Press release: NHS Confederation release top-ups debate paper

16 Jun 2008

A debate on top ups is being launched by NHS leaders to address the difficult issue of top ups. The NHS Confederation has launched a 'Futures debate' paper entitled 'Topping up - should it be allowed?'

Commenting on the paper, NHS Confederation policy director Nigel Edwards said:

"We are pleased to see that the government has indicated that they are going to review their policy on this issue. Excluding patients from the NHS system because they have chosen to top-up their treatment with privately funded drugs seriously threatens to undermine public credibility in the NHS. The current situation is unsustainable and we need to find a solution that recognises a patient's right to spend their own money as they see fit while safeguarding the principles of the NHS."

"If policy is to change, it is vitally important that patients are given access to the best possible information when making decisions on purchasing often very expensive treatments. We can not allow people in such vulnerable positions to have false hope.

"We are asking NHS leaders to help us find a solution to what is a very complex issue. There are many difficult issues to consider fully: How should people be engaged in this debate? How could many adverse effects be mitigated? Would it be helpful for all PCTs to have a common approach to what is not funded? How could patients be helped to make the best decisions? "

"The Confederation asked the IPPR to share some of its thinking to act as a starting point for a discussion with NHS organisations and other stakeholders. This will enable the Confederation to agree a position on this difficult issue.

"The paper explains that the debate about whether patients should be able to buy additional treatments not offered by the NHS produces two polarised points of view. In the press and on the web, opinion is to prevent people topping up is a violation of common sense and the right so the individual. In the political world, topping up is seen as an issue of fundamental importance as it represents a major attack on the underlying principles of the NHS."

James Crabtree, IPPR's Associate Director of Public Services, said:

"The current situation is clearly untenable so we welcome the government's decision to have a review on the issue of top-ups. It should examine the possibility of a top-ups 'premium that could be re-invested into the NHS and NICE providing advice on a specific range of treatments that could be eligible for top-ups."

New treatments, more informed patients and a more transparent approach by NICE to priority-setting are all positive developments. But all make new demands on the NHS. IPPR argues that our health system should be publicly funded and fair and Government should reject changes that undermine the equity of the NHS. A medium way must be found that ensures the equity of the NHS and finds solutions that meet patient demand without creating a two-tier health system"

Key points and questions from the paper:

• New treatments, greater availability of information, greater personal wealth and rationing have created a pressure for the top-up issue to be addressed.
• NHS rules prevent patients from combining private and public healthcare.
• Any move towards a free 'basic core' and charged 'high-quality extended' system or multi-tiered NHS should be avoided.
• Should patients be allowed to pay for drugs which are marginally effective but fall outside the cost-effectiveness threshold for the NHS?

Debate papers can be read at www.debatepapers.org.uk

Notes for editors

The NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.

The NHS Confederation annual conference and exhibition 2008, Delivering the future today, is taking place on 18th - 20th June at Manchester Central.

Contact details

Contact Niall Smith 020 7074 3304 or 07767 770309, Ruth Kennedy 020 7074 3312 or 07884 47 3086, or Ruby Casey-Knight 020 7074 3306 or 07881 957305. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726.

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