UK Health Secretary Alan Johnson has confirmed that the controversial rule which denies National Health Service patients their basic package of care if they choose to top it up by purchasing drugs and other services privately is to be reviewed.

He has asked the National Cancer Director, Mike Richards, to lead an examination of the “very complex issues” involved and report back in October, Mr Johnson told Members of Parliament this week. While the current rules have been in place for 20 years, we need to “ensure we get guidance that is up-to-date and related to what is happening now in the NHS that is fair to everyone,” he said, also stressing the need “to protect the principles of the NHS being free at the point of need.”

As public pressure has gathered for the ban to be lifted, Mr Johnson has remained adamant that doing so would create a two-tier NHS, but in his announcement to Parliament he stressed that he was not asking that Prof Richards “comes down one way or another” on the issue. However, observers believe that a change which would allow patients to purchase drugs not funded the NHS, but also require them to pay for the additional costs of administering the drugs, could be acceptable to Ministers.

Prof Richards said he welcomed the opportunity to lead the review, and urged all interested parties, especially patients, to share their views with him. “We want to do everything we can for seriously-ill patients who wish to explore every avenue to treat their condition, while upholding the founding principle of the NHS that treatment is based on clinical need, not ability to pay,” he said.

Commenting on the review, Shadow Health Secretary Andrew Lansley also stressed the need to ensure that patients accessing private treatment should not lose them their entitlement to NHS case, and also that NHS care should continue to be both comprehensive and free, and based on need.

The Liberal Democrats, who have already said that their health policy will allow NHS patients to top-up their care, said Mr Johnson’s announcement was “a remarkable U-turn” which was “long overdue.” When a doctor recommends a treatment as having value to a patient, “it seems both cruel and perverse to pull the rug from underneath them,” said the party’s health spokesman, Norman Lamb.

Only 7% of voters support the current policy, according to the pressure group Doctors for Reform, which has been preparing a “fighting fund” to enable a judicial review of the guidance. A new opinion poll conducted by the group also found that 48% of people agree that “the NHS should allow patients to pay for extras without making them pay the total cost of their care,” while 43% agree that “the NHS should always pay for every treatment regardless of the cost to the taxpayer.”

77% willing to top up care
Moreover, 77% of voters said they would pay extra towards their healthcare if they were diagnosed with a life-threatening condition, with 31% claiming they would would be willing to pay more than £10,000, according to the poll.

The issue is currently under discussion at the annual conference of the NHS Confederation this week in Manchester. The Confederation’s policy director, Nigel Edwards, said the current situation is “unsustainable” and warned that it “seriously threatens to undermine public credibility in the NHS.”

However, one of the questions which the Confederation will be discussing is whether patients should be allowed to pay for drugs which are “marginally” effective but fall outside the National Institute for Health and Clinical Excellence’s (NICE) cost-effectiveness threshold.

If policy is to change, it is vitally important that patients are given access to the best possible information when making decisions on purchasing often very expensive treatments, said Mr Edwards. “We cannot allow people in such vulnerable positions to have false hope,” he stressed.

- Scotland has already announced that it is reviewing its own top-up rules, although this will apply specifically to cancer drugs.