Health secretary Alan Johnson will today announce the Government's policy on whether to allow patients to 'top up' NHS provision of care, which is not currently permitted. The result is universally expected to be an approval to change this policy, hedged around with practical caveats.

This follows cancer czar Professor Mike Richards' review of existing policy, which states that NHS provision of care should be withdrawn if a patient goes private for part of their treatment. The issue has come to a head in particular around high-cost new cancer drugs, which the National Institute for Health and Clinical Excellence (NICE) has deemed not to be cost-effective.

Various recent reports have highlighted hospitals' strategies for getting around the ban in top-ups by advising patients who can pay to get the drugs administered in their own homes by companies such as Healthcare At Home.

Both the NHS Confederation and the Kings Fund have come out in favour of permitting top-ups provided that there are adequate safeguards in place. However, trades union UNISON remains opposed to the principle of allowing wealthier people to purchase better care.

In a statement on the eve of the announcement, Nigel Edwards, the NHS Confederation's director of policy, called for safeguards for all NHS patients and stressed that changes to the rules governing top-up payments should not be allowed to undermine the core principles of the NHS.

Thin end of the wedge?
Edwards said, “this change in policy is welcome and helps deal with a situation which had become unsupportable. But allowing private payments alongside NHS care cannot be allowed to become the thin end of the wedge – no one wants a two-speed health service and this should not become a step in that direction. The NHS still provides free, comprehensive access to cost effective treatments and it is important to remember that 54 out of 59 cancer treatments assessed by NICE have been approved.

“There is no doubt that the restriction on these payments threatened to undermine public confidence in the NHS and caused considerable worry both for the small number of patients it affected and to the public as a whole".

Improving NICE assessments
Edwards added that improvements are needed to NICE's work processes, "most importantly its procedures need to be speeded up so decisions about useful new drugs are made as quickly as possible.

“There is also clearly scope to improve the way PCTs' exceptional case panels, which decide on whether drugs can be used by patients, operate.”

Edwards also warned that ensuring adequate information about 'top-up' drugs efficacy and side-effects was needed for consumer protection, and suggested "we are hopeful that the Government will look at the relationship with the drugs companies who should also respond to this move by doing their bit by looking at how they cost and market drugs. We now urgently need to explore risk sharing models with drugs companies where they are paid based on effectiveness and that they share the risk of new, sometimes marginal treatments, with the NHS and patients.

“Ultimately if we take steps to improve the way NICE works and the effectiveness of exceptional case panels then it should be possible to reduce the demand for top-ups to a relatively small number of cases.”