Scotland is proposing to lift the ban on NHS patients topping up their care if they wish to pay privately for part of their treatment.

Draft revised guidance for Scotland's NHS boards was issued for consultation today following a similar decision in England last month.

The guidance takes into account November's review by Department of Health national clinical director for cancer Professor Mike Richards, which said top-ups should be permitted under controlled conditions.

60th anniversary

Health secretary Nicola Sturgeon said: "In this, the 60th anniversary year of the NHS, it is essential we uphold and protect the founding principles of the NHS.

"Nothing in the new draft guidance should distract us from the priority of making sure that where a patient can genuinely benefit from a drug they are able to access it on the NHS.

"We must aim to ensure that decisions on 'co-payments' are the exception not the norm.

"However, it is also clear that NHS boards can be faced with complicated circumstances where a patient may wish to pay for treatment not provided on the NHS.

"We took the decision that a new framework with revised guidance would be helpful in assisting NHS boards with the management of such circumstances."


The consultation states:

  • The primary purpose of any NHS organisation is to provide NHS care.

  • NHS and private care should be kept as clearly separate as possible.

  • In all cases, it must be clearly understood by all parties involved whether an individual procedure or treatment is privately funded or NHS funded.

  • The NHS should never subsidise private care with public money, which would breach core NHS principles.

  • Private care should be carried out at a different time and place to the NHS care being provided. This could include the facilities of a private healthcare provider, or part of an NHS organisation which has been designated for private care.

  • The fact that some NHS patients also receive private care separately must not be used as a means of downgrading the level of services that the NHS offers.

To read the consultation, go to

The deadline is 12 January 2009.