Global Insight Perspective | |
Significance | At least 30 public hospitals in England are allowing specialists to prescribe non-reimbursable drugs for NHS patients on the understanding that they will pay for them via a private care provider. |
Implications | The practice is technically in breach of U.K. rules which prevent patients from receiving public and private care simultaneously for the same disease. However, several NHS trusts have found a loophole in the official guidelines that allows them to bend the rules in favour of individual patients. |
Outlook | The news will add further impetus to an upcoming review of "top-up" care within the NHS, which is set to impose nationwide standardisation on the practice. Pharma companies have been offered a risk-sharing deal on the price of new drugs for chronic diseases, which if implemented could reduce the need for NHS top-ups in the first place. |
Public hospitals across England are bending the rules on private healthcare in a bid to offer patients the most comprehensive coverage available, according to the BBC. An investigation by the national broadcaster has found that a private company called Healthcare at Home is supplying "top-up" treatments to patients who are simultaneously receiving care via the National Health Service (NHS). Healthcare at Home has claimed that it has secured such contracts with 30 NHS trusts around the country.
Current law forbids patients in England and across the United Kingdom from receiving a mix of NHS and private treatment, theoretically meaning that they must make a choice between the two. In practice, however, NHS trusts are able to circumvent this by exploiting a loophole in the legislation, which specifies only that patients cannot mix NHS and private treatment within the same "episode of care". Since there is nothing to specify that an episode of care must cover all treatment received for a disease from start to finish, some trusts are allowing patients to receive state care through one physician or specialist while enlisting the aid of another within the same hospital to prescribe medicines that are not funded through the NHS. Patients then pay Healthcare at Home to fill the prescription and supply it to them at their private residence.
The news has come as England's National Clinical Director for Cancer, Mike Richards, is about to release a report on the practice of top-up treatment on the NHS, with a view to eventually standardising it across England. Separate reviews on the same subject are simultaneously being carried out in Scotland and Wales.
Outlook and Implications
While Healthcare at Home is the only private company reported by the BBC to be supplying NHS patients, there is nothing to suggest that it is alone in the country in doing so, and indeed it is likely that the practice is more widespread than first believed. This adds another layer of complexity to the debate about how best to fund treatments for the chronically ill, particularly people with advanced or aggressive forms of cancer.
With several of the newest and most innovative cancer treatments still not recommended for NHS use on cost-effectiveness grounds, despite being approved for marketing in the United Kingdom, the government has already floated a number of schemes to help boost cancer care. Prime Minister Gordon Brown last month revealed that prescription charges for cancer patients would be wiped out over the next few years, in a move that is expected to cost the NHS £200-250 million (US$351-438.8 million) annually (see United Kingdom: 26 September 2008: U.K. PM Announces Prescription Charge Abolition for Cancer Patients). This, however, does nothing to address the problem of accessing treatments that are not subsidised by the NHS.
A second initiative, however, holds more promise both for patients and for the pharmaceutical industry. Weekly talks are reportedly being held between government officials and the Association of the British Pharmaceutical Industry (ABPI) in an effort to develop a harmonised approach to risk-sharing on the price of new drugs, in a bid to see more innovative treatments given backing for reimbursement by the National Institute for Health and Clinical Excellence (NICE; see United Kingdom: 10 October 2008: Government Pushes for Compromise with ABPI on Drug Price Risk-Sharing as Standard U.K. Policy).