Ministers are expected to announce this week that patients will no longer lose their free National Health Service (NHS) treatment if they choose to “top up” their care with advanced new drugs which the Service does not pay for.

The Department of Health (DoH) has consistently claimed that allowing such co-payments would create a “two-tier” NHS, but the Secretary of State for Health, Alan Johnson, has now said that the policy will undergo a “fundamental rethink” as part of Lord Darzi’s review of the NHS.

The growing public demand for change has been fueled by a media campaign, led by the Sunday Times, which has reported the hardships and worries suffered by terminally-ill patients, mainly suffering from cancer, who in their final months have had to pay for their NHS care because they chose also to be treated with drugs which the National Institute for Health and Clinical Excellence (NICE) has decided are not sufficiently cost-effective to be provided under the NHS.

Last week, Conservative Member of Parliament (MP) John Baron led a debate in the Commons calling for the ban to be lifted, following the death from bowel cancer of 64-year-old Linda O’Boyle, who lived in Mr Baron’s constituency of Billericay. Mrs O’Boyle was denied NHS treatment in her final months because she had paid for a course of Bristol-Myers Squibb/ImClone Systems’ Erbitux (cetuximab) - which NICE has ruled should not be offered on the NHS - after she failed to respond to Pfizer’s Campto (irinotecan).

If the NHS has chosen to differentiate between treatments through the NICE process, it is hypocritical to condemn patients for seeking to do likewise, Mr Baron told MPs. He also pointed out that co-payments are already happening throughout the NHS, through private beds, dental and optician services.

Also, an Early-Day Motion tabled by Birkenhead Labour MP Frank Field and others said Mrs O’Boyle had been “prevented from contributing to the cost of drugs that might have prolonged her life,” and called for cancer patients to “be encouraged, and then not penalised, to pay for additional drugs which are prescribed for them by their NHS consultant but are not made available to them on NHS prescriptions.”

Liberal Democrat leader Nick Clegg announced last week that his party’s health policy would now include allowing NHS patients to top-up their care, and Conservative leader David Cameron hinted that he could also support such a move. As well as Erbitux, patients have so far sought to co-pay to receive drugs such as Pfizer’s Sutent (sunitinib) and Bayer’s Nexavar (sorafenib), both for for kidney cancer, and two drugs from Genentech - Avastin (bevacizumab) for breast, colorectal and lung cancer and Tarceva (erlotinib) for lung cancer.

Leaders of the Royal Society of Medicine (RSM) and the Royal College of Surgeons (RCS) have condemned the ban on co-payments, while the British Medical Association (BMA) annual consultants conference this month declared it to be “immoral.” Moreover, the pressure group Doctors for Reform, which believes the current position to be unlawful, is setting up a fighting fund to enable a patient to undertake a judicial review of the legislation and establish a legal precedent.

Doctors believe they should tell patients about these advanced treatments which could help prolong their lives, even though they are expensive and NICE has ruled their availability on the NHS is not warranted. However, clinicians in various parts of the country are getting round the ban by prescribing the drugs for their NHS patients and then arranging for them to be administered at home, by nurses who are employed by private companies.

- Meantime, on June 14 the Western Provident Association (WPA) insurance company launched its unique NHS Health Top-Up plan which, it says “plugs the gaps in NHS care.” Its services include, for enrollees aged up to 60, access to advanced targeted cancer drugs which are licensed but not available on the NHS in England, to a value of up to £50,000 for a monthly premium of £4.20, plus free legal advice.