Top ups put vulnerable patients at risk, Confed hears

Dialogue with patients, which could empower them to make more informed decisions about their care, was currently missing from the process, delegates heard.

Reading University professor of health law Chris Newdick said placing decisions about expensive drugs in the hands of patients carried risks and that topping up was not cost-neutral.

He said: "If you're selling drugs to me and my relatives, I have no expertise and I'm purchasing drugs. Do you need to protect those vulnerable people from exploitation at that stage of their lives because that's when they need some help?"

And he added: "The idea that co-funding is cost-neutral is one of the myths."

Cam Donaldson, director of Newcastle upon Tyne University's Institute of Health and Society, warned that topping up would transfer resources towards the rich and healthy and away from those who were less likely to be able to afford it.

But Andrew Donald, director of commissioning at Birmingham East and North primary care trust, said preventing top ups went against the ethos of choice in the modern NHS.

He said: "I really think we've got ourselves into a mess. We're permitting patient choice and consumerism and letting people be more demanding on us, but when they want to make a choice, because we've set the priorities differently on a particular drug, we're saying they can't co-pay or top up. For me, that feels wrong."

Mr Donald said there was an absence of dialogue between consultants and families about their choices.

"There are a set of stages to this process that are not in place at the moment," he said.

North Yorkshire and York PCT public health director Dr Peter Brambleby said: "It's a real mess at the moment. We need to tidy up the rules and apply them fairly."

For more HSJ coverage of the top-up debate, click here

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