MPs publish NHS top-up fees report

12 May 2009

The Health Committee says in a report published today that while the Richards Review proposal to allow patients to buy additional end-of-life drugs as long as they are administered separately from NHS treatment is the best option for the NHS, it warns that such a separation will be difficult to achieve in practice and could disrupt patients’ continuity of care and the coordination of information-sharing.

The report also warns of the danger of creating a two-tier healthcare system, where two patients with the same condition on the same ward receive different treatments because one can afford it and the other can’t. This must not be allowed to happen. Equally, moving a patient from an NHS ward to a different location for private treatment just to meet a bureaucratic requirement would not only endanger the patient’s life, but is unjust.

The report criticises the new supplementary National Institute for Health and Clinical Excellence (NICE) end-of-life drug guidance which it says is inefficient and inequitable. The current threshold is less cost-effective and means that by spending more on treatments for limited health gain the NHS will spend less on other treatments which give greater benefits to more patients.

The definition used by NICE to limit which groups of patients would benefit from the new guidance – ‘small patient populations’ – is woolly and must be clarified. The Committee warns that most conditions could be broken down to fit the new criteria and the numbers eligible under the new guidance could increase, leading to cost implications for the NHS.

The Committee makes a number of recommendations. It says:

  • the Department of Health should monitor the implementation of the Richards Review and fund research to gather evidence about its effectiveness
  • the NHS and private sector must work in close collaboration and share information to ensure good continuity of care for patients
  • NICE should maintain its quicker decision-making process on which drugs it approves
  • Primary Care Trusts should provide clearer information to patients giving the reasons for any decision to approve or reject an exceptional funding request
  • better progress needs to be made on phasing out the least useful treatments

The Chairman of the Committee, Kevin Barron MP, said:

"This is a highly complex issue and it is clear from the considerations undertaken by Professor Richards that the option of separating NHS and private care is the only one likely to address most effectively the confusion which has surrounded the debate about purchasing additional treatment. Other options, such as a voucher scheme, appear to be unworkable or would undermine the fundamental values of the NHS. Nevertheless, there are real concerns which will need to be carefully monitored.

"We urge PCTs to be more transparent in how decisions are made by exceptional funding panels. We are pleased that steps are being taken in this area, but it is vital that patients receive clear information, quickly, about the reasoning behind panel decisions."

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