Patients should not lose access to NHS if they top up their care

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Speaking ahead of an expected government announcement about the conclusions of a review of the use of additional private drugs for NHS care, Niall Dickson, chief executive of The King’s Fund, said:

'The current situation is simply untenable. Policy should be changed so that, in certain circumstances, patients will not lose their right to access the rest of their care on the NHS if they pay privately for drugs that have been rejected on cost-effective grounds.

'There are areas of the NHS where there is already inconsistency over patient charging, such as eye and dental care, and current rules don’t make it clear to patients why these top-ups are allowed but others, such as the use of non-NICE approved drugs, are not. Variation between local NHS decisions as to whether to allow patients to have non-NICE approved drugs is unclear and confusing and leads to patients feeling like victims of a lottery.

'It must be clear to patients, clinicians and managers the circumstances in which top-ups are allowed so everyone understands the rules, and patients should have access to information about the costs, benefits and limitations of any drug they are thinking of purchasing.

'Patients who decide to pay for an additional drug should also pay for any extra costs to the NHS of administering that drug.

'We will have to wait to see the details of the government's announcement on Tuesday, but it's important that people realise it won’t solve all the problems to do with patients wanting the NHS to provide them with drugs, treatments or devices that are considered too expensive to be freely available. And even if the government does decide to allow top-ups, inevitably some patients will be able to afford to pay and some will not.

'But what we can say is that this review has already been helpful in highlighting the need to look at the value that we put on drugs and care at the end of life and how we assess the cost effectiveness of treatments for very rare diseases.'

Read our full briefing on top-up fees: Top-up payments for drugs in England

Notes to editors

1. A briefing on the issue of top-ups is available above. The King's Fund's official consultation response to Professor Mike Richard's Review is also online. 

2. For further information or interviews, please contact The King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.

3. The King’s Fund seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, developing leaders and improving services. We also offer a wide range of resources to help everyone working in health share knowledge, learning and ideas.