Please read the following Advance statement carefully before commencing treatment:
I wish to be treated by clinicians in a manner considered appropriate by a responsible body of medical opinion and who will not gain or lose financially from the outcome of their intervention. 
 
I therefore withhold my consent to be treated by anyone whose professional judgement might be compromised by the financial implications of their decisions, specifically anyone employed by a commercial healthcare company doing work sub-contracted by the NHS.
I am concerned about the creeping (galloping?) privatisation of the NHS. I would be interested to hear brief comments on the above advance statement.
Is it a principled ‘sticking it to The Man’? Or does it amount to elective suicide! Do I have the relevant legal terminology correct? Do I need to put more in to be taken seriously? ‘A manner considered appropriate by a responsible body of medical opinion’ is the Bolam Test, and that’s the key point of law, isn’t it? I want to be treated by people who are disinterested and whose judgement is unclouded by their own (or their companies) gain or loss. And where could one deposit such a statement? Could it go in one’s medical records?
Does one have the right (assuming one is conscious and able to speak) to insist on being treated by NHS staff? Is there a case in which this right has been tested? It is very definitely not the same as refusing consent to be treated.
I feel very strongly about this. An ‘Urgent Care Centre‘ at my nearest hospital (Croydon University Hospital) is run by Virgin Care (not to be confused with Virgin Health, which appears from its website to be an organisation that runs swimming pools and tennis courts). It seems that Virgin only deal with ‘the walking wounded’ and ‘worried well’: anything serious (and therefore expensive, I guess) goes through to the NHS doctors and nurses in A&E proper. The NHS staff presumably are worked off their feet because by definition everything that comes to them is serious.
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3 Comments

  1. Brian Fisher says:

    Unfortunately, your statement will include all GPs. We are all paid through the Quality and Outcome Framework which pays the practice (only indirectly the GP themselves) for good quality care.

  2. Interesting idea.

    Motivation of individual clinicians by reward related to outcomes is a funny way to phrase it I think. Individual NHS doctors and nurses can advance in their career and salary if they are good at their specialty. NHS providers can be rewarded or fined (in various ways – CQUIN, Never Events, waiting time penalties) if they do/ don’t meet quality standards in their care for you. Not a bad thing unless it starts to encourage gaming. (Un)fortunately however many contracts with private or public providers do not reward good outcomes – ISTCs get paid per case even if they need revision I believe (as do NHS hospitals who could get paid multiple times for each complication if they really mess up).

    This statement would also appear to prevent you from being treated by an agency nurse in an NHS hospital, wouldn’t it?

    Also private providers are not usually sub-contracted – they hold their own contracts with commissioners – although sub-contracting is probably more prevalent than we know about.

    Back to the point – given what you say about the types of work that are privately provided (non-emergency/ life threatening/ unlikely to be unconscious), how likely is it that you would end up in Virgin Care by accident?

  3. Shibley says:

    how do we know that ‘private providers are not usually sub-contracted’ out of interest?

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