Submission to the review of policy relating to patients who choose to pay privately for drugs not funded on the NHS

Patients who choose to pay privately for drugs not funded on the NHS

The Socialist Health Association was founded in 1930 to campaign for a National Health Service and is affiliated to the Labour Party. We are a membership organisation with members who work in and use the NHS. We include doctors and other clinicians, managers, board members and patients.

This issue has been debated extensively within the Association and the conclusions we have come to are these:

A public discussion about the nature of the commitment to a comprehensive health service is timely. We encourage people to take responsibility for their own health. We can hardly refuse them permission to spend their own money while doing so. The essence of a comprehensive universal system is that is available to everyone, no matter what they do. We do not see any legal or moral basis for the idea that people can be refused NHS treatment because they have previously paid for private treatment.

The ban on people getting NHS treatment once they have paid for private treatment only seems in practice to apply to privately funded chemotherapy. Even oncologists frequently tell patients they can try any alternative therapy they like. In other fields of medicine “topping up” is common, if not universal. GPs do not turn children away when they have been treated privately with Calpol, or refuse treatment to people who use herbal medicine. Orthopaedic surgeons are happy to treat people who pay for their own physiotherapy. And people who pay for private surgery often end up in NHS treatment if it goes wrong. Nobody suggests we should deny free music lessons to children who have private music tuition. Those who suggest that a more rational policy for chemotherapy will somehow undermine the principles of the NHS need to explain how those principles have survived topping up in every area for so many years.

We hope that ministers will take this opportunity to make it clear to some politicians who seem keen to avoid this issue that every health system has to confront the issue of rationing. However much money is devoted to healthcare there will always be treatments which are not cost effective.

So the Socialist Health Association suggests that:

We should defend NICE – we would welcome speedier processes for new technologies which show promise, but we do not want politicians interfering with decisions about what technology is cost effective. Nor should the NHS be blackmailed into paying for treatment which is not cost effective. We need to show drug companies that they will get the support of the NHS for introducing their new drugs if the price is lower or if the clinical benefits are unambiguous. And we must make it very clear that all NHS patients should get treatment that is cost effective in their case according to the standards that we have collectively agreed..

Terminally ill people are obviously very vulnerable to suggestions that they might buy extra days of life. We need to ensure that as far as possible they are protected from people selling false hope.

We stand by the line that the NHS – and its staff – should not be offering or delivering additional or better treatment for money.

We have no objection to people paying for non-clinical enhancements to treatment – wine with their meals, amenity beds, bedside internet access.

If people pay privately for some clinical enhancement to NHS treatment which is not delivered by the NHS or its staff that should not affect their NHS treatment (unless there is some clinical reason to object) either at the time or later. They must make information about this treatment available to their NHS clinicians (which might enable data about the effects of snake-oil to be collected and evaluated).

We think consideration should be given to whether the NHS should charge for picking up the pieces – such as admitting you to an NHS hospital – if private treatment goes wrong. That would effectively raise the price of private surgery. But that course of action might have unforeseen consequences.

We do not object to people buying equipment. A better wheelchair, a nebuliser or their own MRI scanner.