This week an NHS trust in Yorkshire will become the latest to offer the service, with a new dermatology clinic performing operations that were once free of charge on patients who are prepared to pay.

The operations will be carried out in an NHS hospital by NHS doctors and nurses during NHS time.

The growth in add-on services has alarmed some experts. Professor Allyson Pollock, director of the Centre for International Public Health Policy at Edinburgh University, says the most vulnerable patients are suffering as a result of fees being widely introduced. “It is shocking that NHS patients can pay for a higher level of care. They are getting priority treatment and are able to pick and choose,” said Pollock.

The Foundation Skin clinic, to be opened by Harrogate and District NHS Foundation Trust, has been described by managers as a “halfway house” between state and private care.

NHS patients will be able to pay the trust to remove moles and warts, to screen moles or to have Botox injections to reduce heavy sweating.

Some of these services were offered free by the trust until 2003, when it stopped paying for them. The new rates will be lower than those charged by private hospitals, however.

The trust admits that the clinic has been set up in response to NHS funding shortages and said patients are happy to pay for treatments no longer available for free.

Dr Kay Baxter, consultant dermatologist at the trust, said: “This clinic has been developed to fill a genuine gap in patient service. A local cosmetic exclusion policy has been in place since early 2003.

“The NHS currently faces many difficult decisions with regard to the funding of treatments. Our patients are very understanding of the reasons behind the cosmetic exclusion policy. They are pleased to be able to access treatment not ordinarily available on the NHS while supporting their local health service.”

Many other NHS trusts across England are now charging patients for treatments or levels of care that would previously have been free.

Patients giving birth at Queen Charlotte’s and Chelsea NHS hospital in London can secure one-to-one treatment from a midwife if they pay £4,000, under the new Jentle Midwifery scheme. One-to-one midwife care is the recommended standard of treatment and has been shown to reduce the need for medical interventions. It is not available to all women because of a shortage of midwives.

The Hammersmith Hospitals NHS Trust, which runs Queen Charlotte’s and Chelsea, says revenue from the scheme, which has so far been used by 74 women, goes back into the NHS and has already paid for 2½ midwives’ salaries.

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