Hospital cleared for cheap test - tube births

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The Department of Health yesterday cleared a London teaching hospital of breaching National Health Service rules after it revealed that it was offering patients test-tube baby treatment at pounds 800 a cycle - a price well below the charge of many private clinics.

The patients, a departmental spokesman said, were "clearly private patients, not NHS patients. The trust has to recover its costs in full, but if it is doing that, it is permissible".

The move, however, was condemned as "a major step in the wrong direction" by Harriet Harman, Labour's health spokeswoman, amid fears that it could lead to similar schemes for other treatments. "It is the thin end of the wedge," Ms Harman said, "the start of the slippery slope towards partial privatisation of the NHS. It starts with IVF [in vitro fertilisation] and ends up with hip replacement." It was a development, she said, of "immense significance".

David Highton, chief executive at the Chelsea and Westminster, insisted that the hospital was acting within the rules and for patients' benefit. It charges health authorities who will pay pounds 800 per cycle for IVF treatment. But where they will not, it offers the patient the treatment privately at the same price - way below the pounds 1,500 to pounds 2,500 many private clinics charge.

That was possible, he said, because the hospital was not seeking to make a profit and consultants were not charging a fee - the hospital simply costs out their time, along with that of technicians, nurses, and other expenses.

"We have to recover all our costs," he said, "but we are doing that." The patients become private because their authority will not pay. "These are private patients from whom we are not seeking to make a profit. They are not NHS patients who are being charged, even though they are being treated in NHS time." Similar IVF schemes operate at King's College Hospital and St Thomas's, both in south London.

NHS legislation prohibits "hybridisation" - charging NHS patients for treatment outside defined areas such as prescriptions. It was that which scuppered a scheme at St Bartholomew's, in the City of London a few years ago when the hospital proposed a pounds 300 levy towards the cost of IVF for NHS patients.

The issue arose, Mr Highton said, because IVF was "at one end of the rationing debate". Only around half of health authorities will pay for it. Mr Highton said the consultants had proposed the scheme for three reasons. They wanted the new unit to be successful; it brought in patients which helped with their research; and they felt NHS provision was too restrictive and wanted to provide at least some IVF treatment at as low a cost as possible - "a mixture of altruism and self interest". Some also undertook IVF treatment at private hospitals in their own time, charging normal private rates.

Mr Highton admitted that the scheme "does raise the issue of co-payment" - patients contributing towards NHS treatment - "although I am clear that what we are doing is not co-payment".

To go down that road, he said, "would be a very big step, the thin end of the wedge of charging for NHS treatment. We already have co-payment for dental services and prescription charges, for example, but to allow it for other treatments would be a massive step that would fundamentally alter the NHS. It should not be something that should be allowed to slip in, in a couple of instances".

The trust had no plans to extend the scheme to other treatments, he said.