Calls are growing for the government to change the rules which permit National Health Service care to be withdrawn for patients who chose to pay privately for “top-up” medicines.

Such extra private payments (“co-payments”) to supplement care provided by the NHS are not illegal, but guidelines issued last summer by the Department of Health state that a patient cannot be both a private and an NHS patient for the treatment of a single condition during one visit to an NHS organisation.

A fundamental principle of the NHS is that treatment is free at the point of care, and allowing patients to make co-payments for treatments such as cancer drugs while still receiving free NHS treatment including scans, hospital stays and blood transfusions, would undermine this principle and lead to the creation of a two-tier NHS, according to the government. Last month, speaking in Parliament, Health Secretary Alan Johnson defended this principle and condemned demands to allow co-payments: “that way lies the end of the founding principles of the NHS”, he warned.

However, many clinicians and others have been calling for a full debate on the issue for some time now, and patients have shown they are perfectly willing to go to court to assert what they believe to be their rights. In Cumbria, an unnamed 62-year-old patient with bowel cancer has recently won her legal battle to be allowed to pay for treatment with Genentech’s Avastin (bevacizumab) while her Primary Care Trust continues to fund the rest of her care, and breast cancer patient Debbie Hurst from St Ives is preparing to go to court to persuade the Royal Cornwall NHS Trust to allow her to pay for the same drug. Her Trust has in fact permitted three other patients to make co-payments to obtain the drug, but it points out that their private care began before the DH guidance was issued last summer.

Mrs Hurst and Colette Mills, a breast cancer patient from North Yorkshire who is being treated with Bristol-Myers Squibb’s Taxol (paclitaxel) but wants her PCT, South Tees NHS Trust, to allow her to pay for top-up treatment with Avastin, plan to launch a campaign to give patients the right to fund medicines which the NHS will not pay for.

Clinicians supportive
Their demands have the backing of clinicians such as the pressure group Doctors for Reform, which last year published a report showing that top-up health payments are now common. UK healthcare is not in fact free at the point of delivery, and “patients are developing sophisticated approaches to purchasing upgrades to their care,” said the group.

One of the report’s authors, professor of cancer medicine Karol Sikora, said: “Having to top-up NHS care is a reality for many patients. But the political debate continues to perpetuate the mirage of a service completely free at the point of delivery. We must have a full and frank debate about the future of healthcare funding.”

Also backing the patients’ campaign is Saga, the powerful group representing the over-50s, which just last month published a survey showing that more than half of people in this age group said they would pay out of their own pocket for treatments for conditions such as cancer if they were not available on the NHS. One in six (15%) also told the survey they have been denied NHS treatment on the basis of cost.

Other options for patients include taking out private medical insurance, or special cancer-only insurance offered by firms such as Western Provident Association and Virgin, which allow people to obtain cancer drugs which the NHS will not fund, although all these options have limitations and exclusions.

UK cancer drug spending just 60% of Euro average
Meantime, the UK continues to lag behind its European neighbours in both survival rates from cancer and spending on oncology drugs. A report just published by the Association of the British Pharmaceutical Industry (ABPI) and PharmaPartners points out that UK spending on cancer medicine currently stands at just 60% of the European average and estimates that, at 2006 rates, additional investment of £403 million a year would be necessary for the UK to achieve the existing average per capita expenditure on cancer medicines in 11 comparable European countries.