Top-Up Fees Threat To The NHS


An admission by director of policy and strategy for the Department of Health, Una O’Brien, has stirred up concerns that ‘co-payments’ or top-up fees have brought in a two-tier NHS.

At a recent House of Commons health committee evidence session, committee chairman Kevin Baron asked her whether patients on the same ward could receive different drugs based on their ability to pay

O’Brien replied: ‘I think it is a theoretical possibility but I would stress that the thrust of the policy overall is to reduce the circumstances in which that would ever arise.’

Karen Jennings, UNISON Head of Health warned yesterday: ‘We want to see the best for patients and the current system needs changing, but introducing top-ups, even for a small number, will shake the very foundations of the NHS.

‘The principle that it is there for you at your time of greatest need, without having to worry about cost or affordability, is one worth fighting for.

‘There is a very real danger that introducing top-ups for drugs will open the floodgates in other areas.

‘There is a whole raft of policies waiting in the wings that will further encroach on the principle of healthcare based on need, not ability to pay.

‘It’s time drug companies faced up to their social responsibilities and cut the cost of their outrageously expensive drugs.

‘These multi-national companies spend more on marketing than they do on research and development.

‘They could play a major role in ensuring patients get the drugs they need without having to resort to top-ups.’

Commenting on the question of patients on the same ward receiving different drugs based on their ability to pay. a BMA spokesperson said: ‘This was always a concern about changing the rules on top-up payments.

‘The key challenge was always going to be avoiding the creation of a two-tier system where some NHS patients receive inferior treatment to others because they cannot afford to “top-up”.

The Royal College of Nursing (RCN) earlier responded to draft Department of Health guidance on NHS patients ‘who wish to pay for additional private care’.

The RCN contributed to the consultation, and recommended that TOP-UP payments be permitted but only for a limited period whilst the full implications were investigated.

RCN Chief Executive & General Secretary, Dr Peter Carter said: ‘This is a deeply complex issue, and the next steps taken by the government will be of immense importance.

‘The implications of unfettered top-up care could have a huge impact on the founding principles of the NHS, which is why the government must be clear in its decision about how top-up care works in practice.

‘We do not want to face a situation where two patients in neighbouring beds can be offered different menus of treatment, based solely on their ability to pay.’