This page answers some of the questions raised in episode two of the second series of Hospital.

Does Imperial College Healthcare profit from administering drugs to cancer patients?

Many NHS organisations also provide private healthcare. The Trust does not profit from NHS patients who ‘top-up’ to receive a drug not available on the NHS. They are charged the wholesale fee for the drug plus an administration charge to cover the costs of administering the drug only. 

Patients who are entirely private are charged a price which includes an element of profit, 100% of which is reinvested into our NHS services. 

What are the rules around ‘topping up’ - a patient mostly receiving NHS treatment but then buying private drugs (not available on the NHS) and receiving them at the Trust? 

NHS patients are perfectly entitled to pay for additional private healthcare not currently available on the NHS, while continuing to receive available care from the NHS. This is known as ‘topping-up’. This often relates to receiving a particular drug or treatment option.

In line with Department of Health guidance the Trust’s policy is that all reasonable efforts should be made to secure NHS funding for a particular treatment or drug, prior to considering that a patient could pay for additional care privately. 

Once all NHS funding routes have been exhausted, or if it involved a drug or treatment that is not licensed for NHS use, if the patient then chooses to pay for additional private care, they will be responsible for all the costs associated with that treatment or drug where applicable, such as nursing and accommodation costs, tests and investigations, and not just the cost of the treatment or drug itself. This is to ensure that the NHS is not subsidising private healthcare.

The process and expected costs involved must be made clear to the patient prior to commencing any additional care. We will always use the lowest insured rate to calculate the estimated cost of the patient’s additional care. 

What are the rules around NHS doctors also doing private work?

When the NHS was formed in 1948 one of the terms agreed was that consultants were allowed to continue with their private work alongside their commitment to NHS services. This condition remains in place today, with consultants able to split their time between working for the NHS and for private services, with stringent rules in place to avoid potential conflicts of interest. Around half of NHS consultants in England are estimated to undertake some additional private work. 

How are doctors carrying out private work regulated?

All doctors – whether providing NHS, private care or both – are bound by the same regulatory procedures, including General Medical Council registration, and the services are subject to Care Quality Commission regulation.

What governance structures are in place for private healthcare provision at Imperial?

The clinical governance structure for private healthcare at Imperial College Healthcare mirrors the NHS with a clear reporting line to the Trust Board, where overall responsibility for quality of care sits, irrespective of the funding stream. 

Although our private healthcare arm is a commercial business, the principles and values of the NHS are very much apparent throughout the organisation. There are strict rules around how our consultants manage their time between NHS and private work. Our consultants always ensure that their NHS work takes precedence over their private work.  

Are there ever occasions where a private patient will take priority over an NHS patient?

No. There are occasions when private work takes place in NHS facilities, such as some operating theatres, but this will always be scheduled around NHS lists. Emergency cases, whether under private or NHS care, are treated exactly the same and only clinical priority is taken into account. If we are very stretched for capacity in our NHS services, we are able to bring into use spare beds in our private facilities, without any additional charge to the NHS.

Why does the Trust administer drugs or treatments that the NHS does not yet prescribe?

The National Institute for Health and Care Excellence (NICE) regulates the approval of new drugs or treatments for use by the NHS. There are a range of criteria that NICE follow before deciding to permit the use of a drug by an NHS including evidence of effectiveness, cost and existing alternatives. 

Should a patient wish to explore a treatment option that is not used by the NHS, the only way this can be carried out without NICE NHS approval is privately as a ‘top up’ treatment. 

For every such request, there are governance processes in place to ensure that this is in the best interest of the patient before the treatment takes place. If a drug or treatment is not yet proven to have a beneficial clinical impact, this will always be communicated to the patient before the treatment takes place.  

In some cases, we know that patients will go elsewhere for a treatment that isn’t approved for use by the NHS and so by administering this ourselves we can monitor them under our clear governance protocols in order to ensure that the administering of treatment is managed as appropriately as possible.

What options are available to screen patients with a genetic risk of cancer and is this funded by the NHS?

People who come from a family with a strong history of specific cancer types will be offered genetic screening to ascertain their risk of getting the same type of cancer in their life.

Should a patient have cancer and have a history of the same cancer in their family, their family members will also be offered genetic screening. All genetic screening is supported by counselling. Imperial College Healthcare has a huge centre dedicated to researching the impact of genetics on cancer and what treatments are best for patients presenting with a genetic mutation that could indicate a higher risk of having cancer in their lives. 

Useful links


NHS England

Department of Health

General Medical Council (GMC)

Care Quality Commission (CQC)

NHS Choices

Cancer Research UK



Cancer research at Imperial

The Brain Tumour Charity

Brain Tumour Research

Ovarian Cancer Action 

Target Ovarian Cancer

Eve Appeal