• Categories
  • Category Archives: Private Medicine

    Something major happened in the NHS in February. No, not the new White Paper on rearranging the furniture; something else. This was the announcement, or lack of announcement, that a large number of GP Practices have been taken over by a US Health Insurance giant – Centene. AT Medics, a London based GP group, which runs 37 practices, has essentially been bought out by Centene. This means overnight hundreds of thousands of patients woke up with a new GP provider, without their consent. The acquisition makes Centene the largest provider of General Practice in England with 69 practices.

    The way this has happened follows a pattern seen in recent years. No consultation or public scrutiny; use of legal loopholes; and the use of the revolving door of ex-NHS leaders who know the system as gamekeepers turned poachers. It is possible by a sleight of hand similar to the methods of the cuckoo. The incoming company adds or replaces directors of the ‘host’ organisation, which technically still exists so keeps its NHS contracts, just as a cuckoo displaces the host’s chicks out of the original nest.

    The significance is twofold.

    Firstly, deep and comprehensive commercial involvement in our NHS is troubling. In this case the US health insurer is not only now the largest provider of GP services in the country, it also is providing contracts to NHS England and Integrated Care Systems to advise how they run the NHS – nationally and locally. This gives great insight into the decision makers and influence over how the money is spent. Combined with Centene having a major stake in private hospitals, it is not hard to join the dots- involvement in the design of systems, financing of services and the provision of services gives companies a great degree of involvement in our NHS.

    Secondly these developments are a logical conclusion to major changes for some years in the way family doctors services are organised and delivered. As a GP I have huge concerns and patients will do as well. Why does it matter?

    When invited in Parliament by his shadow, Jonathan Ashworth, to condemn the takeover, Secretary of State Matt Hancock declined, replying: ‘What matters for patients is the quality of patient care… what matters to people is the quality of care. That is what we should look out for’.

     Is he correct? Is the quality of care all that matters? Or do the people providing it, and their ethos, motivation, interests and agenda matter? Is it possible to disentangle ‘quality’, an abstract notion, from the specific people providing a service and their very non-abstract interests?

    One of the reasons I became a GP, and probably the major reason I have stayed in my practice working full time for nearly 15 years, is the deep-rooted feeling that I have of being part of something more than just a clinical service. Myself and my GP colleagues, similar to many across the country, both lead the service and work in it. Every day we see our patients and work in our communities, we know the people and the community. There is no escaping direct and sometimes blunt feedback. Our teams are small, if there is a problem, we are around to fix it. If something needs to change, we don’t need to enter into a large corporate machine for it to happen. We get the spanner out and make the adjustment.

    Can we really say the same for a company that has its eye on more than just providing a ‘good quality’ GP service for the 69 different sites it has control of? There are those who compare health care to supermarkets, or banks. The argument is that efficiency and scale are what is needed; the people who provide it can change and the patient-doctor relationship isn’t a problem, as long as the measurements prove ‘quality’. This may work for a simple transactional arrangement, such as buying some groceries or cashing a cheque, but healthcare – and especially holistic primary healthcare is a more complicated than that. It does matter who cares. It is all about the people, their motivations and their relationship with their patients and community. This is not to say that UK General Practice can’t be improved, but let’s at least keep the baby if we are changing some of the bathwater.

    If anything, General Practice feels more like farming than retail. When done well, looking after the health of the community well takes time, and deep commitment. When done badly it can result in destruction of the environment and soulless communities. Will this new huge, commercial type of model of healthcare care about this?

    I doubt it.


    US Centene expands in the UK with increased stake in Circle Health


    The impact on NHS finances and NHS patient care

    When the Health and Social Care Act was passed in 2012 the treatment of private patients was expected to become a significant source of NHS hospital trust income. While this has not happened on the scale that some observers foresaw, the continuing squeeze on NHS funding could lead to the treatment of private patients becoming more important, with a potentially significant impact on the availability of care for NHS patients.

    1. This report sets out the findings resulting from interviews with 17 hospital staff carried out in 2016, published research findings, official publications, LaingBuisson’s market surveys, and Freedom of Information requests to all 153 acute hospital trusts in England.

