Planet Insurance

The pressure has been mounting for the Government to fund high cost drugs, especially for cancer care. Initially its line was that only drugs approved by the National Institute of Clinical Health and Excellence (NICE) would be paid for but some discretion was allowed to individual clinicians, Primary Care Trusts and hospitals. Then came Herceptin, where the former Secretary of State was forced to accelerate matters for a group of patients. Around that time Western Provident Association obtained a QC's opinion that patients would be entitled to fund their drugs privately without affecting their NHS care and launched an insurance product to pay the top-up for the drugs.

The matter would probably have been resolved if it were not for a classic NHS head to head - 'choices versus voices'. In the past, the upper hand has been held by 'voices'. The GP decides which hospital patients go to and the consultant decides on their treatment. 'Voices' have been about the collective and equity, and State knows best. They are still very powerful - an example being the smoking ban, where the interests of public health and non-smokers outweighed the individual's right to choose. But 'choices' have become more and more powerful - for example with patients now being offered a choice of hospital.

'Voices' did not like patients paying for their own drugs claiming it would be inequitable and create a two-tier NHS.

In some NHS localities 'choices' won and in others 'voices' won, forcing patients who buy their own drugs to fund the rest of their care too.

In July, Professor Mike Richards, the Government's cancer Tsar announced a policy consultation. The closing date for responses is 22 August. Interestingly, the terms of reference take account of another consultation - on the NHS constitution. The final constitution will be part of a new law to be proposed in 2009. For the first time the UK will have a constitution with real teeth as opposed to the old patient's charter produced by the last Government. Currently, the draft sticks to the NICE line but adds, "you have a right to a rational decision based on evidence, and a clear explanation if the local NHS decides not to fund treatment."

So here lies the way out of the current impasse. If the drug is not funded the individual gets to know why and have a rational discussion about it. If they want to fund the drug that is fine and they still get the rest of their treatment on the NHS. A bit like where we started from except with the choice lying with the patient as opposed (sometimes) to an overly enthusiastic specialist after a research reputation.