Top-up care must not lead to ‘apartheid’ for patients

The Department of Health announced last November that patients should be able to top up their NHS treatment with privately funded drugs without losing their NHS entitlement, a move welcomed by patient support groups and the health insurance industry.

Mindful that there may be some devil in the detail, the department decided to seek stakeholders’ views on implementation of the new policy. It asked: “Is the principle of separateness clear?”, “Are sufficient safeguards in place?” and “Should there be more assurance mechanisms in place to ensure the guidance is followed and does not lead to any unintended consequences?”

As a would-be underwriter of healthcare cover to mind the NHS gap, we shared our views with the department and, in our response to its consultation (which closed at the end of January), welcomed its recognition that good clinical governance – with clear, well integrated care pathways – is essential if patients are to benefit fully from a combination of publicly and privately funded care.

We also emphasised the need for clarity on patients’ entitlement to NHS care so they could make informed choices about provision for additional care – a sentiment we are pleased the government has endorsed in the recently published NHS constitution. Clearly, it is important that patients are not drawn into paying for care to which they are entitled under the NHS.

When it comes to payment, accountability for publicly and privately funded treatment will need to be clearly delineated and observed. To help ensure this, primary care trusts (PCTs) and hospital trusts should make clear the treatments that are available (both as a matter of course as well as on an exceptional basis) and the ones patients will need to fund privately. This should be in a easily accessible form to avoid any doubts.

Strategic health authorities should oversee the guidance, as well as having the power to seek redress on behalf of patients if PCTs fail to implement it.

It is also important to recognise the potential conflict of interest facing NHS hospital trusts and specialists because of their ability to generate extra revenue through provision of non-NHS-funded treatment. This is particularly important if, as suggested by the draft guidance, they charge patients at commercial rates. Patients must be protected here as they may have little or no effective choice over their care provider and be in no position to negotiate prices. Moreover, as charges are likely to vary widely around the country, such a “market” must be regulated.

A national tariff covering all aspects of NHS private care, including specialists’ charges and drug costs, should be considered. Its basis should be the cost of provision – not what such a market would bear.

While the principle of separate NHS and privately funded care is, at first sight, clear, any strict appliance of clinical “apartheid” could have untoward consequences for patients. Sick and vulnerable people could be subjected to unnecessarily inconvenient or wearying treatments (for example, having to have separate infusion lines for their NHS and their privately funded drugs or having to travel between different facilities) and/or needless duplication of blood tests and scans.

In our view, care providers should put patients’ wellbeing first and do their utmost to avoid duplication. We would urge that care providers be allowed to share freely the findings of any tests or scans, whether NHS or privately funded, undertaken as part of their treatment.

Teething troubles are inevitable when any new government health policy is introduced. However, we are confident that, if the issues outlined above are properly addressed, patients’ interests will be safeguarded, they will be able to make the most of the choices available to them and, if they want to, successfully combine their NHS and privately funded care.

Fergus Craig is commercial director at AXA PPP Healthcare