Mike Richards' eagerly awaited report for the Department of Health on NHS top-ups has apparently end...
Mike Richards' eagerly awaited report for the Department of Health on NHS top-ups has apparently ended the system of charging for NHS care where patients opt to pay privately for drugs not available on the NHS. The change of policy has been welcomed by the insurance industry and it seems that a difficult issue has been resolved.
In fact, this is far from the case, as can be seen from the draft guidance on how the policy should be implemented in practice.
The guidance states that where a patient opts to pay for private care, their entitlement to NHS services remains but then adds that it should always be clear whether any treatment is private or NHS funded and that private care should be carried out at a different time and place. This is to avoid the unfairness of two patients being in the same ward and getting different treatments - in other words, this is OK as long as people don't find out. So how will this apply in practice?
First, the patient's clinician must exhaust all potential avenues for NHS funding, establishing whether funding for the non-National Institute for Clinical Excellence approved treatment can be obtained via their Primary Care Trusts which means the postcode lottery remains.
If the treatment cannot be funded in a particular case can we assume the patient will not be charged for the NHS care? No.
The guidance gives two examples. The first is for a high-cost unfunded drug. As well as the cost of the drug, the patient is charged for the cost of any staff involved in its provision, plus any resulting scans or blood tests. As many treatments will be combinations of interventions and drugs, it is hard to see how this can be applied in practice - but it does 'fit' with the separation of funding principle.
The second example goes further. Here a patient needs a cataract operation and wants to have a multi-focal lens fitted which are not routinely available on the NHS. In this case it is not possible to separate out the NHS and private elements of care and the guidance states that the patient can only chose between a single focus lens and care paid for by the NHS or pay for the whole lot privately.
The guidance is a complex backtrack from the principles of the review. Patients will still be none the wiser about whether and what they will have to pay. And for insurers, it will be very difficult to cost. The parallels with long term care are obvious. Private medical insurance providers need to make the case for applying the principles of the review in a simple and uniform way across England.
Richard Walsh is managing director of SPPR Consulting.
