Top Up Care

The BBC has learned that payments to top up NHS care - supposedly banned - are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month.

The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

Ian Jenkins, 47, has kidney cancer which has spread to his lungs.

Reading to his daughter Eve has become a welcome escape.

The longer time I have with her the more chance and the more opportunity there is that she she is going to remember me as her dad

Ian knows his prospects are not good, but he wants to do everything he can to prolong his life.

"I have a two-year-old daughter," he said.

"She is growing up at the moment and her memories of me are developing.

"The longer time I have with her the more chance and the more opportunity there is that she she is going to remember me as her dad."

Ian is a patient at the Queen Elizabeth Hospital in Birmingham.

He wants to top up his care and buy a new cancer drug called Sutent that is not available on the NHS.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you're all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Ian's visit to hospital to see his NHS consultant is treated as one episode of care.

Separately another consultant at the same hospital writes a private prescription for the drugs that Ian wants to keep him alive.

They are supplied at Ian's home by a private company called Healthcare at Home.

Ian pays the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

"Nowhere does it say that an episode of care is from diagnosis to death of your cancer" he said.

"So we've just interpreted the rules in a way which is in favour of the patients."

What is remarkable is that topping up, something the government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: "Top ups are happening today and they'll happen tomorrow.

"So long as they're done through us not using the auspices of the NHS I see no reason why they shouldn't continue."

A Department of Health spokesperson said: "We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

"Professor Richards is looking at how a consistent approach across the country might be best achieved."

All Ian Jenkins wants is to stay alive as long as possible.

But his story does beg the question, why the need for a high level review of top ups if they are already happening all over the country?

I cant see a problem with top up care. If a person cannot afford to go fully private, but can scrap together enough to get the drugs that he/she needs, then what's wrong with that? If people can't top up then they're going to head straight to a solicitor to see if they can force the health authority to prescribe the drugs. Then if the courts come down in the patients favour, the health authority has to pay for drugs that could have been paid for privately, plus the cost of the litigation, a lose lose situation. The money they have then lost will come off the care of other patients.

If people are allowed to top up, the patient gets the necessary drugs, the hospital dont have to stump up for the drugs, other patient care isnt affected, seems like a win win to me!

I think it's depressing that the NHS doesn't automatically pay for anything that can extend a patient's life.

My friend's husband is battling thyroid cancer, and it is worrying enough for her without having to think about how she would find the money for top up treatment. The most frustrating thing is the NHS does have adequate funding, it's just used in the wrong way. Don't get me started!

Yes I agree the NHS does have adequate funding. I think its time they stopped wasting money not only on have too many mangers, but on unnecessary operations. A friend of a friend had her boobs enlarged on the NHS, because she said she was depressed because they were too small. Now that might change her out look on life, but its not life threatening, and I think the only cosmetic surgery that should be done should be from accidents, or medical defects (thats probably not a PC term for them), like grafts for burns, or removal of huge birthmarks or something.

I agree with you, Lou. Surgery for boob reduction should be allowed cos it can be proved that the patient suffers back pain, but absolutely no cosmetic surgery except in the circumstances you said. I don't think any government will be able to sort the NHS out. They're all held to ransom by the NHS managers, the ones who hold the purse strings.

I don't think that IVF treatment should be funded by the NHS either, unless infertility has been caused by illness or treatment for illness.

I agree, its very upsetting for someone not to be able to have a child, but again its not life threatening. And there's always adoption or fostering. People say but its not the same as having your own child, but I've never understood that, surely you love a child for who they are not their genetics.

I totally agree Lou.I have brought up my "step" children (I hate that word) since they were toddlers, To me, they are my own children. The youngest has lived with us since she was 3 years old. I t must be awful not to be able to have children if you really want them, but it is not a life threatening, just a life changing situation.