Burning Issue: Should drug top-up payments be allowed on the NHS?

Published on Tuesday 4 November 2008 22:33

Yes NIGEL EDWARDS, NHS Confedera-tion's director of policy

This change in policy in England to allow co-payments is welcome. But 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.

The NHS still provides free, comprehensive access to cost effective treatments and it is important to remember that 54 out of 59 cancer treatments assessed by the National Institute for Health and Clinical Excellence (NICE) have been approved.

There is no doubt that the restriction on these payments threatened to undermine public confidence in the NHS and caused considerable worry both for the small number of patients it affected and to the public as a whole.

But we do not believe this is the end of the action that is needed. The situation on new drugs will improve if improvements are made to the way NICE work, most importantly its procedures need to be speeded up so decisions about useful new drugs are made quickly.

There is also clearly scope to improve the way exceptional case panels, which decide on whether drugs can be used, operate.

Patient protection and the provision of ample information about the efficacy of any drugs available for topping up, is crucial.

One of the concerns is that many of the drugs people want to top-up with are very expensive, and may only have limited effectiveness, the danger is of giving patients false hope of a cure. Now we have allowed top-ups we need to make sure patients get the best possible advice from their doctors and agencies like NICE about how effective additional drugs might be for them.

No

IAN BEAUMONT

campaigns director, Bowel Cancer UK

We have a number of concerns about how top-up payments will affect patients and the NHS in the future.

The outcomes of Professor Mike Richards' review of top-up payments are a mixture of good and bad news for bowel cancer patients.

The good news is that patients in the advanced stages of the disease will, at last, be prioritised by the government, NICE, and others after years of being treated as second class citizens.

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 currently in the pipeline – which will, in turn, force more patients to pay privately for treatments that should be available to them on the NHS.

Patients will feel under greater pressure to find the money to pay for treatments at a time when they are facing enough pressures dealing with their illness.

We have real concerns that the NHS will be less likely to fund new drugs if there is a system in place to allow patients to pay for them themselves.

Despite the review's no doubt good intentions, top-up payments will result in a two-tier system based on ability to pay, not on clinical need, which will further undermine the NHS and its underlying principles.

In the short-term top-ups might benefit some patients, but in the long-term it is difficult to see how it will not increase the burden on patients and their families at a very difficult time.

The availability of treatments should be based on clinical need and not the ability to pay.