AXA PPP healthcare responds on top up guidance

AXA PPP healthcare, in its response to the Department of Health's consultation on implementation of its guidance for allowing for top up treatment, has identified communication of patients' NHS entitlement, conflicts of interest, and untoward consequences of clinical apartheid as issues giving potential for cause for concern.

Fergus Craig says, “As prospective underwriters of healthcare cover to mind the NHS gap, we are pleased that the government has recognised that good clinical governance - with effective continuity of care and coordination between NHS and private providers - is imperative if patients are to make the most of the choices available to them. Clarity of patients' entitlement to NHS care is critical for successful implementation of the top up guidance and it is reassuring to see that the NHS in England has now enshrined this right in its recently published constitution.”

The insurer is calling for primary care trusts and hospital trusts to publish, in a readily accessible form, which treatments they will pay for and which ones patients will have to pay for themselves. To give the new policy teeth, implementation and monitoring should be overseen by the NHS' strategic health authorities and findings published to enable patients to see for themselves whether it is being fairly and effectively applied.

Conflicts of interest are a potential concern as both NHS hospital trusts and treating doctors stand to generate additional revenue by treating patients in their private facilities. To help to address this, consideration should be given to providing patients with ready access to second opinions and to the findings of independent expert reports to help them to make informed decisions about their treatment.

Protection of patients needs to be strong to ensure they are not drawn into paying for care to which they are entitled under the NHS. This is important as, in practice, patients may have little or no real choice over their care provider and be poorly placed to negotiate prices. Moreover, as patients’ charges are likely to vary throughout the country, this ‘market' should be regulated, with the Department of Health introducing a national tariff for NHS private care based on the cost of provision - not at what the market would bear.

The insurer appreciates the government's concern that NHS and privately funded care should be kept separate to avoid inappropriate cross subsidy. However, too rigid adherence to the principle of clinical apartheid may result in untoward consequences for sick and vulnerable patients, such as being subjected to unnecessarily inconvenient or wearying treatment regimes. Similarly needless duplication and cost of blood tests and scans to monitor patient progress should also be avoided, and care providers allowed to share test results irrespective of whether they were NHS or privately funded.

Fergus Craig concludes, “We welcome the Department of Health's decision to allow patients to complement their NHS treatment and privately funded care. It is a big step in the right direction of giving patients greater choice over their healthcare provision and I am confident that the obstacles highlighted above can be successfully overcome.”

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