NHS ban on top-ups is removed

Patients who choose to top-up their existing care will no longer be denied treatment on the NHS, following the Secretary of State for Health’s complete adoption of the recommendations laid out in the Richards Review.

Until now there has been a degree of uncertainty over whether those claiming under a health insurance policy would be left with a bill for the rest of their NHS care. But the removal of the ban means that for the first time patients can combine NHS treatment with private medical insurance.

Most private insurers say drugs will be covered under their policies provided that they are recommend by the patient's doctor and are proven to improve survival chances or extend life expectancy. But insurance will not pay out for all new drugs in all circumstances; as cost and effectiveness will also be considered.

Until now, the NHS has deemed many patients who chose to pay for expensive but potentially life-prolonging drugs ‘private’ patients. This effectively left them facing bills running into tens of thousands of pounds for the rest of their care.

This has now been overturned after protests from patient groups, many of which were protesting about the ‘postcode lottery’ that existed – some consultants allowed ‘top-up’ payments while other withdrew state-funded care.

Many of the drugs in question will extend a patient's life only for a matter of months, and their expense means that they frequently breach the cost-effectiveness guidelines used by Nice (the National Institute of Health & Clinical Excellence), which decides which drugs NHS doctors can prescribe.

However, there are fears that, if patients can top up their treatment, only wealthier people who can afford such treatments will benefit.

Health insurance companies are now expected to launch new policies that could help more patients benefit from these medical advances. At present there is just one policy on the market that provides cover for such ‘top-up’ payments; WPA’s, MyCancerDrugs. This pays for licensed drug treatments recommended by doctors but not available on the NHS. This cover has to be bought when people are fit and well and is not available to those who are already undergoing cancer treatment. Unlike most private medical insurance policies, MyCancerDrugs does not pay for private consultations or treatment in a private hospital, or allow policyholders to jump waiting lists. It simply covers the cost of the latest drugs.


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