Cancer patients will be allowed to mix NHS and private treatments

PATIENTS should be allowed to pay privately for cancer drugs and still keep their free NHS care in certain cases, the Scottish Government indicated yesterday.

So-called co-payments – patients topping up their care with treatments not available on the NHS – have been banned by many Scottish health boards.

But the government has now admitted current guidance on the controversial issue is not clear and has agreed to give new advice to the NHS.

It also agreed to produce new guidance to help health boards in making decisions to fund drugs not approved by watchdogs for NHS use in some cases.

Some campaigners welcomed the move; others said an increase in co-payments could lead to inequalities and more drugs being refused NHS funding.

Patients in some parts of the country are allowed to top up their care without being penalised by having NHS treatment withdrawn. In other areas, doctors and officials report that co-payments are not allowed.

In June this year, the public petitions committee criticised the lack of clarity over the funding of cancer drugs in the NHS in exceptional cases, and also on the issue of co-payments.

Its inquiry was prompted by the case of Michael Gray, who was forced to pay for a bowel cancer drug after being denied funding by NHS Grampian.

In response to that report, the Scottish Government confirmed its current guidance was that a patient "cannot be treated in the private sector and the NHS at the same time for the same episode of care".

In several high-profile cases, this has meant those wishing to pay privately for a drug also have to pay for other aspects of their care, such as blood tests and scans, which would usually be free on the NHS.

But it went on to say that there may be cases where co-payments could be allowed where it would not compromise patient safety and NHS accountability.

The Scottish Government yesterday said: "There may be a case for simultaneous care in the NHS and the private sector where there are clear clinical accountability and governance arrangements in place.

"Professional judgments need to be made in individual cases, and such judgments may be finely balanced."

It said arrangements for exceptional prescribing and co-payments needed to be made more explicit, with new guidance to be prepared.

The Scotsman has learned that NHS boards approach co-payments in very different ways. For example, NHS Dumfries and Galloway revealed it had let one patient co-pay for the cancer drug Sutent in February.

But NHS Lothian said the "crux" of current NHS guidance was that patients could not pay privately for one part of their treatment and get other treatment on the NHS.

Yesterday's indication from the Scottish Government that co-payments could be allowed was welcomed by campaigners.

Helen Rainbow, campaign manager at Doctors for Reform, said: "The allowance of a level of top-up payment within the Scottish system is an extremely positive development for patients.

"However, it is important that it is further clarified to ensure that no patients lose their entitlement to NHS care."

Cancer Research UK said that if more money was not available for drugs then co-payments may need to be explored.

Professor Peter Johnson, the charity's chief clinician, said:"We believe that solutions to many of the difficulties associated with access to cancer drugs can be found by making changes within the current system.

"But if governments are not prepared to increase spending on cancer drugs and amend the way cancer drugs are assessed as a matter of urgency, then the top-up route may have to be given serious consideration."

But Ian Beaumont, of Bowel Cancer UK, said the charity remained concerned that any move towards a co-payments system in Scotland, however well-intentioned, would have a negative effect on patients.

"It is likely to act as a disincentive for the Scottish Medicines Consortium to approve new cancer treatments and for NHS boards to make them available."

Medical drugs available … at a price

NAME: Erbitux (cetuximab)

WHAT FOR: Has been rejected for use on the NHS for the treatment of bowel cancer.

COST: Michael Gray, a bowel cancer patient from Buckie in Moray, paid £3,400 every fortnight for the treatment.

NAME: Sutent (sunitinib)

WHAT FOR: Has been rejected for use on the NHS for the treatment of kidney cancer.

COST: £2,000 a month

NAME: Avastin (bevacizumab)

WHAT FOR: Has been rejected for use on the NHS in Scotland for the treatment of bowel cancer.

COST: £1,800 a month.