Topping Up

On the other hand, topping up is seen as an issue which affects the underlying principles of the NHS. This, it is argued, is a slippery slope to reducing the NHS to a minimum safety net service in which even effective treatments would require a top-up payment.

The issue over top ups has come to the fore in the main because of a new cutting edge treatments and the NHS’s rationing system carried out by NICE.

In recent years a new generation of cutting-edge drugs, particularly for the treatment of cancer, have become available. These drugs are more likely to be personalised to the individual patient, meaning they are likely to work in specific cases, but will not be effective for most patients. However, they are also more expensive than current treatments and these drugs may fail the kind of cost-effectiveness tests that the National Institute for Health and Clinical Excellence (NICE) and commissioners apply. Since the introduction in 1999 of NICE assessments of new and existing treatments, the NHS has become more explicit about the need to prioritise which treatments should and should not be funded.

The rules are currently being challenged by cancer patients who wish to purchase drugs that have not been approved by NICE and who face being denied the rest of their NHS treatment package as a result. Campaigning organisations like Doctors for Reform have argued that it is unlawful to deny NHS treatment to patients who complement their care by purchasing additional treatments. However, both the Government and PCTs have argued that allowing patients to top up their treatment would undermine the NHS principles of equity.

It is likely that the rules over top ups will be changed mainly due to the following reasons:-

•  Current policy is being applied inconsistently - There is evidence of geographical inconsistency, as some patients have won their battle to mix private and public treatment.
• Top-ups already exist in areas such as in dentistry and prescription charges.

This is an area which is likely to get a lot of coverage in the media in the second half of this year as the Government begin to address top-ups and the gap that is emerging between public funding and the cost of modern treatments.