Should NHS patients be allowed to contribute extra money to their care?

doi:10.1136/bmj.323.7312.563

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Clive Richards, consultant public health physician (clive.richards@nottinghm-ha.trent.nhs.uk)a,
Robert Dingwall, directorb,
Alan Watson, consultant paediatric nephrologistc

^a Nottingham Health Authority, Park Row, Nottingham NG1 5DN
^b Institute for for the Study of Genetics, Biorisks, and Society, University of Nottingham, Nottingham NG7 2RD
^c Nottingham City Hospital NHS Trust, Hucknall Road, Nottingham NG5 1PB

Correspondence to: C Richards

Accepted 23 April 2001

The founders of the NHS were guided by the 1942 Beveridge report and wanted to ensure that “the best that science can do is available for the treatment of every citizen at home and in institutions, irrespective of his personal means.”1 The achievability of this assumption has been questioned ever since. Weale has argued that it is impossible to have universal access to the highest quality of care associated with freedom from cost at the point of need.2 Widespread access may have to compromise quality. Sikora recently suggested that poor UK cancer survival rates reflect a lack of NHS resources to make available “the best that science can do.”3 He argued in a national newspaper that NHS patients should be allowed to pay for additional treatment.4

Summary points

Rationing occurs when markets deny goods to citizens—even when the citizens have the resources to buy goods

Patients wishing to supplement their NHS provision by buying extra treatments bring libertarian and egalitarian values into conflict

The NHS currently proscribes mixed private and public provision of care during a treatment episode, yet such provision does take place

Attitudes are shifting about whether the NHS should allow patients to supplement their care from their own resources

The case

This proposal to allow patients to pay for additional treatment was debated by the Nottingham ethics of clinical practice committee5 in a case referred by a consultant oncologist. The patient was a man in his late 40s with a brain tumour whose prognosis with conventional treatment was poor. The patient had searched the internet and discovered that a drug marketed specifically for his condition was available and had asked the consultant for it. He was told that the drug was considered to be of marginal benefit, and the hospital could not provide it owing to …