Policy on Provision of Top-up Treatments for NHS Patients

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Caroline Chastity James
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1 Policy on Provision of Top-up Treatments for NHS Patients

2 Title: Policy on Provision of Top-up Treatments for NHS Patients. Executive Summary: This policy outlines the system by which patients in East Cheshire can be treated in accordance with the guidance contained in Improving access to medicines for NHS Patients: The Report of Prof. Mike Richards,2008 If demand for top-up treatment increases from its current extremely low level, this policy may need to be reviewed. Supersedes: Description of Amendment(s): N/A N/A This will impact on: Outpatients, Inpatients, Pathology, Radiology, and Finance. Financial Implications: Unknown, but should not incur cost to Trust. Area: All Document Reference: Version Number: 1.2 Effective Date: Issued By: Author: Dr R Stead Medical Director Dr M. Rothwell - MMG Chair Dr Nick Craven CD, OPBU Review Date: Impact Assessment Date: 30/4/16 (unless legislation requires earlier review) June 2009 APPROVAL RECORD Committees / Groups Date Consultation: Finance Committee Medicines Management Group June 2009 Pharmacy Dept. Approved by Director: Medical Director September 2009 Received for information:

3 Executive Summary The Richards Report (23 rd March 2009; e/dh_096428) defined the terms under which patients may elect to pay for additional treatment or drugs ( top-up treatment ) without forfeiting their entitlement to free NHS care. The commonest scenario to which this will apply to is paying for additional chemotherapy treatments not available on the NHS. There is a stated requirement in the letter of David Nicholson, 23 rd March 2009, sent to all Chief Executives, that every care provider should have a policy on how the Report will be implemented. This document represents East Cheshire NHS Trust s policy on implementing the Richards Report. Patients may choose to pay for additional treatments not available on the NHS as long as those treatments are delivered outside of the routine NHS care. They cannot have additional treatment delivered within standard NHS resources. There must be clear separation of the timing and the charging of any additional treatment. The following examples taken from the Richards Report illustrate the core principles which must be observed. 1. Chemotherapy: Patient B chooses to pay for an unfunded cancer drug in addition to chemotherapy she has been receiving on the NHS. She attends an appointment in the morning in the Trust s chemotherapy suite and attends a separate appointment later that day in the Trust s Private Wing, where she is given the unfunded cancer drug. The charge to Patient B includes the cost of the drug, any staff involved and any additional tests or scans only because of the use of the unfunded drug. Patient B is allowed to have additional private care because the NHS element of care and the private element of care can be delivered separately. 2. Cataract Surgery: Patient E needs a cataract operation on the NHS and wishes to pay for a multifocal lens implant (not available on the NHS), rather than a standard unifocal lens implant which is available on the NHS. He wants to pay only for the more expensive lens. This is not allowed. He can either have an operation funded by the NHS and have a unifocal lens, or pay for an entirely private procedure and lens. Patient E is not allowed to have additional private care because the NHS element of care and the private element of care cannot be delivered separately.

4 The Position at East Cheshire NHS Trust As of June 2009 the demand for top-up treatment is extremely low. This is most likely to be because chemotherapy arrangements for local patients are made via The Christie Hospital FT and any issues regarding top-up will be made through them. It is impossible to predict where any future demand for top-up treatment may arise, but it is expected that demand will be low. Consequently, any policy on this issue cannot hope to be comprehensive. This policy may need review once patterns of demand have been identified. If this happens clinicians involved with any cases using top-up treatment should be involved in writing it.

