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Arrangements for NHS patients receiving healthcare services through private healthcare arrangements

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Annex A
Key Principles and Requirements for NHS Boards

This guidance takes full account of the core principles of the NHS as set out below:

  • the NHS provides a comprehensive service, available to all
  • access to its services is based on clinical need not an individual's ability to pay
  • the NHS aspires to high standards of excellence and professionalism
  • NHS services must reflect the needs and preferences of patients, their families and their carers
  • the NHS works across organisational boundaries with other organisations in the interests of patients, communities and the wider population
  • the NHS is committed to providing the best value for taxpayers' money, making the most effective and fair use of finite resources
  • the NHS is accountable to the public, communities and patients that it serves

The following key requirements should apply:

  • the primary purpose of any NHS organisation is to provide NHS care;
  • in the case of a medicine, all avenues for obtaining it via the NHS should be fully considered and exhausted as appropriate before provision of combined NHS and private care is considered;
  • NHS and private care should be delivered separately and there should be clear separation in legal status, liability and accountability between NHS and private care provision;
  • in all cases the discrete elements of NHS and private care must be understood by all parties;
  • the NHS should never subsidise private care with public money, which would breach core NHS principles;
  • any arrangements to combine NHS and private care must be lawful;
  • any arrangements to combine NHS and private care must not compromise the legal, professional or ethical standards required of NHS clinicians;
  • on the basis that the private and NHS elements of care can be fully delineated they should be capable of being delivered independently at a different time and place from each other. This could include the facilities of a private healthcare provider, or part of an NHS organisation which has been designated for private care, including amenity beds;
  • the NHS must not offer a two-tier service: the NHS provides treatment free at the point of access. Unless legislation allows, the NHS cannot charge patients for NHS care.