    2. The report describes the scale and distribution of private patient treatment in NHS hospitals. It discusses two issues: whether the treatment of private patients generates additional income for NHS hospital trusts, and whether treating patients privately in NHS hospitals risks disadvantaging NHS patients.

    Why do private patients want to be treated at an NHS hospital rather than a private hospital?

    1. A primary reason for patients wanting to pay for treatment at an NHS hospital rather than a private hospital is that higher-risk or more complex cases cannot be safely treated in a private hospital if, as is typically the case, it has no on-site specialist teams or intensive care beds. Even patients who are eligible for NHS treatment may elect to be treated as private patients in order to have their choice of consultant, for example, or to be treated more quickly, or to have a private room.

    2. Another reason, which is particularly relevant to self-paying patients (as opposed to those with private health insurance), is that the price charged for treatment in an NHS hospital’s dedicated Private Patient Unit or PPU is reported to be often up to a third less than in a neighbouring private hospital. Some private patients may also think that the quality of care in an NHS hospital will be higher, thanks to having on-site multispecialty teams of clinicians and offering more assurance of safety, although these advantages have not been widely appreciated in the past.

    What drives the NHS’s interest in treating private patients?

    6. The Health and Social Care Act 2012 raised the limit on the share of total trust income that NHS hospital trusts may receive from private patients to 49%, and since then NHS hospitals have been encouraged to see private patients as a significant potential source of income. In 2015-16, four years on from the passage of the Act, the total income that the NHS generates from private patients had increased from £511m to £596m – a 16% increase in nominal terms and a 12% increase in real terms (at 2012/13 prices) .

    Table 1. Private patients treated in NHS hospitals in England: number, share of total Finished Consultant Episodes, and income generated (UK data).

    private patient numbers

    Sources: Finished Consultant Episode data from NHS Digital 2011, 2012, 2013, 2014, 2015, 2016; income data for UK from LaingBuisson 2016

    1. Despite this increase in the income generated from private patients, the percentage of NHS activity which is dedicated to treating private patients has remained very small. Only 0.5% of all Finished Consultant Episodes in NHS hospitals are for private patients and this percentage has not changed substantially since the Health and Social Care Act became law. In 2013, NHS hospitals’ share of the total income earned from the treatment of all private patients in England was little over 8%.

    2. During interviews, some healthcare professionals suggested that in addition to generating revenue from private patients, NHS hospitals might encourage the treatment of private patients to support consultants who want to treat private patients and sometimes need to treat them in the NHS hospital where they work – whether because a patient is too high-risk or has a condition too complex to be treated at a local private hospital, or because the hospital has facilities that are not otherwise available, or for other reasons. Some clinicians interviewed also thought that treating private patients adds status to a hospital and enables it to attract high-quality staff, in particular consultants.

    9. The amount of income generated from private patients by the NHS varies greatly between NHS hospitals. A small number of NHS hospitals in London earn a significant income from private patients, and many others have invested in private patient beds or dedicated private patient units (PPUs) in an attempt to boost this source of revenue. By June 2016, the number of PPUs had risen from 84 in 2014 to 91, though with a slightly reduced total number of beds – 1,142, down from 1,155 in 2013.

    1. LaingBuisson  estimate that in 2016, besides 1,143 dedicated beds in PPUs, another 1,500 NHS beds in NHS hospitals in England were used to treat private patients about ten percent of the time. Taken together this means that approximately 1% of the NHS’s roughly 131,000 beds were set aside for, or used by, private patients at any given time – equivalent to the number of beds in two average-sized NHS hospitals. While small, the number of NHS beds not available for NHS patients should be seen in the context of total NHS bed numbers having fallen significantly over the past 30 years, and being markedly fewer per head of population than in comparable European countries. With overnight bed occupancy rates peaking at 95% (or even more) in the winter months, the loss of capacity for treating NHS-funded patients is potentially a significant issue, as pointed out by the Kings Fund. It should also be seen in the context of the planned further reduction in the number of hospital beds set out in the Sustainability and Transformation Plans due for implementation in 2018.

