Sense at last


As expected, the government yesterday decided to allow 'private top-ups' within the NHS. In other words, patients are now going to be allowed to pay privately for additional drugs and treatments, without losing their right to NHS care and having to foot the bill for all of their treatment.

Previously, the government had always put the NHS' soviet-era ideology ahead of the health of patients, arguing that, "co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS". In previous blogs, I have described that policy as immoral, irrational, and quite possibly illegal, so I'm glad the government has finally seen sense. I'm still not sure why they needed an official review to tell them it was wrong to actively prevent people from accessing life-saving drugs and treatments, but there you go.

The real shame is that Andrew Lansley, the Tory health spokesman, doesn't seem to see it that way, telling the media, "I find it astonishing frankly, that we seem, the government seems, to be drifting into a system where we’ll end up with a two tier national health service." The Tories' general lack of radicalism on health reform is probably sensible – politically speaking – but standing in the way of genuine progress to score a partisan point is just wrong. For the party of individual choice to speak out against letting people spend their own money on their own health is perverse.

And make no mistake: allowing top-ups is a very definite step in the right direction as far as healthcare reform goes. Firstly, it lets people pay out-of-pocket for things that are too expensive to be provided by the taxpayer – good. Secondly, it will encourage the growth of affordable top-up insurance plans, giving many more people access to those new and expensive drugs. But there's a more important aspect to this decision: it ends the long-running fiction that the state (or rather, the taxpayer) can ever provide everything.

The lasting impact of this decision will hopefully be that the NHS becomes a defined benefit, rather than an open-ended entitlement.