There's no consistency in co-payment policy

The absence of joined-up thinking in the NHS is strikingly highlighted by its attitude towards paying for treatment.

Useful but expensive drugs are increasingly being denied to patients on the grounds of lack of cost-effectiveness. This might make financial sense of a sort, were it not that - unbelievably - anyone choosing to buy extra oncology medication is then denied access to all NHS anticancer treatment. According to Alan Johnson, this is 'to stop the development of a two-tier system of healthcare', where those who can pay receive better treatment than those who can't.

I could understand his concern if the ban on co-payment were implemented consistently. Does buying OTC medication from the chemist or consulting a private counsellor or physiotherapist bar the patient from receiving NHS antibiotics, antidepressants or orthopaedic treatment? If not, why not? Why is buying additional anticancer treatment such an appalling crime in the government's eyes? Could it be that it is embarrassed at not providing it itself and wants to punish and control those who show it up?

As for stopping two-tier healthcare, how many people can't get an NHS dentist and are forced to go privately? Already we have co-payment for individual NHS dental treatments, and elderly patients have to fund part or all of the cost of their carers from their savings. The lack of NHS psychotherapists means many patients have to pay privately or forego treatment. Not exactly consistently applied policy, is it?

But there is potential danger in routinely allowing co-payment, because it risks letting the NHS reduce its responsibilities, requiring patients to make up the difference. This could happen in two ways: the government might redefine 'need', supplying only a minimal health service and forcing patients to top up to get anything like comprehensive care; or an all-encompassing NHS might be free only to low-income families, with everyone else forced to go private, despite paying fully for the NHS in their taxes.

Both these methods would be a convenient way for the government to reduce NHS costs, and both are obnoxious. Clearly the NHS needs a better, more integrated method of financing expensive treatment. There is a way: more next week.

Dr Lancelot is a GP from Lancashire. Email him at

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