    2. The distribution of income from private patients is very concentrated. The ten PPUs with the greatest private patient income are all in London, thanks to the concentration of more affluent people in London and southeast England, and because London is the destination of choice for private patients from outside the EU. Between them, these ten PPUs account for 58.7% of the total private patient income received by NHS hospitals in 2015/16. Some hospitals in Greater Manchester and Cheshire, however, have also seen some growth in income from private patients in 2015/16.

    3. Around a third of NHS hospital trusts reported no income from private patients in 2015/16; excluding these, the median hospital trust income for that year from private patients was only £769,000 (calculated from Foundation Trust Accounts and NHS Trust Accounts). A further third reported private patient income over £1m; thus private patient income in the NHS is highly concentrated amongst a small number of NHS hospitals.

    Table 2 shows the top ten hospital foundation trusts in terms of the share of total income derived from private patients.

    top 10 trusts private income

    1. Foundation trusts have seen greater growth in private practice than nonfoundation trusts . Non-foundation trusts which are struggling to meet NHS financial and other targets are less likely to be able to treat private patients, since Department of Health guidance states that private practice must not adversely affect the ability of a hospital to meet the needs of NHS patients. As one consultant at a trust in the south-east of England put it, “When we are struggling to meet the NHS targets there is no place for private patients…. There is a massive bed crisis, a bad situation, we can’t manage. So there are no private patients at all. It is not banned, but there simply is no room.”

    Is the treatment of private patients in NHS hospitals profitable?

    1. While income from the treatment of private patients is known with reasonable accuracy, it is only possible to tell whether it represents a net gain to the NHS if the costs of the treatment are also known, and this is frequently not the case. Sally Gainsbury’s 2008 study, based on Freedom of Information requests to 182 acute hospital trusts in England, found that some trusts were losing money on some procedures for private patients. Many hospitals admitted that they could not calculate the cost of treatment of private patients, and only thirteen provided data. According to that study, out of the 4,142 patients for whom data were provided, thirty percent (1,238) were charged less than the cost of their treatment, and four percent were charged less than the NHS tariff. The total profit made from the treatment of the other 2,904 patients outweighed the losses made, but some trusts probably made losses overall on their treatment of private patients.

    2. Given the importance attached by NHS England to the treatment of private patients, echoed on many NHS hospital trust websites, it seemed important to try to find out how far the situation reported by Gainsbury in 2009 had changed – how far the £596m revenue that NHS hospitals in England earned from treating private patients in 2015/16 represents a net gain for the NHS. One hundred and fourteen out of 153 trusts responded to an FOI request to provide figures for the annual number of finished consultant episodes for private patients, and the income and expenditure relating to them.

    3. Most of the 114 trusts that responded reported earning some income from treating private patients, but 73 of these were unable to report their expenditure on doing so, in most cases due to not measuring or not recording it.

    4. The figures provided by 9 trusts, however, indicate that each of them made a loss on the treatment of private patients in some or all of the years from 2010/11 to 2015/16. Overall 4 of these 9 hospital trusts made significant losses between 2010 and 2016, with one, Frimley Health NHS Foundation Trust, making a loss of £18m over the six-year period.

    Table 3. Profits and Losses (in pounds sterling) made by some NHS hospitals from treating private patients (losses shown in red)

    Loss making trusts

    1. The reasons why trusts do not measure or record costs are numerous, but interviews with hospital doctors made it clear that recording the procedures performed for private patients separately is burdensome and seldom done systematically, even when hospitals have guidance in place for clinicians on the requirement to do it. Some trusts were only able to give the combined cost of patients from overseas whose care is paid for by their home country’s healthcare systems, through reciprocal arrangements with the UK, and those who pay for their own treatment or are covered by insurance.

    2. Some of the money due from private patients is never received. Table 4, drawn from Foundation Trust accounts, shows the scale of debts written off for the ten NHS Foundation Trusts with the largest bad debts, ranging from Guy’s Hospital, which wrote off £407,000 in 2015/16, to Aintree which lost £53,000. This represents on average 3% of the income received from private patients for these ten hospital trusts with bad debts. According to the accounts of Foundation Trusts the total value of bad debts written off for all private patients treated at NHS Foundation Trust hospitals was £1.77m in 2014/15 and £1.81m in 2015/16.

