Memorandum submitted by Breakthrough Breast
Cancer (CP 31)
1. INTRODUCTION
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. ARE CHARGES
FOR TREATMENTS
AND HOSPITAL
SERVICES EQUITABLE
AND APPROPRIATE?
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. WHAT IS
THE OPTIMAL
LEVEL OF
CHARGES?
3.1 Breakthrough believes patients using
wig services should be given greater flexibility to make part-payment
towards a wig of their choice.
4. WHETHER THE
SYSTEM OF
CHARGES IS
SUFFICIENTLY TRANSPARENT
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. HOW SHOULD
RELEVANT PATIENTS
BE MADE
AWARE OF
THEIR ELIGIBILITY
FOR EXEMPTION
FROM CHARGES
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. WHETHER CHARGES
SHOULD BE
ABOLISHED
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. RECOMMENDATIONS
FOR ACTION
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 BACKGROUND
TO HAIR
LOSS
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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