The issue of whether patients should be allowed to top-up their National Health Service (NHS) treatment with privately-purchased drugs and other treatments without being forced to pay for all their treatment privately divided the British Medical Association (BMA) annual conference in Edinburgh yesterday. While 63% of doctors voted in favour of allowing patients to top-up, they also voted, by a 50.2%-49.8% margin, against demanding that the government should permit such co-payments.

Instead, 71% backed proposals to call on the government to set up a Royal Commission to review all the evidence and implications for the NHS and for patients of permitting co-payments and require it to report back with recommendations by next summer.

Also, a motion stating that “a co-payment system does not imply a two-tier NHS but rather recognises the reality of healthcare rationing in the UK” was lost, with 53% of the membership voting against it.

As predicted, the conference debate on co-payments was passionate and sometimes personal. Orthopaedic surgeon Gordon Matthews, whose wife has terminal bowel cancer, said that the proposal was not a threat to the NHS and pointed out that a tax-based system cannot provide unlimited treatment. He was supported by Stephen Austin of the BMA consultants committee, who said the ban was “not what the NHS stands for and goes against the founding principles of the BMS.”

However, other speakers warned that permitting co-payments would in fact overturn one of the Service’s basic principles, which is that treatment should be available on the basis of need and not ability to pay. Ahead of the conference, BMA chairman Hamish Meldrum had told The Sunday Telegraph newspaper that it was his “gut instinct” was that allowing top-up payments would go against an NHS which is free at the point of use, fair and equitable to all. However, he added that these were his personal opinions and that an “open and rational” debate on the issue was needed. He also called for processes at the National Institute for Health and Clinical Excellence (NICE) for dealing with new drugs to be speeded up.

Conference also voted yesterday in favour of motions to: - recognise that not all treatments and medications are available to patients on the health service equitably across the UK; - require Health Departments to recognise that banning co-payments denies patients treatments that may be to their benefit and forces patients to accept healthcare rationing; - “remain adamant” that the introduction of such co-payments must not be a route to extend NHS user charge; - require that any co-payments be introduced only after a mechanism is devised to prevent the extension of NHS user charge; and - propose that co-payments only be chargeable for treatments appearing on a national list agreed between NICE and the NHS Medical Director.

NHS “should be run more like supermarkets”

Meantime, Dr Meldrum’s comments to the conference on Monday that the NHS in England is being run “like a shoddy supermarket war” have been described as “ridiculous” by liberal think tank Progressive Vision. “The NHS should be subjected to more supermarket-style competition not less. It would help to ensure that health care became more responsive to the needs and desires of patients and less driven by the interests of doctors and doctors’ unions,” said the group’s director, Shane Frith.