Select Committee on Health Written Evidence

Memorandum submitted by Breakthrough Breast Cancer (CP 31)


  1.1  Breakthrough Breast Cancer is the UK's leading breast cancer charity and is committed to fighting breast cancer through research and education. Breakthrough has established the UK's first dedicated breast cancer research centre, in order to obtain our vision: a future free from the fear of breast cancer. Breakthrough campaigns for policies that support breast cancer research and improved services, as well as promoting breast cancer education and awareness amongst the general public, policy makers, health professionals and the media.

  1.2  Our memorandum reflects the views of Breakthrough and members of its Campaigns and Advocacy Network (Breakthrough CAN), many of whom have personal experience of breast cancer.

  1.3  Breakthrough welcomes this inquiry. Our memorandum focuses specifically on the issue of co-payments and charges for NHS wig services, as an example of how co-payments and charges in the NHS can impact on the patient. Breakthrough staff and CAN members would be willing to provide oral evidence to this inquiry, if the committee would find this useful.


  2.1  Women and NHS Trusts have reported real concerns over the quality and accessibility of wig services in many parts of the country, and in particular regarding patient dignity and sensitivity, lack of choice of wigs, and payment for wig services.

  2.2  There are major discrepancies in the cost of the service depending on where people live and whether they receive their chemotherapy treatment as in-patients (where people are entitled to a free wig) or as out-patients (where people are not entitled to a free wig).

  "In our experience, each hospital is different—they may give a prescription (for a wig) if they are an outpatient but usually only to in-patients. The majority of patients are outpatients when they have chemotherapy. Also the prescription can only be used towards NHS wigs and these are very low quality (compared) to what's generally available. We've had lots of queries from women who want to use the prescription for a non-NHS wig and put money towards the amount but this is not allowed". Breast Cancer Care northern regional office.

  "Members are not happy that they have to pay for the first £50.00. Lots of ladies are pensioners or unemployed and don't have it to spare. The breast care nurse has to go to charities for help". Hartlepool Breast Care Support Group.

  2.3  Many patients are unhappy with what they see as a lack of choice in who can provide their wigs, as they are limited to NHS suppliers. It is essential that patients be offered a full-range of wigs, taking into account hair colour, style and type.

  "When our patients can't get what they prefer locally many get their wigs from other sources, for example local markets that are cheaper or other specialised wig shops which are out of the area and are usually expensive . . . some patients complain that they feel pressurised to purchase their wigs from the local shop which is contracted to the hospital." Chemotherapy Sister, Newham.


  3.1  Breakthrough believes patients using wig services should be given greater flexibility to make part-payment towards a wig of their choice.


  4.1  There needs to be much greater transparency in how patients are told about their local wig service facility and its payment system.

  "Interestingly, no-one seems to know that inpatients requiring a wig do not have to pay for it. I suspect that people are discharged before they learn that this facility is available to them!" Chiltern Breast Cancer Support.


  5.1  The majority of CAN members involved in our wig service consultations paid a prescription charge for their wig. Breakthrough believes it is best to be informed of charges at the earliest possible time.

  "I was told straight away that I would have to pay a prescription charge for the wig. I was then given a slip with the details of how to pay, with the wig."

  5.2  Good practice should demonstrate wig suppliers offering advice on how to maximise the use of the prescription charge.

  "I chose to buy two wigs and was advised to buy the dearer one from my NHS payment rather than using my own money."

  5.3  Wig suppliers should also be aware of the sensitivity of a patient's needs when using the wig service, in particular regarding their financial situation. One scheme that stands out as good practice is provided by a women's group in Brigg who sponsored a patient's wig.


  6.1  The Department of Health should consider the impact the abolition of prescription charges in Scotland and Wales may have on wig payments.


  7.1  The Department of Health should review payments for wigs with a view to tackling the lack of choice and inequalities inherent in the current system.

  7.2  The review could consider the feasibility of introducing a system which would allow top-ups to prescriptions. One advantage of such an approach is that it would allow women to make part-payment towards a wig of their choice. However, any work on the feasibility of this type of system would need to consider the potential impact on equalities of having a system in which the quality of wigs is, in part, dependent on ability to pay.

  7.3  It might also consider the impact the abolition of prescription charges in Scotland and Wales may have on wig payments.


  8.1  Breast cancer is the number one health concern for UK women and remains the most common cancer in UK women—nearly 41,000 women and around 300 men are diagnosed each year. On average 63 women are diagnosed with breast cancer in each constituency every single year.

  8.2  Many patients diagnosed with breast cancer will undergo chemotherapy (treatment using drugs designed to destroy or control cancer cells) as part of their treatment programme and may, as a result of such treatments, suffer varying degrees of hair loss. Some will opt to wear a wig during their treatment time. Other people diagnosed with other cancers also undergo chemotherapy, possible hair loss and as a result may wear a wig. Therefore the number of people accessing wig services is considerable.

  8.3  For some people, coping with hair loss is the most distressing side effect of treatment. Hair can be very much part of a person's self-image and losing it may affect confidence and self-esteem.

  8.4  It is also a very visible side effect of cancer, often leaving a person feeling vulnerable and exposed, and for women in particular feeling unfeminine and unattractive.

  8.5  Hair loss impacts even further in cultures where hair is seen as a symbol of fertility and desirability, or alternatively as a sign of health and status.

Vicki Nash

Breakthrough Breast Cancer

December 2005

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