The Scottish government risks creating a two-tier health system by permitting patients to supplement their NHS treatment with expensive private prescription medicines, a leading cancer charity warned yesterday.
Permitting patients to obtain drugs privately while receiving the rest of their care through the NHS could increase discrimination in healthcare against those people least able to pay, Ian Beaumont, communications director for the charity Bowel Cancer UK, said.
"Any move towards a co-payments system in Scotland, however well-intentioned, will have a negative effect on patients," he said.
In a letter this week to the Scottish parliament, Nicola Sturgeon, Scotland's deputy first minister and cabinet secretary for health and wellbeing, said "there may be a case" for cancer patients to top up their NHS care with drugs not paid for by the health service. Her comments were the first indication of official support in the UK for "co-payment", demanded by an increasing number of patients who are willing to pay for expensive cancer treatments that the NHS will not fund.
Westminster responded to growing pressure this spring and announced a review of the issue by the cancer tsar, due to conclude next month. The review follows concerns over "postcode prescribing", with primary care trusts across the country taking different positions on paying for drugs or permitting patients to pay for them while receiving the rest of their care on the NHS.
The government's drugs advisory body for England and Wales, the National Institute of Health and Clinical Excellence, has recommended against the NHS paying for a number of costly new cancer drugs judged not to be cost-effective in terms of the health benefits they provide.
In her letter, however, Ms Sturgeon indicated support for "simultaneous care in the NHS and the private sector where there are clear clinical accountability and governance arrangements in place". She stressed that judgments would need to be made in each individual case, and co-payment "would be unlikely to be a viable option" if the risks of drugs not available on the NHS were "highly likely to
compromise patient safety, clinical or professional accountability".
The Scottish government has its own Scottish Medicines Consortium to assess drug reimbursement, which is shortly to begin developing principles on drug prescribing and funding.
Bowel Cancer UK, along with other cancer charities and the pharmaceutical companies, argues that the methodology used by Nice to assess drugs is flawed and should be modified to permit the NHS to reimburse the cost of more drugs.
In the latest case of conflict over expensive treatments, Colin Ross, a terminal multiple myeloma patient, yesterday took West Sussex Primary Care Trust to the high court over its refusal to pay for the drug Revlimid. The medicine has yet to be reviewed by Nice.
