British health boss in U-turn over patients’ top-up care

After at least four deaths and a year of protests about top-up payments, Alan Johnson, the health secretary, is expected to declare that National Health Service rules allowed them all along. In an announcement which is due to be made to parliament at the beginning of November, Johnson is expected to “clarify” government policy, claiming that patients are already permitted to pay for private drugs while continuing to receive NHS care. He will state that the problem arose because of a misinterpretation by some NHS hospitals.

Although it represents a victory for the campaign, led by The Sunday Times, it will be heartbreaking for the families of cancer patients who died after their NHS care was withdrawn because they topped up their treatment. This weekend one family made public an emotional letter telling of the anguish and outrage caused by the NHS decision to withdraw care. The letter, written by Linda Linton, a mother of three who died from bowel cancer at the age of 57, tells how she asked to be discharged from hospital because she feared her rising treatment bills.

Linton had her routine treatment withdrawn by Maidstone and Tunbridge Wells NHS Trust because she paid privately for the drug cetuxi-mab which was recommended by her NHS consultant. Linton, from Sittingbourne, Kent, wrote: “I wanted to go home because I was worried about the mounting costs of my treatment, room and food. I was told that if I discharged myself I was at risk of multiple organ failure.”

Linton, who wrote the letter four months before her death in October 2006, explained how the scandal was draining her energy: “It is six in the morning and I should be resting and trying to recover from my ordeal, but I am too upset and angry about what has happened to me . . . “I thought that I could pay for this drug and resume treatment but this is not the case. I have been forced to become a private patient and pay for everything. Could you please inform me who is responsible for the decision to force me out of the NHS?”

Linton was one of dozens of cancer patients who have been told by the NHS that if they top up their care with a private drug recommended by their consultant they will forfeit the rest of their health service care.

John Baron, constituency MP of Linda O’Boyle, who died in March aged 64 after her NHS care was withdrawn because she paid for the cetuxi-mab drug, said of Johnson’s expected announcement: “That will clearly be a U-turn by the government. This position will not fool anybody.” Patients who have been denied NHS care because they bought private drugs are suing for the treatment which has been withdrawn.

Although dozens of NHS trusts have told cancer patients that they cannot buy private drugs while simultaneously receiving NHS care, The Sunday Times revealed in July that numerous others have been allowing top-ups.

Johnson is expected to announce a solution that will avoid creating a two-tier NHS, with patients in the same ward receiving different standards of care according to their ability to pay. The University Hospitals Birmingham NHS Foundation Trust treats patients who supplement their NHS care by paying private hospitals or companies for extra drugs. Professor Nick James, a consultant oncologist at the trust, expects Johnson to endorse this approach nationally. “I don’t think they are going to like the spectacle of patients in adjacent beds getting different treatments and one of them getting better at the end of it. They will try to partition it off so that it is invisible to the NHS patients,” James said.

The Department of Health said: “We know there is variation in how individual trusts are applying the current guidance and that is why the secretary of state asked Professor Mike Richards, national clinical director for cancer, to lead a review.”

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British heart attack victims face longer journey for surgery as only 54 hospitals can now operate

Unrealistic theory threatens lives

Thousands of heart-attack patients will be forced to travel further for emergency treatment because of a change in the techniques used to save their lives. The Department of Health will announce tomorrow that balloon angioplasty – administered to treat heart attacks caused by blocked arteries – will be made available to nearly every eligible patient. But the procedure is available at only 54 centres across England – about one in every four hospitals – which means instead of being taken to the nearest accident and emergency department, as now, about 25,000 patients will be taken straight to their nearest specialist angioplasty clinic, which could be many miles away.

One of the concerns is that, in practice, patients could still be taken to A&E before being transferred to a specialist unit, which may increase the time it takes to get lifesaving treatment. However, paramedics are to be given training to spot heart attacks that have been caused by blood clots so that patients can be taken directly to an angioplasty centre. Angioplasty is used to treat patients whose heart attacks have been caused by blocked arteries.

About 25,000 of the 60,000 heart attacks treated each year are of this type, and a quarter of those patients are, at present, given the procedure, in which a tiny balloon is inserted into the artery and inflated to clear the blockage. The Government says it aims to treat 97 per cent of eligible heart-attack patients by using angioplasty within three years.

But experts admitted that although the number of centres offering the specialist treatment had risen from 35 in 2006/07 to 54 this year, a further increase was not likely. Cardiologists have described the proposal as a ‘challenge’, as specialist angioplasty units will have to be staffed by an expert team 24 hours a day, seven days a week. For the treatment to be effective it should be given within two hours of the heart attack, meaning some hospital trusts may need to double their number of cardiology consultants.

The proposals are the latest stage in the centralisation of NHS care. The Government has long pushed for the creation of ‘superhospitals’ – vast regional centres with specialist clinics catering to population areas of up to two million. Maternity services also face being moved from local hospitals to larger regional units and GPs could move from local surgeries to multi-purpose health centres, or polyclinics.

But Katherine Murphy, spokeswoman for The Patients Association, said the Government had got it ‘completely wrong’. She added: ‘What the Government always fails to consider is the convenience of access for patients. They should be providing a service at local level because that is what patients want.’

At the moment, most patients whose heart attacks have been caused by a clot are treated using thrombolysis – an injection of drugs to dissolve blockages. Professor Peter Weissberg, medical director of the British Heart Foundation, said the NHS had to commit ‘sufficient resources’ to turn the proposals into reality, especially for people in rural areas. He added: ‘We must not replace a first-class thrombolysis service, which is proven to save lives, with a second-class angioplasty service, which might not.’

The Department of Health said: ‘It is preferable to travel further to achieve a better outcome. However, if the journey time is too long, then early thrombolytic treatment is given instead.’

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