New guidance published today clarifies the position around rights of access to NHS services for patients paying for additional "top-up" private treatment or medicines.
It includes case studies to help clinicians and managers decide when it is appropriate for NHS care to continue, such as on safety or clinical efficacy grounds. It also sets out examples of where NHS care should be denied, such as where this would compromise the care of NHS patients.
It stresses that doctors and managers should exhaust "all reasonable avenues" for securing NHS funding before suggesting a patient’s only option is to pay for care privately.
The guidance follows the long standing controversy around situations where NHS patients who chose to buy additional non-NHS funded treatment such as some cancer drugs gave up their right to NHS care.
In response National Cancer Director Professor Mike Richard's report on Improving Access to Medicines for NHS Patients, published in November last year, and the Secretary of State’s announcement of a package of measures designed to make more drugs available to NHS patients free of charge on the NHS.
In a letter to NHS managers published today the NHS chief executive David Nicholson said measures, such as the National Institute for Health and Clinical Excellence’s introduction of greater flexibility into its appraisal of more expensive drugs for end of life conditions, should significantly reduce the number of patients who will ever want to pay for additional private care.
But he adds for those "few" patients who may still wish to pay for additional private care, the Department published guidance for consultation which made clear that NHS patients should not lose their entitlement to NHS care as a result of choosing to buy additional private care, and that any private care must be delivered separately from NHS care.
Mr Nicholson said the Department received 146 consultation responses on the guidance, and said it was "pleased to note the broad support for Professor Richards’ recommendations and the aims of the guidance".
In response to specific issues raised in consultation, such as a request for more detail about what separation means in practice, the final version of the guidance includes a number of changes which are explained in the accompanying government response. It also includes a number of case study scenarios to help clarify the position and stresses that primary care trusts should "particularly bear in mind the need for timely decisions, especially when patients are seeking funding for end of life treatments".
"In line with the founding principles of an NHS based on clinical need and not ability to pay, PCTs must never take a patient’s financial circumstances or willingness to pay into account when making decisions on funding," the guidance adds.
This guidance establishes that, where a patient opts to pay for private care, their entitlement to NHS services remains and may not be withdrawn.
- Patients may pay for additional private healthcare while continuing to receive care from the NHS. However, in order to ensure that there is no risk of the NHS subsidising private care:
- It should always be clear whether an individual procedure or treatment is privately funded or NHS funded.
- Private and NHS care should be kept as clearly separate as possible.
- Private care should be carried out at a different time to the NHS care that a patient is receiving.
- Private care should be carried out in a different place to NHS care, as separate from other NHS patients as possible.