As health ministers north and south of the border consider allowing patients to mix and match NHS and private treatment, Morag Lindsay examines the case for change

NHS at crossroads

Published:

COURAGEOUS: The late Mike Gray with his wife, Tina McGeever . . . he managed to persuade NHS Grampian to pay for his treatment for bowel cancer

As the National Health Service’s 60th anniversary year draws to a close, policymakers are considering a move which could topple its founding principle of free healthcare for all, regardless of wealth or privilege.

Health Minister Nicola Sturgeon is this week expected to set out the Scottish Government’s position on whether or not patients should be allowed to top up their NHS care with private treatments.

And next month, the UK Government will begin digesting the findings of a four-month review of the same issue.

At present, guidelines state that if patients wish to pay for treatment which is not available through the NHS, they forego the right to NHS treatment.

Campaigners for change say if someone has the means to pay for an additional drug they should be allowed to do so without it threatening their right to be treated on the NHS. Supporters of the status quo say permitting patients to mix and match private and NHS treatment raises questions of accountability – who to blame if something goes wrong.

Moreover, they say allowing NHS patients to top up their own care would set the UK on a slippery slope to a two-tier health service, where only the richest have access to the most expensive treatments.

Ms Sturgeon’s intervention has been prompted by the case of Mike Gray.

The Moray man spent his last months fighting for the right to be treated with the cancer drug cetuximab and took his case to Holyrood after NHS Grampian refused to pay for the medicine.

Because Mr Gray and his family went ahead and paid for the life-prolonging drug themselves – at a cost of £3,400 per cycle – the health authority said they would also have to pay for treatment he had previously received on the NHS, such as chemotherapy.

Despite having advanced bowel cancer, the courageous 53-year-old from Buckie persuaded the health board to back down and fund the treatment shortly before his death in April.

Labour MSP Frank McAveety, who chaired the public petitions committee which heard Mr Gray’s plight, said the case demonstrated the need for greater flexibility.

“Hopefully, individuals in the future will not need to face some of the considerable difficulties, both financially and emotionally, that Michael and his family faced,” he said.

Ms Sturgeon is known to have reservations about co-payment. In July she issued a statement celebrating the 60th anniversary of the NHS that underlined the Scottish Government’s resolve to ensure the NHS remains true to its founding principle of being free at the point of delivery.

And any statement this week would pre-empt the outcome of a comprehensive review of NHS guidelines currently taking place in England, raising the prospect of separate systems north and south of the border should English health chiefs decide on a different course of action.

The English review follows the controversial case of Linda O’Boyle, from Essex, who died after being refused bowel cancer treatment.

Like Mr Gray, the 64-year-old had been receiving NHS treatment, including chemotherapy, after being diagnosed with bowel cancer in 2006. But when she paid £11,000 for an eight-week course of cetuximab, she was denied the basic package of NHS care and died in March this year.

The man leading the review, Professor Mike Richards, the national clinical director for cancer, is expected to report back to the Westminster Government in October.

Rapid developments in medical research and technology in recent years have created this dilemma, unimaginable in the infancy of the NHS.

As ever more sophisticated, and costly, drugs are manufactured and licensed, local NHS managers are increasingly faced with difficult decisions on how best to spend limited resources.

Do they spend many thousands of pounds on a new drug which will improve the quality of life of a terminally-ill patient for a few months? Or do they spend the same sum on a much cheaper treatment which could cure many more people?

Current NHS guidelines state: “A patient cannot be both a private and an NHS patient for the treatment of one condition during a single visit to an NHS organisation.”

But not all health authorities stick rigidly to the guidelines – with some calling into question what counts as “a single visit”.

And critics, including leading patient groups and charities, argue that a two-tier system already exists.

In dentistry, for instance, patients can have treatments, such as fillings, done on the NHS while paying privately for their teeth to be cleaned.

Countries such as the Netherlands, France and Germany already operate systems of mixed funding for treatment and drugs and a survey for the British Medical Association (BMA) in July found half of British people expect to pay something towards their NHS treatment by 2018.

The overwhelming majority – 93% – agree the NHS should continue to be funded from taxes and remain free at the point of use but many accept they will have to top up the costs themselves.

BMA chairman Dr Hamish Meldrum said a debate was necessary but warned that to go down the road of co-payments without a debate risked “the further erosion of the principles of the NHS, which are equity and being free at the point of use”.

The BMA voted narrowly in favour of co-payments at its annual conference in Edinburgh. The Royal College of Nursing has also given its guarded support.

Unison, the biggest public services union representing health workers in the UK, remains opposed to any creeping privatisation of healthcare. The NHS Confederation, which represents health managers, has said the current system is “unsustainable”.

As part of the Westminster review, the charity Breakthrough Breast Cancer is hosting a “citizens’ jury” on the issue of top-up care in London tomorrow.

Journalist Polly Toynbee will be in the chair and members of the public will be able to listen to evidence, cross-examine expert witnesses and come to their own conclusions on the rights and wrongs of co-payment.

Whether the politicians come down for or against a change to the guidelines, the charity says it is essential that the issue is resolved to prevent patients, such as Mike Gray, having to fight for drugs when they are already unwell.