Lord Crisp, former chief executive of the NHS, has suggested that topping-up of recommended drugs should be made the exception to the NHS system, rather than the rule.

Writing for The Times, Lord Crisp, who as Sir Nigel Crisp was chief executive of the NHS and permanent secretary to the Department of Health, Crisp points out that “fairness has always been at the heart of the NHS”. Although the present system where those who choose a drug not recommended by the NHS must pay fort all their care privately as well as for the drugs is unfair, Crisp says, “the Government needs to find a way to deal fairly with these patients. I believe that it can do this if it recognises that they are exceptional cases and treats them as such”.

Small numbers
Although the cases are heart-rending, Crisp points out that the numbers in question have been relatively small – 1,300 as opposed to the 11 million annual admissions to NHS hospitals, or the million people seen in outpatients or GPs' surgeries every 36 hours. He adds, “they represent less than a quarter of 1 per cent of NHS spending. There is no need to change the NHS on their account”.

He warns against the logic that some proponents of top-ups are using to deduce that the problem is best solved by defining a core N HS care package, noting that international experience shows that “core minimum packages mean that poorer people get a worse deal”. He also questions how the core package would be defined.

Crisp also states that he “believes strongly that private enterprise plays an invaluable role in creating new drugs and treatments and that competition creates innovation that benefits us all”. Yet he notes that amending the current system to allow top-ups in exceptional circumstances, while retaining NICE’s gatekeeping role and the NHS universal ethos is “cheaper and fairer”.

Cancer czar Mike Richards’ report on toping-up NHS care is due out this month. Crisp has rarely made interventions in health policy since his resignation in 2006.