Should NHS patients be allowed to pay extra for their care?

Editor—Richards et al in their article raise the issue of patients contributing to payments for cancer drugs in Britain's NHS.¹ It is pleasing to see that times are changing for ethics committees even if the pervasive tone of self righteousness is a bit grating. If British politicians cannot manage to improve the NHS, why should a patient not pay for drug treatment perceived as beneficial? Would the group consider it unethical for a patient to pay for vitamin pills, special diets, alternative medicine, or a second opinion?

Over the next three years there is going to be a major shift in cancer care. New molecularly targeted medicines that block specific signalling pathways and angiogenesis will become available. These will take the form of simple tablets, to be taken once a day. They will prolong survival by a few months in many cancers, but as the predictive power of genomics and proteomics bites, cancer will become a chronic, controllable disease. The cost will exceed the budget of Britain's national cancer plan, which is just a catching up exercise on 30 years of underinvestment by successive governments. In a global society no group of armchair ethicists sitting in Nottingham can stop people ordering these new drugs through the internet and paying with their credit card. Debating the issue is futile.

What we can do is to ensure that the core cancer services offered to everyone by the NHS improve. The cancer plan provides an excellent structure but is underfunded. Creating the new bureaucracy has provided excellent spin for politicians who think they have “done cancer.” The reality is grim—ageing radiotherapy machines, clear examples of continuing postcode prescribing, overworked staff, and lack of consultation time. Allowing patients to pay for treatments outside the core is one way of bringing additional resources into the system. Another is to privatise their delivery.