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Crocodile tiers
  1. David M Shaw
  1. Dr D Shaw, Faculty of Medicine & Centre for Applied Ethics and Legal Philosophy, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ; d.shaw{at}dental.gla.ac.uk

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Over the last few weeks there have been several prominent stories in the national press about people being forced to pay for their NHS treatment because they have chosen to pay for supplemental private care. One case is that of Jack Hose, who has bowel cancer and was prescribed irinotecan on the NHS, but this treatment was not effective.1

Refusing to give up, Mr Hose was privately prescribed cetuximab in combination with irinotecan with some success. His local NHS trust has now informed him that if he continues to pay for private care, he will also have to pay for all his NHS care, including repaying the cost of his original irinotecan prescription. Alan Johnson has supported this stance, claiming that to do otherwise would create “a two-tier” NHS. In fact, this attitude is unethical and self-contradictory.

First, a two-tier NHS already exists inasmuch as some drugs are available in some areas but not in others because of trusts’ individual funding decisions. It is disingenuous to claim that a two-tier NHS is unacceptable when the notorious “postcode lottery” means that …

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