A lethal dogma

December 17, 2007 10:09 AM

We already have not just a two-tiered health service but a many tiered one.  The top tier is occupied by the roughly 13 per cent of the population who have private medical insurance.  The other tiers are composed of the various sections of the population who get very different results from the NHS.  A recent Civitas study exposed how the middle class are able to play the system and get better results than the poor.  With all that in mind it is pretty clear that a dogmatic insistence that everyone treated by the NHS occupy some nominal single tier is a bit of a joke.


Unfortunately, a report in the Sunday Times set out how that joke isn't proving terribly funny for Colette Mills, a former nurse.  Her local NHS Trust uses Taxol to treat breast cancer but she thinks that her chances would be a lot better with Avastin.  She is willing to pay for the drug and any costs to the hospital associated with using it, about £4,000 in total, but is not able to afford the £10 to £15,000 cost of treating her condition entirely privately.  That would mean paying for nurses' time, blood tests, scans and the countless other costs associated with cancer treatment.


So, let's get this straight: the hospital she is being treated at will treat private patients with Avastin, will treat NHS patients for free but won't let an NHS patient pay a little extra for a drug that might save her life.  All because "co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS".  Are those principles worth people's lives?


A two-tier system will necessarily exist in any rationed healthcare system.  You'll never be able to provide all the healthcare people can use, to everyone, at any time.  That will always leave some people, who are able to pay, wanting to buy more.  Even if you ban private treatment people can still go abroad.


With that in mind making it artificially difficult to move up a tier doesn't strengthen the principle of a universal NHS.  All it does is mean that a lot of ordinary people can't get drugs reserved for the super-rich.  One can believe that the NHS should provide Avastin itself.  However, so long as it doesn't it is fundamentally inhumane to make it unreasonably difficult for people to move up a tier when their survival is at stake.  To risk Colette Mills' death in a vain hunt for an illusory principle.

We already have not just a two-tiered health service but a many tiered one.  The top tier is occupied by the roughly 13 per cent of the population who have private medical insurance.  The other tiers are composed of the various sections of the population who get very different results from the NHS.  A recent Civitas study exposed how the middle class are able to play the system and get better results than the poor.  With all that in mind it is pretty clear that a dogmatic insistence that everyone treated by the NHS occupy some nominal single tier is a bit of a joke.


Unfortunately, a report in the Sunday Times set out how that joke isn't proving terribly funny for Colette Mills, a former nurse.  Her local NHS Trust uses Taxol to treat breast cancer but she thinks that her chances would be a lot better with Avastin.  She is willing to pay for the drug and any costs to the hospital associated with using it, about £4,000 in total, but is not able to afford the £10 to £15,000 cost of treating her condition entirely privately.  That would mean paying for nurses' time, blood tests, scans and the countless other costs associated with cancer treatment.


So, let's get this straight: the hospital she is being treated at will treat private patients with Avastin, will treat NHS patients for free but won't let an NHS patient pay a little extra for a drug that might save her life.  All because "co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS".  Are those principles worth people's lives?


A two-tier system will necessarily exist in any rationed healthcare system.  You'll never be able to provide all the healthcare people can use, to everyone, at any time.  That will always leave some people, who are able to pay, wanting to buy more.  Even if you ban private treatment people can still go abroad.


With that in mind making it artificially difficult to move up a tier doesn't strengthen the principle of a universal NHS.  All it does is mean that a lot of ordinary people can't get drugs reserved for the super-rich.  One can believe that the NHS should provide Avastin itself.  However, so long as it doesn't it is fundamentally inhumane to make it unreasonably difficult for people to move up a tier when their survival is at stake.  To risk Colette Mills' death in a vain hunt for an illusory principle.

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