Top-up fees : fourth report of session 2008-09, Vol. 1: Report, together with formal minutes, oral and written evidence

This Health Committee report examines the issue of top-up fees in relation to NHS patients wishing to buy additional drugs privately.

In June 2008, the Secretary of State appointed Professor Mike Richards - National Clinical Director for Cancer - to examine the availability of NHS medicines and to provide guidance on the circumstances where patients should be able to purchase additional drugs not funded by the NHS.

As a consequence the Department of Health and NICE set out three decisions to implement the recommendations: NHS trusts were told to end immediately the practice of withdrawing NHS treatment from patients who purchased drugs privately; guidance was provided to NHS trusts where patients continued to purchase private drugs; and, supplementary guidance was issued to NICE to make available a greater range of more expensive drugs to a greater number of NHS patients.

Although the Health Committee welcomes the above new approaches, it also sees certain consequences, in particular the development of a two-tier health system. For example, the Committee believes it would be wrong for very seriously ill patients to be moved from an NHS ward to a different location so as to administer a privately paid drug.

Another potential danger is that two patients with identical conditions in the same NHS ward receive different treatments because one patient could afford it and the other could not.

The Committee believes good continuity of care between the NHS and the private sector is therefore essential in this area.

Overall the Committee is not convinced that a two-tier system will not develop, and that the Department of Health needs to monitor the implementation of Professor Richards' recommendations.

Professor Mike Richards' November 2008 Report "Improving Access to Medicines for NHS Patients" is available to download from the Department of Health website.