Patients to be given right to 'top up' NHS treatment by buying private drugs

By Tamara Cohen

Patients will be allowed to top up their Health Service treatment with drugs bought privately in a U-turn by the government, it was reported last night.

Alan Johnson, the Health Secretary, is said to be poised to relax the ban on patients paying for life-extending treatments while receiving NHS care.

Until now ministers have refused to allow individuals to combine NHS and private treatments saying such a move would undermine the ethos of the Health Service.


But Mr Johnson has been under pressure to reform the system after experts ruled it to be unsustainable.

A source told The Times that ministers hope an independent review of the issue next month will help to make the case for change.

‘Whatever is recommended won’t satisfy everyone. There is no magic bullet that resolves this very difficult issue’, a senior figure told the newspaper.

A Department of Health spokesman last night played down the reports, saying ministers had launched a review in July looking into the issue.

‘The review will report back in October. Ministers are looking into this but no decisions have been made’, she said.

It is understood there will be reforms made to the system under which local NHS committees decide which patients are exceptional cases, and can receive drugs not yet approved by NICE.

Professor Mike Richards, the national cancer director, is conducting the review into ‘co-payment’.

Mr Johnson agreed to reconsider the issue in June after a series of reports about patients who were refused NHS care after buying drugs for cancers of the kidney, bowel, lung, breast and multiple myeloma.

There was a public outcry over the death in March of Linda O”Boyle, a grandmother who was denied free NHS treatment after buying a drug to treat her bowel cancer.

If top-ups are allowed, these are likely to be capped, and patients may also have to pay for any associated costs incurred by the NHS such as treatment for side effects.

Any changes would be accompanied by measures to speed up the approval process for new drugs and make them cheaper, the source added.

The National Institute for Health and Clinical Excellence assesses the cost-effectiveness of new medicines and recommends whether they should be provided by the NHS in England and Wales.

Where it has turned down a drug, or has yet to make a decision, patients can appeal to their local NHS primary care trust to be treated as an exceptional case.

Those who favour top-ups argue that a postcode lottery already exists where patients in some areas are granted treatments that could extend their lives while others are not.

Earlier this month, the King’s Fund, a health policy think tank called for patients to be allowed to pay for top-up drugs to stop the creation of a black market in cancer drugs.

Professor Karol Sikora, a leading cancer specialist who supports top-ups, said: “This situation cannot go on, it’s against natural justice.’

But some doctors, MPs and the Royal College of Nursing argue allowing wealthier patients to purchase better care will lead to a two-tier system based on ability to pay rather than clinical need.

Professor Richards said that he was in discussions with patient groups NHS staff, pharmaceutical companies and the insurance industry over which patients would be willing to pay for extra care.

Push on for insurers to share autism costs

DOVER - Because of his severe autism, the cost of educating 5-year-old Jack Ursitti runs $100,000 a year. But unlike expenses with most medical conditions, the bills for treating him will be borne by Dover schools and the rural town's taxpayers - not his family's medical insurance.

Now, the nation's largest autism advocacy group, Autism Speaks, is planning a legislative push in 20 states, including Massachusetts, to require private insurance companies to pay a portion of the intensive, expensive educational treatments that many medical professionals say are a child's best chance to overcome, or just learn to cope with, profound and lifelong developmental and learning disabilities.

Similar laws have passed in the past several months in Arizona, Florida, Louisiana, and Pennsylvania requiring private insurers to pay toward a variety of therapies, including applied behavior analysis. That system, known as ABA, involves a weekly regimen of more than 30 hours of intense, often one-on-one, positive reinforcement techniques for teaching children how to speak, play, learn, and function in the world.

But private insurers are balking at the proposed requirement, especially coverage of the specialty ABA programs, which they say are relatively new and unproven, and not effective for all children. ABA teachers are not licensed in many states, and insurers contend that the therapy system is still too new to be regulated sufficiently.

Requiring insurers to pay for educating autistic children would "drive up costs for everyone," said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, an industry group representing 12 health plans operating in the Commonwealth.

Health insurers should not be dragged into the educational arena, particularly to pay for ABA classes, she added. "In a sense, it's asking for a blank check for therapies that we'd want more evidence to prove are really effective," Buyse said.

But parents of autistic children are determined to get their youngsters into programs that offer even a glimmer of hope. They also want to shift society's perceptions of autism.

"If my son couldn't hear and needed a cochlear implant, we wouldn't be asking the school system to take responsibility," said Jack's mother, Judith, coordinator of the New England lobbying effort for Autism Speaks. "As a society, we have to acknowledge that autism crosses a line from an educational issue to a medical one. Jack was diagnosed by a neurologist, not a schoolteacher."

Richard DeRoo of Reading, a software engineer whose 11-year-old son, Evan, has autism, said parents are desperate for more financial help.

Since his diagnosis at age 3, Evan has needed extensive behavior, speech, physical, and occupational therapy, his father said. The family paid for some of that care out-of pocket at a cost of $25 to $50 per hour.

Legal Things for peace of mind

Today the Zen Habits blog talks about five legal things for peace of mind and I want to talk about four of them.

First of all, get a will done. While you may not have to worry about it after you're passing do not put your family through having to figure out what to do with your stuff and money after you are gone.

My Uncle on my mother's side passed away only a few weeks before my father and the stress of dealing with my Uncle may have been something that pushed my father over the edge. My Uncle did not have a lot, a worthless piece of land near Kingman, Arizona which might have been worth something in a few years, a run down trailer and a $1000 car.

However, because he did not leave a will and he had no children, several members of the family fought over every little piece he had. It even came down to fighting over the genological records that my uncle had. In fact, several members of the family have not talked to each other since because of all the strife it created. Do a will!!

Next up is to have a living will. You never know what might happen and people need to know what to do. After my mother had a stroke a couple of years ago, I was left with making all the decisions about her health. She was suffering from Dementia so she could no longer make the decisions and never had a living will so once again the family started fighting. Everyone knew what was best and all seemed only to care about what was best for them, not for our mother. If she had made out a living will we would had known her wishes and carried them out.

Next up is to get the insurance you need so you do not have any worries if something happens. Even if you're renting your present office, home, or store make sure you are fully covered. Also, get Errors & Omissions insurance if you work in a business that is giving advice or doing services that people may be unhappy with the services no matter how hard you try and will try to sue.

Finally separate your business from your personal assets. Set up a corporation or a limited liability business entity to shield your personal assets incase of a fore mentioned lawsuit.

The most important thing is to get the proper legal advice in each of these areas so you do what is best for you.