When it comes to the funding of drugs, the NHS

is like a mountain-top snack-bar that warns that only food and drink bought on the premises may be consumed there.

Under what is effectively a kind of medical totalitarianism, the NHS rules that very ill people who seek new drugs are the equivalent of cheeky picnickers. It does not allow anyone to buy drugs that it does not provide. If they do, all the services previously provided free by the NHS have to be paid in full by the patient.

Terminally ill patients find themselves paying not just for standard NHS drugs but also for their administration, their transportation and even taking blood (£115 plus VAT).

In a society that values choice, and in a modern health service that boasts of its ability to cater for a patient's wishes, there is a strong body of opinion that this rule springs from ideological spite as much as anything. To deny anyone, effectively by bankrupting them, the right to pay for drugs that may give them a few more months of good quality of life is inequitable and invidious.

But there is a convincing argument against co-payments. Campaigners say that it will offer the NHS the ultimate get-out clause, letting the cash-strapped body off the hook on the provision of expensive drugs. As Cancer Research UK said: “They're hardly falling over themselves to provide new drugs anyway.”

Many are opposed to top-ups on the grounds that only the rich could afford them. Myeloma UK, which works for those with a rare cancer of the bone marrow, for which there is an effective drug, Revlimid, available but not yet funded by the NHS, is not in favour of co-payments on the ground that it would be unjust for those with more expensive diseases.

“It would be a proxy solution to a problem that requires a comprehensive rethink to NHS funding issues,” it says.

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