Row over two-tier health service as ban on 'top-up' cancer drugs lifted

Alan Johnson, the Health Secretary, yesterday gave the go-ahead for terminally ill cancer patients to buy "top-up" drugs privately without losing their right to free care under the National Health Service.

He faced criticism that he had taken a step towards two-tier health treatment, but said that any other decision would have been cruel and inhumane.

Mr Johnson also announced plans designed to offer more life-extending medicines on the NHS in an effort to stop sufferers or their family paying for the drugs themselves.

The controversial moves come after several patients died fighting for the right to receive specialised drug treatments on top of their NHS care.

Previous NHS rules meant that people who received private treatment – often using drugs awaiting approval from the National Institute for Health and Clinical Excellence (Nice) – lost all entitlement to free NHS care for the same condition.

Terminally-ill patients can now receive private drugs as long as they are administered away from other NHS patients. The change was ordered by the Government to come into effect from yesterday.

Mr Johnson denied he was undermining basic health service principles of all citizens receiving equal care regardless of their personal wealth.

He said: "It will damage and jeopardise the future of the NHS if we carry on with what is seen by most people as a cruel procedure. This issue was causing distress to patients and their relatives and none of us wanted that uncertainty and inconsistency to continue."

But Andrew Lansley, the shadow Health Secretary, said: "They've gone from letting patients lose their NHS care to creating a two-tier NHS, where some patients will get better care simply because they can pay for it. And they're trying to dress it up by calling it "separate" care. The bottom line is that the Government should be working to ensure that patients receive these drugs free of charge on the NHS, rather than forcing people to pay for them."

Mr Johnson announced moves to approve more drugs on the health service that were believed to offer a "substantial average extension to life compared to the current treatment" for small numbers of patients considered to have a life expectancy of less than two years.

Following criticism of the prolonged Nice approval system – forcing seriously ill patients to pay for medicines yet to be endorsed by Nice – Mr Johnson also set out plans for new drugs to be assessed more quickly.

Talks are being held with pharmaceutical companies to put new drugs on the market at a lower price with the option of raising it if their effectiveness became obvious. The effect of the moves, the Government said, would be to make more cancer drugs available on the NHS, leaving only a "small number" of patients in the position of having to go private.

The moves follow an urgent review by Mike Richards – the Government's so-called "cancer tsar" – into reducing the need for sufferers to dip into the savings for treatment.

An estimated 8,000 cancer sufferers a year ask for unlicensed drugs to treat their condition.

The therapist's story: 'Cancer was stressful enough, without this'

Linda O'Boyle died this year after being refused bowel cancer treatment on the NHS. The 64-year-old former occupational therapist from Billericay, Essex, was receiving chemotherapy for the rapidly advancing illness when her doctor advised her that she could extend her life by taking the drug Cetuximab. As it was not usually provided on the NHS, she and her husband, Brian, decided to take £11,000 from their savings for an eight-week course of the drug. Mr O'Boyle believes the treatment provided his wife, who had three sons and four grandchildren, with another three months of life. However, when Southend University Hospital NHS Foundation Trust learnt of the couple's decision, it withdrew her free care, including the chemotherapy drug she was receiving, and told them to pay for the treatment. Mr O'Boyle, 74, a former NHS manager, said: "It was stressful enough for Linda having cancer – without her having all this stress on top of it."