Sunday, June 22, 2008


The debate on co-payments has increased again over the part couple of weeks and it seems to need exploring further.

The current debate seems to focus upon the Tory policy of top up health care, i.e. creating a two tier health care system that effective excludes people who can't afford to pay from receiving clinically effective treatment - breaking the founding policy of the NHS: health care based on clinical need not ability to pay.

Clearly the Tory policy is barking mad and should be opposed at every turn, however the current Labour policy appears to deny patients NHS care when they opt to have additional care on top of their NHS treatment. Desperate patients are therefore banned from seeking desperate alternative measures.This too seems wrong, but we need to understand why.

The top up rule was alledgely put in place top prevent doctors misusing the system to benefit their private practice and the Department of Health document: "A code of conduct for private practice: recommended standards of practice for NHS consultants"

The relevant section says:

2.13 Where a patient wishes to change from private to NHS status, consultants should help ensure that the following principles apply:
• a patient cannot be both a private and a NHS patient for the treatment of one condition during a single visit to a NHS organisation;

Interestingly this doesn't actually ban patients having top up treatments... although some trusts seem to treat it as such.

The key to the debate is whether or not the NHS can provide the full range of clinically effective treatments that patients need. Clearly the founding principle of the NHS states that it should and it seems that at present this principle is adhered to. The formation of NICE aids this principle (although I have some reservations about the processes behind NICE) providing a clear indication of what treatments are clinically effective and reasonable to be provided by the NHS.

The present system means that the founding principle is adhered to and ignoring that NICE could make mistakes, that BigPharma are great at publication bias, that alternative treatments not backed by BigPharma get little research funding, etc., this should make top-up treatments a complete waste of time and money.

However is people want to waste their time and money on extra treatments, should they be allowed to do this without being expelled from the NHS. I think the answer has to be yes.

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