5 Policy on implementing The Report of Prof. Mike Richards: Improving access to medicines for NHS Patients March 2009 If a patient wishes to have treatment not available under the NHS the clinician involved should: 1. Refer the request to the CECPCT Bespoke Care Panel who may be able to provide funding (contact the Chief Pharmacist for details of how to apply to Bespoke Care Panel). (Recommendation 9 in Richards Report.) 2. If the treatment is to be funded by the patient then the clinician in charge of the case should decide how the care can best be delivered in the spirit of the Richards Report (see examples above). 3. The proposed treatment schedule should be discussed with the Medical Director, to confirm it is in the spirit of the agreement and it should be documented in the case notes. A copy of the care plan should be sent to the Medical Director and the Director of Finance. 4. If the Clinician in charge of the case, in agreement with the Medical Director, decides to undertake the private element of care on Trust premises he / she should make arrangements, as appropriate, with: A) Pharmacy for the dispensing of any drugs. Pharmacy will charge the patient cost of the drugs plus an agreed fixed handling fee. The schedule of dispensing fees is available from the Chief Pharmacist on request. B) Outpatient Manager for clinic time, if. The hospital will charge an agreed fee for the clinic time. C) Bed Manager if an inpatient bed is for treatment. The hospital will charge an agreed fee for the admission time. D) Any other departments or staff as e.g. additional scans. 5. All bills for care should be sent to the Director of Finance who will be responsible for billing the patient. 6. Responsibility for providing continuity of care rests with the clinician supervising the case; if the private element of care is to be delivered on separate premises, or under a different clinician, then the clinician responsible for the NHS element of care should satisfy themselves and provide assurance to the Medical Director that appropriate governance arrangements are in place for the safe transfer of care between the NHS and the private sector. (Recommendation 9.)

6 Equality and Human Rights Policy Screening Tool Policy Title: Richards Report Policy Directorate: Trust wide Name of person/s auditing / authoring policy: Dr M Rothwell, Chair Medicines Management Group. Dr Nick Craven, Director Out Patient Services. Policy Content: For each of the following check whether the policy under consideration is sensitive to people of a different age, ethnicity, gender, disability, religion or belief, and sexual orientation? The checklist below will help you to identify any strengths and weaknesses of the policy and to check whether it is compliant with equality legislation. 1. Check for DIRECT discrimination against any minority group of PATIENTS: Question: Does the policy contain any statements which may disadvantage people from the following groups? 1.0 Age? 1.1 Gender (Male, Female and Transsexual)? 1.2 Learning Difficulties / Disability or Cognitive 1.3 Mental Health Need? 1.4 Sensory 1.5 Physical Disability? 1.6 Race or Ethnicity? 1.7 Religious Belief? 1.8 Sexual Orientation? 2. Check for DIRECT discrimination against any minority group relating to EMPLOYEES: Question: Does the policy contain any statements which may disadvantage employees or potential employees from any of the following groups? 2.0 Age? 2.1 Gender (Male, Female and Transsexual)? 2.2 Learning Difficulties / Disability or Cognitive 2.3 Mental Health Need? 2.4 Sensory 2.5 Physical Disability? 2.6 Race or Ethnicity? 2.7 Religious Belief? 2.8 Sexual Orientation? TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING DIRECT DISCRIMINATION = 0

7 3. Check for INDIRECT discrimination against any minority group of PATIENTS: Question: Does the policy contain any conditions or requirements which are applied equally to everyone, but disadvantage particular people because they cannot comply due to: 3.0 Age? 3.1 Gender (Male, Female and Transsexual)? 3.2 Learning Difficulties / Disability or Cognitive 3.3 Mental Health Need? 3.4 Sensory 3.5 Physical Disability? 3.6 Race or Ethnicity? 3.7 Religious, Spiritual belief (including other belief)? 3.8 Sexual Orientation? 4. Check for INDIRECT discrimination against any minority group relating to EMPLOYEES: Question: Does the policy contain any statements which may disadvantage employees or potential employees from any of the following groups? 4.0 Age? 4.1 Gender (Male, Female and Transsexual)? 4.2 Learning Difficulties / Disability or Cognitive 4.3 Mental Health Need? 4.4 Sensory 4.5 Physical Disability? 4.6 Race or Ethnicity? 4.7 Religious, Spiritual belief (including other belief)? 4.8 Sexual Orientation? TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING INDIRECT DISCRIMINATION = 0 Signatures of authors / auditors: Date: Equality and Human Rights Compliance / Percentage Calculation Number of Yes answers for DIRECT discrimination. Number of Yes for INDIRECT discrimination. Total answers for POLICY CONTENTS discrimination. (A)0 (B)0 (A+B)0 Percentage content non compliant = 0 (Divide a+b by 36 x 100)

RECORD KEEPING IN HEALTHCARE RECORDS POLICY

RECORD KEEPING IN HEALTHCARE RECORDS POLICY Version 6.0 Key Points The Policy provides a framework for the quality of the clinical record facilitates high quality, safe patient care and that subsequently