    Table 4. Largest bad debts and claims abandoned in relation to private patients

    NHS bad debts

    How do NHS Trusts determine how much to charge private patients?

    1. Failure to set prices for treating private patients which reflect the cost of delivering the care may also explain why some hospitals were making a loss from their private patients. Despite the substantial income which is generated by treating private patients, there is no standard price-setting approach across the NHS.

    2. Of the 114 NHS acute hospital trusts that responded to an FOI request, 78 provided information about their methodologies for setting the prices charged to private patients. As Table 5 shows, 22% of the responding trusts did not have a standard procedure for setting private patient charges, and of trusts that did have a standard procedure, most based their prices on either (a) a calculation of the costs of the treatment, (b) NHS tariffs, (c) insurance company or market prices, or (d) a combination of these. Six trusts stated that they add a mark-up to the national tariff (the price per procedure, such as a hip operation, which is set centrally by Monitor and NHS England). Of these, four disclosed their percentage mark-up, which varied from 20% to 50%.

    Table 5. Approaches to price setting

    Price setting

    1. Table 6 shows the resulting variation in the prices set for a range of procedures by four hospitals, reflecting these differences of approach. The variations are strikingly wide, although this may be partly accounted for by different ways in which interventions are coded or bundled together (for example, some trusts charge a separate price for the contrast injection that is given before some MRI scans). It is also notable that for two interventions the price charged to private patients is below the NHS tariff. As noted above, some prices may be set low, and even below the cost of the intervention, in order to compete in the local private healthcare market, or to attract or retain consultants. To the extent that  this approach plays a significant role in price-setting, however, the treatment of private patients seems unlikely to add to a trust’s net revenues.

    Table 6: Examples of prices charged for private patient treatments (in £s) in four NHS hospitals (differences from the national tariff shown in brackets)


    1. Setting tariffs in such a way as to attract private patients while also making a profit is obviously a commercial skill which NHS hospitals have not historically needed. A study published in the Health Service Journal in 2012 found that many PPUs charged 50% less than private hospitals for comparable services.

    2. To conclude, it is not possible to say whether the NHS benefits financially from devoting resources to the treatment of private patients. Given that these resources are significant and that NHS hospitals are running large
      deficits and are under pressure to make risky economies, this is an issue that needs urgent clarification. When NHS income from private patients is predicted to grow by 6% a year till 2020 it is important to determine whether this would represent a net financial gain.

    Does the treatment of private patients adversely affect NHS patients?

    1. The NHS Code of Practice for Private Patients states that “provision of services for private patients should not prejudice the interests of NHS patients or disrupt NHS services”, and “NHS commitments should take precedence over private work”. In theory, therefore, private patient care should not impact on the availability of beds or other resources for the treatment of NHS patients.

    2. This principle appears to be compromised in practice in various ways. For example, junior doctors who were interviewed said that “clerking” (taking notes on) private patients admitted without adequate notes tended to take time away from attending to NHS patients. Others said that private patients – and NHS patients who had previously been private patients of the admitting consultant, and so were already known to them – tended to get more attention from the consultant, and therefore also from the junior doctors in the consultant’s team, than NHS patients. Two nurses who were interviewed, however, said that when private patients were admitted to the NHS wards they worked on, nurses often did not know which patients were private and therefore did not treat them differently.

    3. It seems unlikely that NHS patients are significantly disadvantaged in terms of receiving consultations and care from health professionals, so long as the number of private patients relative to NHS patients is small and the pressure of work permits all patients to receive appropriate attention from all the staff. If NHS funding per patient continues to fall, however, and the ratio of private to NHS patients increases, a pattern of different levels of treatment could potentially emerge in some hospitals.

    4. A more measurable disadvantage may flow from the treatment of private patients making NHS patients wait longer. A major reason why patients choose private treatment over NHS treatment is to be treated speedily. If they are treated in an NHS hospital, and especially if the treatment requires theatre time, treating them quickly is only possible if NHS patients wait longer, as several consultants who were interviewed acknowledged.

