Nurses call for clarity in response to government review on NHS top-ups

Published: 05 February 2009

EMBARGO: 00:01 5 February 2009

The Royal College of Nursing (RCN) today responded to draft Department of Health guidance on NHS patients who wish to pay for additional private care. The RCN contributed to the consultation, and recommended that top up payments be permitted but only for a limited period whilst the full implications were investigated.

Dr Peter Carter, RCN Chief Executive & General Secretary said:
“This is a deeply complex issue, and the next steps taken by the government will be of immense importance. The implications of unfettered top-up care could have a huge impact on the founding principles of the NHS, which is why the government must be clear in its decision about how top-up care works in practice.

"We do not want to face a situation where two patients in neighbouring beds can be offered different menus of treatment, based solely on their ability to pay. The government made the right decision in November in lifting the ban on top-up payments while examining the full implications of the policy, and I am pleased that many nurses took part in our consultation on that issue. If a patient decides to top-up their care, will they be taking NHS services and facilities away from other patients? Will a trust in the South of England be able to offer patients the same options to top-up as a trust in the North of England? The government needs to carefully avoid the creation of a deep and complex postcode lottery.

“Nurses will be on the front line, experiencing the practical effects of following through on this policy, and helping all patients with advice, assistance and difficult decisions. For instance, one nurse manager has rightly voiced the concern that some patients could be encouraged to spend their savings on treatment which could be futile or inappropriate for their condition. Patients must have the reassurance that their welfare will always be paramount, and that good guidance will ensure that a balance is struck in the best interests of patients.”

Notes to editors

The full response to the consultation can be found at http://www.rcn.org.uk/aboutus/policy/consultations

Key Points from the RCN response –
• The government needs to work with health professionals and patients to ensure that this does not result in a two tier NHS. SHA’s should monitor the implementation of this guidance at the local and Regional level and report back to the Dept Health on a regular basis. The RCN will also be monitoring the situation carefully. We are committed to working with the Department of Health to ensure the best possible outcome.

• We welcome the statement that “the fact that some NHS patients also receive private care separately should never be used as a means of downgrading the level of service that the NHS offers”.

• The pace of change must ensure that the full effects are understood before a policy is permanently applied. As one Nurse Manager put it –
“Whilst the Secretary of State has tried to minimise risk, implementation of the proposed guidance may prove logistically difficult and there would always be patients falling into ‘grey areas’…there is a case of a pilot scheme to identify the as yet unknown pitfalls.”

• Members raised some concerns about a potential increase in patient movements between different care settings to deliver on the separate care principle. In order to maintain patient comfort, dignity and infection prevention and control, patient movements should be kept to a minimum. This will require careful planning involving patients and clinical staff.

• RCN has also expressed concern about an increase in the movement of clinicians between NHS and private facilities and the effect this might have on services.

• Additional resources will need to be allocated to clinical staff on the front line to take into account the extra time spent in developing and delivering information to inform patient choices. One registered nurse said –
“As the patient’s advocate, Nurses will necessarily spend additional time attempting to solve confusions, answer questions and to contact other partners in care on behalf of the patients.”

• The work and remit of the National Institute for Clinical Excellence (NICE) must be publicly explored in order to find a new consensus on the allocation of NHS resources. PCT exception processes must be revised and standardised based on best practice.

• In the meantime, decision-making processes within PCTs and NICE must be more open to public scrutiny and should feel fairer and faster, in line with government pledges in November.

For further information, interviews or illustrations please contact the RCN Media Office on 0207 647 3633, press.office@rcn.org.uk or visit http://www.rcn.org.uk/newsevents/media

Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.