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July 2010
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Cancer Commissioning—at a global and a local level: London Cancer New Drugs Group Annual Meeting
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Additional private care in practice
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David Webb (Director of Clinical Pharmacy, London, Eastern and South-East Specialist Pharmacy Services) reported that additional private care had become a thorny issue for the NHS—a visible aspect of the tension between collectivism and individualism. “There has been a great deal of talk, but very little action,” he said.
When Nye Bevan first talked about the spectre of cost creating a barrier between patient and clinician he also talked about the ‘inevitability’ of some patients wanting to buy more than the new NHS was likely to be able to provide. Over six decades later, in 2008, the Department of Health report, ‘Improving access to medicines for NHS patients’ (by Mike Richards) referred to a historic tension between equity and autonomy. “So clearly, little has changed,” said Mr Webb. “This is not a new phenomenon.”
- Professor Richards established four basic principles:
- A framework that would minimise the number of people having to seek additional paid-for therapies
- Greater clarity for those who continue to seek additional care
- Better information highlighting the benefits, toxicities and costs of such care
- Transparency in the fundamental separation of NHS and private care
Mr Webb argued that the notion of ‘top-up’ care should be discouraged when discussing additional private care. With top-up, it would be quite possible for two patients in adjacent beds to receive different care based on their ability to pay. It also suggested that the NHS had reverted to only the most basic provision of care, with everything else having to be paid for.
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Discussion.