New NHS Top-Ups Guidelines

Although taking out a private medical insurance policy is a cost effective way to deal with any unexpected ill health it is not an option for some people. Chronic or terminal illness, for example precludes you from health cover and if you have a pre-existing condition this will not be covered on a new policy. People who are excluded may still want the benefits of private health insurance but may not be able to afford to pay the full costs. An alternative is to use the NHS and top up with private care.

Top-ups have caused a great deal of controversy over the last year however the government have revisited their first attempt and after a twelve week review that started on 4th November 2008 have now published their final guidance on NHS patients wanting to pay for additional private care. The new guidance became effective as from the 23rd of March.

One of the important things about top-ups is the fact that the more expensive and life-prolonging drugs that are not offered as part of the National Institute for the Health and Clinical Excellence (NICE) guidelines can be purchased privately by the patient. However despite the new guidelines top-ups may still create an administrative, moral and logistical minefield.

The main points of the guidance are as follows:

-The NHS should not withdraw care if a patient chooses to buy additional private care
-Private care should be delivered separately
-NHS should never subsidise private care
-The patient should never be charged for NHS care
-There must be a clear separation between NHS and private care

Conflict of interests, for example, is one important issue as many consultants also work in private practice. The guidance here is clear:

'In the course of their NHS duties and responsibilities, consultants should not initiate discussions about providing private services for NHS patients, nor should they ask other NHS staff to initiate such discussions on their behalf'

Other problems will arise if a patient wants treatment where the NHS part and the private part cannot be separated. The government guidelines gives the following example:

'Patient E needs a cataract operation. This procedure normally involves removal of the crystalline lens from the eye and replacement with an artificial lens with a single focus. After cataract surgery, patients normally have to wear glasses for some purposes, usually for close work. Patient E asks his NHS Trust to insert a multifocal lens at the time of surgery as this may reduce the need for him to wear glasses. The multifocal lens is not routinely available on the NHS. Patient E is willing to pay for the cost of the multifocal lens but wants the NHS to provide the surgery involved free of charge as part of the cataract operation. The Trust informs him that it is not possible to pay for the multifocal lens while carrying out the surgery on the NHS as it is not possible to separate the private element from the NHS element of care. The Trust informs him that he can have the single focus lens free of charge on the NHS or the multifocal lens as an entirely private operation. Patient E is not allowed to have additional private care because the NHS element of care and the private element of care cannot be delivered separately.'

In more serious cases where the patients life would be endangered if they had to be moved in order to receive the private part of their care then the trust managers can made discretionary decisions along with the patients consultants.

It remains to be seen whether the new guidelines are enough to satisfy the trusts, the public and the medical establishment.