Topping up NHS treatments

Doctors for Reform, describes itself as “a group which believes that the time has come to look at new ways to supply and fund healthcare”. They want to move to a social insurance system. Although independent they attract a lot of interest from the Conservative Party.  Their campaign against the “Topping up rule” which prevents people adding services which they pay for privately to NHS services. (A code of conduct for private practice: recommended standards of practice for NHS consultants 2004), has been taken up by the Times.

This rule regulates the behaviour of doctors, not patients.  Patients regularly mix NHS services with private treatment, especially in primary care, and in dentistry it is almost universal.  Billericay MP John Baron cites the death of one of his constituents who paid £11,000 for an eight-week course of  Cetuximab and was then denied further NHS treatment.  This doesn’t seem to be in accordance with the code which says:

  • a patient cannot be both a private and a NHS patient for the treatment of one condition during a single visit to a NHS organisation;
  • any patient seen privately is entitled to subsequently change his or her status and seek treatment as a NHS patient;
  • any patient changing their status after having been provided with private services should not be treated on a different basis to other NHS patients as a result of having previously held private status;

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 tell patients they can  try any alternative therapy they like. GPs do not turn children away when they have been treated privately  with Calpol, or refuse treatment to people who use herbal medicine.  We don’t deny free music lessons to children who have private music tuition.

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 any money while doing so.  The essence of a comprehensive universal system is that is available to everyone, no matter what they do.

So we suggest:

  1. We should defend NICE – we would like some speedier process for new technologies which show promise, but we do not want politicians interfering with decisions about what technology is cost effective.

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

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

  1. 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 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).

  2. Should the NHS charge for picking up the pieces – such as admitting you to an NHS hospital – if your private treatment goes wrong? That would effectively raise the price of private surgery. But that line might have unforeseen consequences.

  3. We do not object to people buying equipment – a better wheelchair, a nebuliser, their own MRI scanner?

Competing interests: An NHS customer who wants the principle of a free service to continue.

Martin Rathfelder, Director

Originally written for Onmedica June 2008