THE quality and extent of cancer care within the NHS has been thrust into the spotlight this week as Anne Marie Rogers took her fight for the right to receive the breast cancer drug Herceptin on the NHS to the High Court. Ms Rogers says that the refusal of Swindon Primary Care Trust to provide the drug to her is a “death sentence”.

Her legal fight is the first court case against a decision not to provide the drug, which is said to halve the chances of the aggressive HER2 form of breast cancer recurring.

Many people with private medical insurance (PMI) who undergo cancer treatment would, however, be covered for Herceptin, says Dr Chris Dark, medical director of the insurance firm PruHealth, part of Prudential. “We looked at the evidence for use of Herceptin, which was incontrovertible. So rather than wait for a decision from the National Institute for Health and Clinical Excellence (NICE) (the body that decides which drugs are to be used on the NHS), we decided to include its use under our cover.”

Few people with PMI, however, are likely to know if their policies will cover them for new treatment or participation in groundbreaking trials. While cancer treatment is covered under most PMI policies, few cover all aspects of treatment and the details may be hidden in the small print.

Some policies may have restrictive clauses, which means that patients are forced to go back to the NHS for treatment at a later stage or made to pay for care at a time when they are most vulnerable. This can happen, for example, when cancer becomes incurable or hospice care is needed.

Graeme Warner, director of Manson Warner Healthcare, the insurance broker, says that most PMI companies will provide cover for Herceptin, both in the initial and later stages of treatment. “This undermines the current stance of the NHS and can, in some cases, mean the difference between life and death,” he says.

Yet according to the cancer charity Cancer Bacup, which conducted a survey of PMI cover, information for patients is often unclear or unhelpful. The report found that only BUPA, WPA and Clinicare covered all stages of cancer, while others often ceased cover when cancer became incurable or fell into the category of a chronic condition when treatment had been continuing for more than five years.

Michelle Rowley, a spokeswoman for the charity, says: “Since the report, we have been working with the Association of British Insurers to improve information to patients. A couple of insurers have taken on board what we said and tried to improve what they offer. But we haven’t seen an industry-wide change and are aware that there are still a lot of problems.”

The charity was surprised to find in the report that consumers were being given misleading information by sales staff or brokers. “Some sales staff are telling consumers that treatments for incurable cancer are covered when the same company told us in the survey that they are not.”

Nevertheless, Mr Warner says that, in general, the advantage of policies is that the tests, referrals and treatment for cancer can be much quicker if done privately. “Although there can be regional variations, you are more likely to have faster treatment by going privately,” he says. “In some areas NHS treatment is extremely quick and efficient. But we have seen many incidents where initial consultations, scans or X-rays can be particularly prolonged, which means that there are months of waiting before diagnosis.”

Some companies have launched special cover for cancer, including BUPA and AXA PPP Healthcare. These cover core conditions including stroke and cancer but tend to be midway policies between critical illness and traditional PMI. Dr Dark says that for treatments such as chemotherapy and radiotherapy, private patients are likely to use NHS facilities, since there are very few radiotherapy units in private hospitals. Policyholders will also need to have treatment approved in advance. “We have a responsibility to protect people from inappropriate treatment, although we will approve experimental treatments if they are part of a proper clinical trial,” he says.

BUPA claims to be the only insurer to cover cancer treatment from diagnosis to treatment of secondary cancer, and that it will pay for nearly all the 20 cancer drugs not widely available on the NHS.

Anne Marie Cooklin, a spokeswoman for BUPA, says: “We made a policy decision a few years ago that if people developed cancer, we wanted to be sure that their policy would cover them.” BUPA does not cover the cost of hospice care but it does make a contribution towards it.

• Cancer Bacup: www.cancerbacup.org.uk.
• For more on insurance visit www.timesonline.co.uk/insure

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