Ian Gibson’s blood is boiling

Co-payments – if you haven’t heard of them, you soon will. When the Richards Review of the consequences of additional private drugs for NHS care is published in October, the cat will stalk among the pigeons.

Co-payments is the term used to refer to the extra payment made when a patient seeks privately to fund a drug or treatment not provided by the NHS, while still receiving NHS care. At present, NHS guidelines state you are either a private patient or an NHS patient and that you cannot ‘top-up’ the NHS basic care package by paying for extra drugs.

Some are heralding co-payments as the future of NHS care. Supporters of co-payments say that the National Institute for Clinical Excellence is not doing the job it is supposed to do in assessing and authorising treatments. They also talk about individual rights and consumer choice, and say each person should be allowed to do as they please with their money. This makes my blood boil. 

NHS principle

I have spent the past ten years campaigning to get patients access to new drugs. No one has fought the battle as long and as hard as me and my colleagues on the All Party Parliamentary Cancer Group. However there comes a point when you have to take a step back and look at the big picture.

The founding principle of the NHS is that treatment is based on clinical need, not ability to pay, and that treatment is free at the point of delivery. To undermine this fundamental principle is to embark upon the slippery slope to privatisation. Co-payments will force more people to go privately for some treatments. Once co-payments are an option, PCTs will become increasingly reluctant to authorise drugs because they know that, if they don’t, the individual will have the option to pay. 

Polarised debate

The media have, as usual,. polarised the debate and given two options. We either allow co-payments or we deny taxpayers access to basic NHS care when they opt to go private. Public opinion is being informed by this polarised view.

In the race to expose NICE and the NHS as drug-denying demons, the media have totally ignored the science behind many new drugs. NICE makes the decision on whether to authorise drugs based on a rigorous process which takes in both the efficacy and the cost of a drug. We have a stringent system of medical licensing for a reason.

The vision of an NHS where patients do some research on the internet and decide they will be cured by one new wonder drug or another, even if it has not been through any standardised trials, is horrific. Is this public engagement? It is more like public brainwash.

Media misrepresentation

Genuine patient and public involvement would be to have an informed debate about the effect of these drugs, the research behind them, the promises they make and what they can actually achieve.

The media has represented Herceptin as a miracle cure. In some ways it is – but only for five per cent of women who take it. One in twenty women who use Herceptin are cured. In 2007, only about ten per cent of people cured of cancer were cured by drugs, while half were cured by surgery.  

Structural changes

There is a third way. We must allow everyone to access treatment where they need it, when they need it and free of charge. We must examine potential structural changes in the health service and potential changes in patient care.

Most of the new proposals floating around have come from the Darzi Review of the Health Service and the draft NHS Constitution.

For the first time, the Department of Health has stated that there must be a clear and transparent process for exceptional cases where people can appeal against a decision by a PCT to refuse a drug or treatment. Doctors must explain more clearly to patients why they have made a decision about a drug or treatment. Patients must be briefed on the efficacy of new drugs. Structurally speaking, NICE must approve drugs much faster, and Darzi believes that this can be done in a matter of weeks. Introducing personal health budgets whereby each person has a fixed sum which they can spend how they wish – be that on expensive cancer drugs or homeopathy – is one option.

Look out for the debate to heat up in October.

Dr Ian Gibson is MP for Norwich North