bring them in line with the "rest of Europe". The devolved administrations across the rest of the UK are monitoring what the Department of Health is doing with Wales and Scotland already carrying out their own reviews.
Nigel Edwards, director of policy at the NHS Confederation, which represents managers, said a change in policy would help deal with a situation which had become "unsupportable". And Karen Jennings, of Unison, which represents a range of health workers from nurses to hospital porters, said allowing top-ups would "shake the very foundations of the NHS".
But he added: "Allowing private payments alongside NHS care cannot be allowed to become the thin end of the wedge - no one wants a two-speed health service."