Hospitals may reject top-ups

Leading hospitals in England may have to refuse patients who want to top up their care as they could be breaching NHS rules.

Elite hospitals with Foundation Trust status have a limit on the number of patients they can treat privately and NHS managers have warned that unless the cap is abolished they will have to turn top-up patients away.

The House of Lords is due to debate scrapping the cap this week. An amendment to the bill has been put forward by Baroness Meacher, who is chairman of a Foundation Trust in London.

Baroness Meacher, a crossbencher asserted that the cap just does not make sense anymore.

"Of course, we don't want to see hospitals treating just private patients, so the amendment requires that any money made be reinvested back into NHS care," she told the BBC.

Alan Milburn, former Health Secretary, proposed the cap in an attempt to convince backbench Labour MPs in 2002 to back the bill, paving the way for Foundation Trusts to be free from central government control. 

Unions are opposed to scrapping the cap. A spokeswoman for Unison said: "Our fear is that it will allow these hospitals, with all their freedoms, to effectively become private facilities. That is not in the interests of NHS patients."

The government agreed to allow top-ups, where patients pay privately for care not available on the health service while continuing to receive their basic package of NHS treatment, in November 2008.

The move came as a result of several high profile cases where cancer patients had been denied NHS services after paying for drugs themselves. However, the Foundation Trust Network has said the cap poses a serious obstacle for the building of integrated care services as set out under Lord Darzi's review.

Sue Slipman, Foundation Trust director said that hospitals are worried that because they are close to the cap they will have to send patients to other centres. "Top-ups is still bedding in, but in the future it could be a serious problem," she told the BBC.

Commenting on the consultation, Slipman said: "Foundation Trust income from all sources - including from private patients - is used to benefit NHS patients. The only possible option we could endorse in the consultation is to maintain the status quo."