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Monday 21st May 2018

Equality and top-up fees in the NHS

17th November 2008

Alasdair Palmer considers the issue of the co-payment system for drug treatments within the NHS in the Telegraph.

consultant1QIn November, the government decided at long last that patients who wanted to fund their own treatment to buy drugs not provided by the NHS would not automatically be denied health service care as a result.

The high-profile cases of patients suffering from terminal illness such as Linda O'Boyle - who paid for the cancer treatment Cetuximab to extend her life, but was forced to pay £11,000 for private healthcare - were picked up on by the media and brought to public attention.

Despite this, many people still believe that if the health service cannot fund certain drug treatments then patients should not be given care within the NHS if they pay for it out of their own pockets.

Why is this? No one suffers when a patient funds their own treatment and there is "a very obvious benefit to the patient. A policy which generates benefits without causing harm is obviously better than one which just causes harm."

The real problem here is "a misunderstanding of the ideal of equality: if everyone cannot have a benefit, it is better that no one should have it."

This puts forward the idea that nobody should be given treatment if it is not possible to attain equal standards of care for all patients. However, this is an unachievable aim - doctors have different levels of experience and competence. Patients who receive care from "better" doctors get better levels of care than patients who receive treatment from less skilled practitioners.

No one who believes in equal care for all is going to say that as a consequence of variable treatment standards we should abolish the NHS. But this is the "logical consequence" of the opinion that every patient must be treated equally.

Professor Mike Richards was the author of the report which influenced the government to change its stance, but he recommended "a compromise".

This compromise said that patients who funded their own treatment should not be excluded from health service treatment. Professor Richards recommended, however, that they should not receive treatment in NHS hospitals and must fund any extra "tests, scans and treatments" which arise because of any complications from additional, self-funded drugs.

This compromise is a complex and fundamentally imbalanced one which throws up many questions. It will lead to patients receiving care "in wildly different ways, depending on the whim of the administrator who makes the decision" about their case.


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