The government’s proposal that top-up care can be safely quarantined in privately run facilities seems to run counter to many aspects of good clinical care. Concerns that continuity could be undermined and patient safety compromised appear well founded.
Not that these concerns should have stood in the way of the government’s decision. The idea that an individual’s decision to seek paid-for treatment should bar them from NHS care has long been indefensible and impractical. The NHS exists to ensure patients receive the best cost-effective care, not to penalise those seeking alternate or additional remedies.
However, the consultation the government is undertaking into the idea will need to reach more realistic conclusions. It may be that rather than imposing an unworkable separation on care, those choosing to pay for additional treatment will have to bear the full cost of the NHS staff delivering it.
Of course, the number of patients affected will be tiny. Even if the number grows above the 15,000 that appealed – 75% successfully – for extra funding to their local trust last year, most nurses will not encounter such a patient.
But there is a significant danger that they will encounter a belief from patients that the NHS is somehow delivering second best care. This divisive misconception may be a consequence of the move not to continue the ban on top-up care.
It is this belief which is the biggest threat to the sense of shared endeavour that underpins the NHS and could prove highly disruptive to good quality nursing.
Nurses can do much to combat this threat by ensuring that they are able to explain the basis of funding decisions. They should also be in a position to counter common myths such as the belief that the newest and most expensive drugs represent the gold standard – when, of course, it is tried and tested treatments about which outcomes and side-effects are fully understood, which are often more effective and, of course, affordable.