There “may be a case” for allowing cancer patients to top-up their National Health Service (NHS) treatment with privately-purchased care, Scottish government ministers have said.

“Decision-making in relation to a patient who believes they can enhance their health through additional treatment which they exercise a choice to purchase should be seen as part of a…framework of assessment of risk and clinical benefit,” Nicola Sturgeon, Scotland’s deputy first minister and cabinet secretary for health and wellbeing, has said, in her response to the parliamentary Public Petitions Committee report into the availability on the NHS of cancer drugs.

There cannot be a “one-size-fits-all” approach in “determining the extent to which elements of NHS and private health care could be combined;” judgements need to be made in individual cases, and decisions on co-payments must be underpinned by guiding principles and a risk-based approach, Ms Sturgeon also told the Committee.

However, a leading cancer charity has warned that any move towards a co-payments system in Scotland, “however, well-intentioned,” will have a negative effect on patients.

Bowel Cancer UK spokesman Ian Beaumont believes that such a move will act as a disincentive for the Scottish Medicines Consortium (SMC) to approve new cancer treatments and for NHS Boards to make them available, on the grounds that patients can get them privately. “In turn, this will further discriminate against those people who are least able to pay for treatments and against exceptional cases, thus adding to the inequities that this inquiry sought to address,” he says.

Need for greater clarity, more public understanding

The Scottish government’s response also accepts the Public Petitions Committee’s call for clearer guidance and greater public understanding of both NHS top-up payments and the system of “exceptional prescribing” of treatments which have not been approved by the SMC.

Ms Sturgeon's response acknowledges that the “end-to-end” progress for the introduction of new drugs, from licensing through to exceptional prescribing panels, needs to be explained to the public in an accessible and understandable way, and she says the government is planning to produce guidance to help ensure this, aided by the forthcoming Better Cancer Care Plan. Working with the SMC, NHS Boards and the Scottish Cancer Task Force, the government “will articulate the principles against which local decision-making arrangements should operate,” she says, adding that, while these will where appropriate include requirements relating to patient and public involvement, the need to ensure clinical confidentiality means that “this type of participation may not always be possible.”

The ABPI in Scotland said it welcomed this “clear message from government that there needs to be greater openness, transparency and consistency," particularly in “the prescribing by specialists of cutting-edge medicines under exceptional patient criteria.”

Andy Powrie-Smith, the ABPI’s director in Scotland, also said the emphasis in both the report and the government response on the need to greatly improve data-gathering to inform NHS decision-making was “hugely important.” He added: “we look forward to this initial work to collect information on cancer medicines being rolled out across the rest of Scottish patient care.”
- England’s National Cancer Director Mike Richards is due next month to publish the results of his review of the ban on NHS care tops-ups. His inquiry will cover all treatments - not just cancer drugs, as was the case in the Scottish report.