Page last updated at 17:16 GMT, Tuesday, 4 November 2008

Top-up plans 'should go further'

Karol Sikora
By Professor Karol Sikora
Medical director of Cancer Partners UK

Erbitux (cetuximab), is used to treat bowel cancer
Drugs including Erbitux have not been funded by the NHS

The government has announced cancer patients can pay for their own drugs and not lose their NHS care.

But leading expert Karol Sikora, whose organisation Cancer Partners UK runs independent cancer centres, says it should push forward with even more radical reforms.

The decision to allow people to pay for additional cancer drugs that the NHS will not provide has ended truly universal care for all.

There is already a growing use of top-up payments to break access barriers in the NHS in areas as diverse as hearing aids, access to diagnostic tests such as scans and even home nursing care services.

In some areas, for example fertility treatment, this is enshrined in NHS guidance from the National Institute for Health and Clinical Excellence (NICE), whereby the health service pays for three IVF attempts but further ones must be self-funded.

It is essential that NHS patients not paying for extra care are not adversely affected by the right of patients to top-up

If the treatment is successful, the mother to be reverts back to the NHS for her antenatal care.

Many politicians, whatever their persuasion, have until now been in denial.

Meanwhile, cancer patients have learned to become very sophisticated consumers of extra clinical services outside the NHS using a mixture of different providers sometimes in different cities.

Payment in advance?

The recommendations from the government's cancer czar Professor Mike Richards also say the patient should pay any additional costs linked to delivering the drugs or managing side-effects.

But there should be no effect on prioritisation for patients' NHS care and no deleterious effect on those choosing not to top-up.

And constructing a package which factors in the average duration of care would enable patients to be offered a fixed price for the provision of a single top-up drug over a set period of time.

Extra funds 'should be used to improve NHS cancer care'

This could be delivered by either the NHS or in the private sector.

Clearly there is much complexity around the issue of how to pay. Do we make patients pay in advance?

If not paying in advance, what happens with those who default on payments?

How do we factor in the extra administrative costs to the NHS, which struggles already to capture activity data on its current activities? These all remain to be sorted out, but are purely logistical details.

Falling behind

It is essential that NHS patients not paying for extra care are not adversely affected by the right of patients to top-up.

This can be achieved by the NHS charging the true total costs of extra care, including its management, together with a supplement to ensure improvement in NHS chemotherapy and radiotherapy facilities for all.

Independent providers, both new and existing, could be sought to bid for contracts to supply a top-up service to cancer centres to drive efficiency, competition, value for money, convenience and quality for patients.

This could be in partnership with the NHS, either on the same site or in separate centres at a different location.

Such centres could offer a menu of top-up drugs to patients also receiving NHS care.

In all cases the relevant drug would always need to be licensed for the particular clinical situation and prescribed by the patient's NHS consultant who will retain responsibility for their care.

The NHS consultant should not receive additional income just for prescribing the top-up.

And it is essential that efficiency savings throughout cancer care delivery are ploughed back into service improvements.

It is clear that our spending on new cancer drugs and high quality radical radiotherapy are falling behind other countries of comparative wealth.

A suitable infrastructure for the ethical delivery of top-up services will be urgently required.

But the real tragedy is the inefficiency of the NHS which has led to many cancer drugs routinely available in European countries simply not being used here.

Continuing the reform of the service is more important than ever. There should be no need to top-ups for cancer care.

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