MPs have warned that moving patients out of NHS wards and into private facilities in order for them to receive privately-purchased additional end-of-life drugs is wrong and could endanger their lives.

Such an “undoubted disruption to a patient's quality of life just to meet some bureaucratic requirement” is also unjust, and risks creating a two-tier health care system, where two patients with the same condition on the same ward receive different treatments because one can afford it and the other can’t, say the members of the House of Commons Health Select Committee. They warn: “this must not be allowed to happen.”

The MPs’ warnings come in a report published this week following their inquiry last November’s recommendation by England’s “Cancer Tsar” Mike Richards that NHS patients should be allowed to top-up their care with privately-purchased treatments which are not funded by the Service, provided these are administered separately from NHS treatment.

The government accepted this proposal and it has now been put into practice. The Health Committee report acknowledges that this option presents the only realistic way forward, stating: “although we are not convinced by the arguments that dismiss the threats of establishing a two-tier system or that separation of patients is practicable for only a part of their treatment, we can see no transparent way of rapidly alleviating the problem.” However, it warns that such a separation will be difficult to achieve in practice and could disrupt patients’ continuity of care and the coordination of information-sharing.

"This is a highly complex issue and it is clear from the considerations undertaken by Professor Richards that the option of separating NHS and private care is the only one likely to address most effectively the confusion which has surrounded the debate about purchasing additional treatment,” said the Committee’s chairman, Labour MP Kevin Barron. “Other options, such as a voucher scheme, appear to be unworkable or would undermine the fundamental values of the NHS. Nevertheless, there are real concerns which will need to be carefully monitored,” he added.

The MPs’ concerns were not shared by Committee member Conservative MP Peter Bone, who told a press conference to launch the Committee’s findings that he had “no problem” with patients in the same ward receiving different treatment because one had purchased an additional drug.

The report is also critical of the National Institute for Health and Clinical Excellence (NICE)’s new supplementary end-of-life drug guidance, which it describes as “inefficient and inequitable.” The current threshold is less cost-effective, it says, and warns that, by spending more on treatments for limited health gain, the NHS will spend less on other treatments which give greater benefits to more patients.

'Woolly' definition
The definition used by NICE to limit which groups of patients would benefit from the new guidance – “small patient populations” – is woolly and must be clarified, say the MPs, who point out that most conditions could be broken down to fit the new criteria and the numbers eligible under the new guidance could increase, leading to cost implications for the NHS.

Among the report’s recommendations are that:
- the Department of Health should monitor the implementation of the Richards Review and fund research to gather evidence about its effectiveness;
- the NHS and private sector must work in close collaboration and share information to ensure good continuity of care for patients;
- NICE should maintain its quicker decision-making process on which drugs it approves;
- better progress needs to be made on phasing out the least useful treatments; and
- Primary Care Trusts (PCTs) should provide clearer information to patients, giving the reasons for any decision to approve or reject a request for exceptional funding. “We are pleased that steps are being taken in this area, but it is vital that patients receive clear information, quickly, about the reasoning behind panel decisions,” they say.

Commenting on the report’s comments and recommendations on NICE’s approach to appraising end-of-life treatments, the Institute’s chief executive, Andrew Dillon, said it will take account of them in its July review into how the new advice is being applied.

“NICE has always shown flexibility in making decisions on high-cost treatments, particularly where they offer an extension to life. We anticipate that the recent advice on end-of-life treatments will result in some, although not a large number, of additional positive recommendations. Our consultation on the change, last year, leaves us confident that this is what NHS users want and we do not believe, at current levels of funding, that they will result in an unmanageable additional financial burden for the NHS," said Mr Dillon.

The Department of Health will now consider the Committee report and make a formal response to Parliament.