By Graham Satchell
As more new drugs for cancer become unavailable on the NHS should you be able to top up your care and buy the drugs privately?
Diane Wishart faces a struggle to get drug
England is already reviewing the rules and later this week Scottish health minister, Nicola Sturgeon, will clarify the position in Scotland.
The current rules say you cannot mix NHS care with private care.
If you "top up" your NHS care with a cancer drug you have to go totally private.
The expectation is that the Scottish National Party government will stay with the status quo and not allow so called co-payments.
That will come as bad news to Diane Wishart. Diane is 39 with two young daughters. She has breast cancer which has spread to her lungs and liver.
Diane has been fighting to get a new drug Avastin which is licensed, but not available on the NHS.
It does not cure cancer, but can prolong a patients life. It costs about £60,000 a year.
Diane has been told if she buys the drug privately she will have to go totally private and pay for all her treatment.
"You can't put a cost on life," Diane said.
"They should at least allow us to pay for it ourselves and not put a brick wall up, which is what they have done.
"It is really frustrating: when you are young and have got two kids you want to get access to everything you can."
Pressing for change
Top-up payments have come to a head at the Scottish parliament because of a complaint by another cancer patient Mike Gray.
Mike was denied NHS treatment after paying privately for a new cancer drug.
He died while the committee looking at his case was still hearing evidence.
Labour MSP Frank McAveety, who chaired the inquiry, said it was for the Scottish government to change the rules.
"It is out of order that people are denied cancer drugs and when they do pay for those drugs they are denied the NHS care that should come along side that.
"We should be intelligent enough in the 21st century to find a flexible way of doing that without necessarily compromising the founding principles of the NHS."
So will Scotland allow top up payments?
Ms Sturgeon has raised two concerns. The first is clinical: If part of your treatment is private and part NHS who has overall responsibility for your care, and who is accountable if something goes wrong?
The other is a point of principle. Allowing top up payments smashes the fundamental point of the NHS, that it is free, based on need not your ability to pay.
What about those who can't afford to top up?
It is a view shared by many clinicians.
"It is the thin end of the wedge for the end of the NHS," said Dr Rob Glynne-Jones, chief medical advisor to the charity Bowel Cancer UK.
"It won't any longer be a free service at the point of need.
"It will degenerate into a mixed economy with very basic health care provided by the NHS and other things being paid for like the model in the States."
Despite that concern there is a head of steam building to change the policy in England.
The British Medical Association has narrowly voted in favour of co-payments,
The Royal College of Nursing has also reluctantly said it is time for a change, as has the NHS Confederation which represents hospital trusts.
Mike Richards, the cancer tsar for England, who is reviewing the rules in England will report in October.
There are many hurdles to cross yet but it is possible there could be one policy in Scotland and another in the rest of the UK.
For Diane Wishart and thousands of patients in her position it is simple.
She believes she should not be punished for trying to buy a drug that might extend her life.
Even if it does mean the end of a founding principle of the NHS.