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British Prime Minister Gordon Brown, right, with Health Secretary Alan Johnson
British Prime Minister Gordon Brown, right, with Health Secretary Alan Johnson
British Doctors, Patients Fight for Right to Buy Costly Medicines
Faced with legal action, Britain’s National Health Service considers allowing NHS patients who pay privately for costly, non-approved drugs to continue receiving public health care services.
30-Second Summary
Six cancer patients have taken legal action against the NHS, Britain’s public health care system, for the right to take medication not covered by the NHS that may drastically increase their chances of survival.
The contested NHS ‘top-up’ policy stipulates that if a patient buys medication privately, the National Health Service will not cover any other medical expenses.
Patients say they’re forced to either pay thousands of pounds to cover all of their health care, or to remain on less-effective, NHS-approved drugs.
The recent death of cancer patient Lisa O’Boyle made national news in England. Doctors told her that the drug Cetuximab, which is not covered by the NHS, would help her chances of survival. When she bought the drug on her own, the NHS said they would stop funding her free treatment.
The patients in the lawsuit want access to drugs which have generally been proven safe and effective, but have not been approved by the National Institute for Health and Clinical Excellence (NICE) because they are not considered cost-effective for the health care system.
The NHS argues that adding such privately-funded drugs to public care creates an unequal, two-tiered system. However, following the legal action, negative publicity and pressure from Parliament, it has agreed to review the policy.
The contested NHS ‘top-up’ policy stipulates that if a patient buys medication privately, the National Health Service will not cover any other medical expenses.
Patients say they’re forced to either pay thousands of pounds to cover all of their health care, or to remain on less-effective, NHS-approved drugs.
The recent death of cancer patient Lisa O’Boyle made national news in England. Doctors told her that the drug Cetuximab, which is not covered by the NHS, would help her chances of survival. When she bought the drug on her own, the NHS said they would stop funding her free treatment.
The patients in the lawsuit want access to drugs which have generally been proven safe and effective, but have not been approved by the National Institute for Health and Clinical Excellence (NICE) because they are not considered cost-effective for the health care system.
The NHS argues that adding such privately-funded drugs to public care creates an unequal, two-tiered system. However, following the legal action, negative publicity and pressure from Parliament, it has agreed to review the policy.
Headline Link: NHS to review policy
Health secretary Alan Johnson announced that there would be a review of the 20-year-old, top-up policy. Mike Richards, the national clinical director for cancer, will lead the review, which will report back to the government by next October. “This is a very complex issue so it needs to be reviewed,” Johnson said. “We want to be fair to everyone ... while protecting the principles of the NHS.”
Source: The BBC
Background: NHS’ ‘top-up’ policy enacted to prevent two-tier system
The policy was created 20 years ago to prevent private consultants from “raiding NHS waiting lists.” It received little attention until last year, when it was used to withdraw free health care from patients who used private treatment. This was done to support the NHS’s founding mission “to provide care to all that is free at the point of use, untainted by a “two-tier” system that produces better outcomes for the better off.”
Source: The Economist
The media profiled many patients whose free care was cut off by the NHS. The most well-known is bowel cancer patient Linda O’Boyle. She attempted to top up her NHS care with the drug Cetuximab, which is only available for NHS patients in Scotland. She and her husband paid £11,000 for two months of treatment with Cetuximab, but were told that they would also have to pay for care that was previously covered by the NHS. She died this past March, becoming the first patient to die while challenging the top-up policy.
Source: The Daily Mail
Doctors for Reform, a group representing nearly 1,000 doctors, raised £35,000 to launch a legal action to force a judicial review of the policy. Dr. Christoph Lees said, “Doctors are caught in a terrible dilemma: do you tell a patient about a drug that could improve their quality of life, or do you pretend it doesn’t exist?”
Source: Times Online
Richard Eckley, a 68-year old farmer, chose to pay for a drug that doubles his chance of survival. In doing so, he is also forced to pay for doctor appointments, blood tests, scans and other procedures once covered by NHS. “We feel very disappointed that, after we have paid all this money into the health service [in tax], it is not there for us when we need it,” his wife said. Eckley, along with five other patients, is taking legal action to force NHS to pay for their health care.
Source: Times Online
Opinion & Analysis: The ‘top-up’ ban: egalitarian or unfair?
The Guardian’s John Appleby writes, “But before giving a green light to top-ups, a publicly funded health system has to take a wider perspective and ask a hard question. If we are prepared to allow some patients to top up their treatment can it be done without seriously damaging the equity of our current system?” He suggests that all patients will have to be given access to top-up drugs, which would threaten the affordability of NHS. “The difficult issue facing politicians is how to ensure that NHS principles are not undermined while at the same time being proportionate and humane.”
Source: The Guardian
The Independent’s John Rentoul writes that the founding principle of the NHS was “that everyone would be entitled to medical treatment regardless of their ability to pay.” However, it has become “pickled into the idea that everyone had to be treated the same.” He adds, “The Government's policy is like telling parents that if they pay for a private tutor, their children won't be allowed to continue to attend a state school. In other words, if everyone cannot have something, then no one can.”
Source: The Independent
Related Topics: NICE and the ‘Postcode lottery’
The National Institute for Health and Clinical Excellence (NICE) determines which drugs and treatments are to be used in NHS health care. It makes these decisions based primarily on cost-effectiveness, rather than the effectiveness of treating disease. This past January, the House of Commons published a report calling for “a change in the law so that Nice can assess not only medical costs and benefits but also the broader social impact of new medicines.” However, the report “steered clear of radical calls for reforms” and the Association of the British Pharmaceutical Industry said that “patients will see little benefit.”
Source: Financial Times (free registration may be required)
In a typical decision by NICE, it chose to not include lung cancer-drug Tarceva based on its cost. Anne Davis, wife of a man who died of lung cancer in part because he couldn’t get access to Tarceva, said, “No-one should be denied their last hope of treatment and surely a price cannot be put on a person’s life. It’s appalling a decision has been based around cost rather than health benefits.”
Source: Evening Chronicle
The NHS has been criticized for its postcode lottery system, which designates levels of care based on where a patient lives. The Sunday Sun recently profiled one cancer patient who may sell his home and move to a part in the country that supplies the drug Sutent. “I feel angry towards the NHS because it is supposed to act according to a socialist principle to provide healthcare for all. I want this drug to be available to everyone no matter where they live,” his daughter said. “If Dad should lose his life to cancer, it would be devastating, but to lose his life to bureaucracy would be far, far worse.”
Source: Sunday Sun
Reference: NHS, NICE and Doctors for Reform
The National Health Service is Britain’s national health care service. Its Web site includes health advice, health news, a list of services it provides and a look back at its 60-year existence.
Source: National Health Service
The National Institute for Health and Clinical Excellence is an independent health organization that is used by the NHS to determine which drugs should be included in NHS care. On its Web site, NICE presents its health guidance and explains how it decides what treatments, drugs, procedures and health advice should be used by the NHS.
Source: National Institute for Health and Clinical Excellence
Doctors for Reform is an organization of nearly 1,000 British doctors who have launched a campaign to allow patients to top up their health care. Its Web site features news and debate on the top-up issue, and answers frequently-asked questions about the NHS. It asks for donations for its legal fund that it is using to challenge the top-up policy.
Source: Doctors for Reform
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