Health Secretary Alan Johnson is expected to announce within the next two weeks that the ban on patients paying privately for drugs and other treatments which are not available on the National Health Service (NHS) without forfeiting the rest of their NHS care is to be lifted.

England’s national cancer czar, Professor Mike Richards, who has been reviewing the rules, is due to present his recommendations any day now, and these are expected to call for patients to be allowed to buy drugs which the National Institute for Health and Clinical Excellence (NICE) has either not assessed or has deemed to be insufficiently cost-effective for use on the NHS. The change to the rules will however be accompanied by safeguards to prevent, as far as possible, the development of a two-tier NHS, and the most significant of these is expected to be that NICE will be asked to change the way it assesses life-prolonging drugs. The Institute will be required to take far greater account of the benefits such treatments provide in terms of quality of life for terminally-ill patients, especially those with cancer, say experts.

These new criteria are expected to bring, speedily, a range of currently-unavailable drugs into NHS use, and it is hoped that, as a result, the number of drugs which patients can finance for themselves under the new rules will be substantially reduced. This could go some large way to settling the fears of many people that allowing top-ups will mean the end of an NHS which is based on the principle that treatment is provided on the basis of need and not the ability to pay, and also their concerns that it will act as a disincentive for NICE to approve new drugs and for Primary Care Trusts (PCTs) to make them available, on the grounds that people can get them privately.

Lord Ara Darzi, who has recommended moves to speed NICE’s procedures in his Next Stage Review of the NHS, told Parliament in the summer that, while top-ups are a separate issue, faster NICE approvals would have a “tremendous impact” on the co-payment debate.

- The Sunday Times newspaper has forecast that, in making his announcement, Mr Johnson will tell Parliament that NHS patients have in fact always been permitted to purchase drugs privately without forfeiting the rest of their care, and that the problem has arisen because some NHS hospitals have simply misunderstood the rules.