119. In conclusion, although we are not convinced by the arguments that dismiss the threats of establishing a two-tier system or that separation of patients is practicable for only a part of their treatment, we can see no transparent way of rapidly alleviating the problem other than Professor Richards' Option 3. We recommend that every effort is made to minimise the numbers of patients involved by:

• Speeding up the NICE process.
• Increasing the work on disinvestment on the least useful other treatments.
• Standardising PCTs' Exceptional Funding Request procedures including the communication of decisions and the reasons for them to patients and families.
• Instructing NICE to issue brief, understandable, accessible and well publicised explanations for lay people to explain the reasons for refusing funding for drugs, to give patients and their relatives clearly spelt out information upon which they can base their decision about paying for some but not all medicines.

120. We recommend that the Department monitors the implementation of the Report's recommendations by funding research to gather evidence about:

• The actual degree and modes of separation of care achieved by different trusts with and without existing private facilities.
• The support of consultants, especially those who do not normally undertake private practice, and other staff for the scheme.
• The effects on PCTs' ability to fund other established, essential treatments for other conditions that do not have the benefit of NICE guidance.
• The numbers of patients applying to pay for extra drugs.

121. We recommend that the Department also actively addresses the problems of prioritisation by initiating open discussions about NHS treatments or services that should be reduced or not provided.