Top-ups are just the thin edge of the wedge in an inevitable movement towards a co-payment model for funding healthcare, according to a leading clinician.
Speaking at Laing and Buisson’s annual PMI conference, Professor Karol Sikora, medical director of Cancer Partners UK, predicted that the existing NHS funding model would never be able respond to the growth in expensive medical innovations.
“The need for top ups has been dampened but it is going to come back with a vengeance,” he said.
Highlighting poor access to targeted radiotherapy and a pipeline of 40 new drugs (at a cost of up to £100,000 per patient), Professor Sikora, currently developing a network of independent cancer therapy centres, warned that in the current NHS “not everybody can have everything”, making the involvement of the private sector inevitable.
The conference took place in the same week that the parliamentary Health Committee raised concerns that the implementation of top-ups guidance could result in the emergence of a two-tier NHS. The report on top-up fees also described the new guidance on approving endof-life drugs as an “inequitable and an inefficient use of NHS resources,” highlighting the finite funds available to the Department of Health (DH).
The committee expressed doubts about whether the principle of delivering NHS and privately-funded care separately was even feasible, fuelled by evidence from the Royal College of Physicians and a claim from one NHS chief executive that it was “naive” and “simply not possible”.
“This undoubted disruption to a patient’s quality of life just to meet some bureaucratic requirement would not only endanger the patient’s care but would be unjust,” the MPs concluded. The report expresses their “surprise” at the failure of the DH estimate the costs of separating care.
Dr Gary Bolger, head of medical policy at insurer AXAPPP healthcare, welcomed the Department’s relaxed guidance on separation of care (which prioritises patient safety), describing it as “clinical apartheid”, but expressed ongoing concern that primary care trusts, rather than oncologists, should take responsibility for communicating funding decisions to patients.
Dr Bolger said that AXAPPP was keeping the potential to launch a topup product under review but predicted that it was unlikely to happen this side of a general election.
“After the general election, things may well change – especially with ever increasing consumer demand for healthcare services and increasing pressure on NHS funding,” he explained.
While Professor Sikora’s presentation highlighted the emergence of “emerged, informed consumers” of healthcare, research from Beating Bowel Cancer suggested that oncologists are failing to inform their patients about all treatment options.
According to the charity’s Ethical Dilemmas survey carried out in February of this year, 76% of oncology consultants only sometimes or rarely mention non-funded treatments to patients and 80% felt that only one in five patients were already well-informed about them.