NHS 'top up' question is about fairness

1 April 2008

The Daily Telegraph, Janey Daley, 1 April 2008

Should patients be denied NHS care simply because they choose to pay for an additional treatment or medication which is presently unavailable under the national heath service?

The question goes to the heart of what constitutes "fairness" in the government administration of healthcare. At present, the Department of Health enforces a literal, and quite brutal, definition of equality: no one should be able to have anything that cannot be made available to everyone.

For patients to be able to "top up", at their own expense, the treatment which the NHS is prepared to supply to them would create what Labour politicians call a "two tier" health service in which the better-off would have access to advantages that were unavailable to those who could not afford them.

Alan Johnson, the Health Secretary, is known to be personally opposed to such "co-payment".

So the cancer patient who wishes to purchase a drug that NICE has not chosen to make generally available to cancer sufferers, perhaps for reasons of cost-effectiveness, is told that he (or more likely she, since it is breast cancer which has raised the most well-known cases) will lose all rights to NHS care as punishment.

This has always seemed a peculiarly vindictive and illogical interpretation of the concept of universal healthcare. How does the individual who chooses to spend his own money – or perhaps even funds raised by friends or charitable community efforts – on a drug or a procedure, disadvantage anyone else receiving standard NHS care?

It seems, in fact, quite wicked to lock patients out of NHS care – for which they may well have been paying through their taxes for many years – simply because they have had the temerity to want something unavailable in current practice, or are willing to purchase a form of treatment for themselves thereby shortening the waiting list for remaining patients.

Now a campaigning group of doctors has decided to challenge the legality of the DoH guidelines. Doctors for Reform is attempting to raise funds to back a judicial review of the regulation which stipulates that once a patient has purchased any aspect of treatment privately, he is bound to pay for the entire cost of all his treatment.

While the patient would receive pro bono representation for his case, the cost of losing the action would amount to around £35,000 - and it this sum which the campaign needs to raise.

If the action proves successful, a major precedent will have been set: "co-payment" will be established as the right of all NHS patients, and the ideological wall between private and NHS care will have been breached.

Anyone wishing to contribute to the doctors' cause can contact them via their website: www.doctorsforreform.com.