Calls for NHS rule change to allow co-payment
pharmafile | April 30, 2008 | News story | |
Calls to allow patients to contribute to the cost of NHS services, including expensive cancer treatments have been renewed.
'Co-payment', where patients pay part of their treatment costs, is currently banned under most circumstances on the NHS, but some stakeholders are urging for the rules to be changed.
Pressure to change is particularly strong in the field of cancer, where a wave of expensive new treatments are being launched, but are often not available on the NHS.
Chris Brinsmead, head of AstraZeneca's UK business and the new ABPI President, was among those who have expressed their support for the move.
Speaking at the Westminster Health Forum conference on reform of NHS cancer services, Brinsmead responded positively to the suggestion.
"My view is that the industry should work with the government to figure out a way round it," he said.
The main obstacle to introducing co-payment on the NHS is that it would contravene the fundamental principle of a 'free at the point of care' health service, which aims to give everybody fair access to treatment.
But many patients say in practice the rule is itself unfair.
Some patients want to pay privately for new cancer drugs but still get the rest of their treatment free on the NHS. Under current NHS rules this is not allowed, forcing patients that want to go private to pay for all their care.
"There must be a solution – if we put our heads together we can find a way through this," Brinsmead commented.
However he conceded that the Health Secretary Alan Johnson has indicated his opposition to such a rule change, saying such a rule change would spell the end of the NHS's central principle of a 'free at the point of care' service.
Dr Sandy Bradbrook, chief executive of Heart of Birmingham PCT, also indicated his support for a re-think on the policy. He pointed to the fact that co-payments are already a reality in terms of paying a flat fee for prescriptions.
"There is a way forward on this because at the end of the day we need to balance [finite] NHS budgets with the needs of patients," he said.
"There has to be some way of making that bridge; and co-payments do [already] exist."
But several of the speakers expressed their opposition to the move, citing experience in the US where co-payments have placed a heavy burden on patients.
Dr Kalipso Chalkidou is associate director in NICE's clinical and public health directorate, and also a Harnkess Fellow at the John Hopkins Bloomberg School of Public Health in the US.
"We have to be careful what we wish for. A lot of patients in the US are facing financial catastrophe because of the co-payments system there," she said.
Responding to claims that NICE was denying patients access to new cancer treatments, Dr Chalkidou said NICE was not the only body to influence the decision: "It's also about the people who set the prices" she said.
Ciaran Devane, chief executive of MacMillan Cancer Support agreed the US experience of co-payment was not positive.
"I am not a fan of co-payment having seen it in the US. For those of use with big salaries, it doesn't feel like a big thing, but if you are on benefits then it feels like a big thing. So I think moving away from 'free at the point of care' health is a big risk."
Professor Karol Sikora, a cancer specialist and member of Doctors for Reform, said the NHS had to face up to the growing cost of new treatments, and that this required a revolution in its funding.
Despite this growing calls for change, there seems to be little political will for change, either from the government or the opposition. Mark Simmonds, MP and Shadow Minister for Health, said he agreed that the problem of access to new cancer medicines was a growing one, but predicted the issue wouldn't be addressed until after the next general election.
