The Times (KC) 04-Nov-08
From Kidney Cancer Resource
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Penalty ends for ‘topping up’ care
David Rose
Thousands of patients will learn today that they can pay for the latest drugs to “top up” care from the NHS.
Tablets & Pills
Ministers are expected to announce that there is no legal reason why patients should forfeit their free NHS treatment if they pay for extra drugs, despite accusations that this contradicts the founding principles of a publicly funded health service.
The Times disclosed in September that restrictions on “co-payments” would be relaxed after Alan Johnson, the Health Secretary, asked for a review.
Mike Richards, the national clinical director for cancer, who conducted the review, will announce measures to widen access to the latest drugs and ensure that as few people as possible have to pay extra for treatment. There will also be guidance for health service managers on when “co-payments” are appropriate.
Professor Richards is likely to suggest that those who wish to “top up” their treatment might be treated by a different doctor or in a different hospital from the one administering their NHS care. These patients are also likely to be asked to pay the additional associated treatment costs incurred by the NHS, up to a limit.
Mr Johnson is expected to present the final report to Parliament this afternoon. Any changes to NHS guidance will be accompanied by measures to help the National Institute of Health and Clinical Excellence (NICE) to publish its recommendations about the cost-effectiveness of a drug within three months of it being licensed. At present this can take two years, after which the watchdog can refuse or limit its use. Patients whose doctors still recommend a limited treatment must persuade a local committee that they are an exceptional case, but if that fails, some may wish to pay for treatment.
NHS guidelines state that patients should not mix and match public and private treatments in the same “episode of care”, but at least 30 hospitals in England allow patients to do this.
Ministers were driven to examine the issue after a public outcry over the death in March of Linda O’Boyle, a grandmother denied free NHS treatment after buying a drug to treat her bowel cancer.
A senior Department of Health source said that the Government had acknowledged the “harsh implication of withdrawing NHS care and charging patients for costs after they paid for extra treatment”. “That is what we are trying to resolve,” he said.
Up to 15,000 patients a year appeal to primary care trusts (PCTs) to receive drugs that are not available on the NHS because they are not yet approved by NICE.
Charities say that cancer patients, in particular, are being denied the latest, high-cost drugs, which are not considered cost-effective but can allow extra months or years of life.
Scotland is conducting its own review on co-payments specifically for cancer treatments.
The British Medical Association said yesterday that the existing guidance for English hospitals had to change. “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,” a spokesman said.
Ministers are keen to avoid a situation where two patients on the same ward receive different standards of care because one can afford to pay for drugs and one cannot.
The Rarer Cancers Forum suggests that the average yearly cost of a top-up payment for the latest cancer treatments would be £21,000.
CASE STUDY ‘The drug is working’
Andrew Crabb is hoping that it will be third time lucky when his appeal against the refusal of his primary care trust to give him a £3,000 a month kidney cancer drug is heard today.
His family and friends have paid for five courses of the drug – Sutent – which he says has transformed his life.
“I was basically dying, I couldn’t do anything,” he said. “But the drug has stopped the growth and reduced it. Now I ride my bike, go fishing, play darts and go swimming with the grandchildren.”
Money is running out, however, and as The Times reported in August, Mr Crabb, 50, a former bricklayer and father of three, faces having to sell his home in Oxfordshire to fund the treatment. He has had the relative good fortune that Oxford Radcliffe Hospitals NHS Trust already goes against recommendations that patients who pay for “top-up” drugs privately must forfeit their NHS treatment.
Joanna Sugden
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