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Call for re-think on top-up fees

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Ministers should allow patients to have private cancer treatment alongside NHS care as an interim measure while a more thorough review of the top-up payment system takes place, says the RCN.

The college last week published its response to a review sparked by several cases of patients in England being banned from receiving NHS care after paying privately for additional cancer drugs.

Health secretary Alan Johnson asked government national cancer director Mike Richards in June to review policy on patients who choose to pay privately for drugs not funded on the NHS, with a deadline of October.

In its submission to the review, the RCN says this is far too short a period of time in which to consider the full complexity of the issue, nor is the scope of the review broad enough.

It points out that treatment combinations exist in many other areas such as long-term care, social care, audiology and dental services.

The RCN submission clarifies the distinction between co-payments and top-up payments. Co-payments are a contribution to the overall cost of a product. Top-up payments are those made to buy products in addition to those provided by the NHS.
The ‘bewildering array’ of both across health and social care settings must be looked at for ‘proper reflection of the whole picture’, the RCN said.

‘We recognise that there do have to be limits but we should be having the bigger political debate on what is the NHS package that we get free and what should we have to pay for. While we have this debate, people should be able to top up,’ said Howard Catton, RCN head of policy.

At the British Medical Association’s conference in July, doctors agreed with the RCN that the review was not detailed enough.

The RCN also calls for a review of how PCTs handle patient requests for the NHS to pay for treatments outside the scope of NICE – known as exceptional case requests – plus national guidelines to ensure consistency. The Rare Cancers Forum recently described the exceptional case system as ‘in chaos’ (NT News, 19 August, p7).

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