Top-Up Fees: Completely the wrong debate

There’s been a load of discussion in the press over the last few months about so-called ‘top-up fees’. The question is raging, should people with cancer – buying their own drug treatment to stay alive or to prolong their lives – also have access to NHS treatment for free. The stories are understandably moving ones.

A typical story is here. Carole Simmons, a 59 year old woman, was diagnosed with bowel cancer. The NHS refused to pay for a drug called Avastin that offered her valuable months of extra life. Because Carole and her family found the money for Avastin, all NHS treatment was withdrawn – so they had to find an additional £20,000 for other drug treatment, scans, consultant visits and so on. Carole wasn’t rich, incidentally. She was a former teaching assistant. Her husband worked for the fire service. They found the money because they had to.

Carole Simmons lived for an additional nine months – and in that time she was able to go on holiday with her family, see her grandchild start school, and attend her sister’s 40th wedding anniversary. Most of us will have no doubt that the extra nine months of life was well worth having, for Carole and her family.

There’s a Government sponsored enquiry going on just now into NHS top-up fees, set to report at the end of the month. It’s a virtual certainty that it will rule in favour of top-up fees. Bodies like the BMA and the Royal College of Nursing now favour top-up fees. Many press articles are pushing hard for top-up fees to be introduced. The NHS Confederation, representing both NHS and private suppliers of NHS treatment, supports top-up fees. There’s little doubt which way the recommendation will go.

The real issue, though, is being glossed over. Why the hell is it that patients with cancer can’t get life saving treatment and life prolonging treatment on the NHS? Why is it that people are forced to scrape together the money to pay for their own drug treatment, or face death if they can’t? Why isn’t the NHS paying for the drug treatment that cancer patients need?

There have been a whole series of restrictions from ‘NICE’ that look simply obscene to most of us – with some decisions thankfully now starting to be challenged and overturned. Women with breast cancer have been denied Herceptin. Older people losing their sight have been told they can’t be treated with Lucentis – an effective treatment but apparently it costs too much. People with dementia have to wait for their symptoms to become severe before the NHS will pay for Aricept. Why? This makes no sense.

We’re told time and again that the NHS has limited resources, people want too much health care, we have an aging population, we can’t afford to pay…  Well, maybe – or maybe it’s just a question of priorities.

Last week the Government ‘found’ £500 billion to bail out the banks – presumably so that the banks can be stabilised enough to go on investing in the PFI and privatisation schemes that are tearing the NHS apart. If there’s unlimited money for banks, why is the money not there for people with cancer?

Of course it’s wrong that people who pay for cancer drugs are then forced to pay for the rest of their care. It’s even more wrong, though, that as a society we’re prepared to stand back and let those people die by denying them the best available cancer treatment in the first place. The argument over top-up fees simply misses the point.

I believe the real agenda here is a softening-up process. Little by little, the top-up fees debate leads us towards a conclusion that the NHS can’t be expected to pay for all the health care we need. Little by little, we’re led to believe that the NHS can provide only a basic safety net – and if we want better treatment we will have to pay. That leads us very quickly indeed to a society where access to healthcare is determined primarily by ability to pay.

Sixty years ago, Aneurin Bevan said this: ‘The collective principle asserts that… no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means’ (In Place of Fear, p 100).

Brown and Johnson would do well to remember the values that underpin the NHS.


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