I have recently had a comment piece published in the British Journal of Nursing in favour of the NHS allowing top-up fees.  Unfortunately, I cannot link to it as it is subscription only, however, here is the text.

Top ups are the welcome next stage for public private partnerships

As the government reviews the rules on private top ups for NHS patients who want to access innovative medicines denied to them by the state, Nurses for Reform (NFR) are delighted that ministers will choose freedom in the coming weeks and in so doing embrace the next level of partnership working with private medicine.

To put the top up issue in context and to appreciate how far we have already come on the journey of partnership working, just consider the following. In 1948 the government sent a leaflet to every home in the country promising in black and white that ‘the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it’.


Today, below the veneer of such historic sentiment, there are already seven million people with private medical insurance. Six million people have private health cash plans. Eight million people pay privately for complementary therapies. More than two hundred and fifty thousand people privately self-fund for independent acute surgery each year. And many millions more pay privately towards long-term care. This is not to mention the collapse of NHS dentistry or the fact that more than 56 per cent of trade unionists now use some form of private health coverage that stands in opposition to the principles of 1948.[1]


Moreover, the 2000 Concordat with independent sector hospitals, the rise of independent sector treatment centres, the push for independent foundation trusts, the patient choice agenda and in social care, the arrival of top ups and social enterprises, all illustrate the fact that what appeared to be utopian in the 1940s no longer chimes with fundamental reality.


The idea that state can do it all, on its own – for everyone, is dead. Today, the state is already working alongside the independent sector and it will go on harnessing ever more economically market driven incentives over the decades ahead – irrespective of which political party is in power.


In 2008, NHS patients can no longer be banned from paying privately for medicines that the state cannot fund. People are already at liberty to buy extra treatments and services. Both systems are increasingly working in partnership and together they are growing the resource base of our national healthcare family.


For front line nurses, doctors and other health professionals trying to care for seriously ill patients across the state and independent sectors, what matters is that the rules that have precluded all but the rich from accessing new and innovative medicines are now scrapped. In line with the egalitarian spirit of the 1940s it is no longer acceptable that only the wealthy should have access to innovative medicines which invariably buy them, as dying patients, a few extra years or months of life. Everyone must have the opportunity to privately top up their treatment and care without stigma or prejudice from the NHS.


Sixty years on, British patients, voters and politicians are rightly moving on from the failures of the past. Overwhelming public support for private tops ups is not only moral and the sign of a vibrantly libertarian society but it is simply a symptom of how things have already turned against the dystopian realities of unsustainable nationalised healthcare.

For NFR, America does not represent either a desirable market model or the way forward. The US has a highly planned, regulated and government funded healthcare system which takes – through state programmes such as Medicaid and Medicare – a historically greater proportion of GDP than the UK’s NHS.

Overall, the impending move by Professor Richards and the government to grant the most seriously ill NHS patients the freedom to privately top-up for innovative medicines, not formally approved by NICE, is not only humane and to be welcomed but it will help to shore up what little moral credibility the state sector can now muster on this front.


To do otherwise would not only be an impractical denial of already existing reality but it would dramatically debase the NHS by further forcing it into the quagmire of eugenic decision making. The government knows this and that is why the future is clear. Private top ups are the welcome next stage for public private partnerships.

[1] Daniel Kruger; ‘Why half the members of trade unions have private health care’; Daily Telegraph; 11 September 2001.