    5. It appears that to give proper effect to the Code of Practice for Private Patients a rule is needed to the effect that faster treatment cannot be obtained by being a private patient in an NHS hospital unless the hospital can demonstrate that it provides additional facilities, staff and beds, over and above those needed to treat NHS patients and corresponding to the number of private patients who will be receiving such faster treatment.

    6. A particularly invidious challenge to the principle of priority for NHS patients is that that a patient may “jump the queue” by paying for the first part of their care and receiving an earlier diagnosis and/or initiation of treatment,
      and then transfer to NHS funding. Regulations state that patients moving from private to NHS funding should face the same waiting times, access to medications and standard of care as any other NHS patient; and NHS guidelines state that “patients referred for an NHS service following a private consultation or private treatment should join any NHS waiting list at the same point as if the consultation or treatment were an NHS service. Their priority on the waiting list should be determined by the same criteria applied to other NHS patients”.

    7. This means that if a patient chooses to transfer from private care to NHS care before receiving treatment there should be an assessment of the patient’s clinical priority. The interpretation of this rule in practice may leave room for queue-jumping, however. For example, while one trust’s guidelines state that the assessment should be carried out by the clinical director of the department, another trust says the assessment should be done by the consultant looking after the patient’s care, and that he or she should only “consider discharging” the patient and putting them on the appropriate NHS waiting list. The latter guidance does not explicitly bar the consultant from placing their formerly private patient on the waiting list ahead of other NHS patients with similar or even higher clinical needs. To avoid this, all trust guidelines should require the assessment to be made by the clinical director of the department or an alternative independent consultant.


    1. Information provided by NHS acute hospital trusts, published reports and health professionals working in the NHS suggests that increasing the provision of private healthcare within the NHS may pose risks to the use of NHS funds and the care of NHS patients. Procedures for acceptance, treatment and charging of private patients are not standardised and frequently not transparent, with some trusts stating that commercial confidentiality prevents them from providing such information. To ensure adherence to the values of the NHS, including equity of access and quality of care, and to ensure financial sustainability, NHS hospital trusts should be required to measure, record and report the costs of, and income from, the treatment of private patients.

    This was first published on the Centre for Health and the Public Interest  site, where there is a version with footnotes and references.


    Reforming private hospitals in England after the Ian Paterson scandal

    Executive summary

    1. This report sets out a series of recommendations to reform the private hospital sector in England following the Ian Paterson scandal which left over 500 hundred women who underwent unnecessary breast surgery in two private hospitals maimed and injured.

    2. As we have shown in two previous reports, there are a number of systemic patient safety risks which are specific to the private hospital sector. The reaction by both the regulator the Care Quality Commission and the private hospital sector to the Ian Paterson scandal highlights the extent to which those risks remain and will continue to do so unless extensive reforms are introduced.

    3. Based on an extensive review of the CQC inspection reports of 177 private hospitals in England this report provides evidence which identifies the
      characteristics of the private hospital business model which make it susceptible to exploitation by ill-meaning or incompetent surgeons.

    4. The report shows that these systemic risks stem from one central flaw. Unlike any other type of hospital the vast majority of private hospitals seek to transfer the risk and the liability for something going wrong to the NHS or other companies.

    5. The refusal by private hospital companies to accept full responsibility for what happens in their facilities means that patients will always be at risk. Or put another way there can be no guarantee of patient safety in private hospitals without full liability.

    6. Further, the regulatory regime which covers private hospitals does nothing to address this central weakness and has in most cases ignored or overlooked the extent to which patients have been put at risk.

    7. The report makes the following 5 recommendations to reform the private hospital model in order to make them truly safe for patients and to avoid a repetition of the Ian Paterson case.

    8. First, private hospital companies should directly employ the surgeons and anaesthetists who work at their hospital facilities and should take on responsibility for monitoring their activities and appraising their performance. The failure by the private hospitals to accept the liability for the actions of Ian Paterson was not an isolated case, but is central to how the private hospital business model operates. Allowing hundreds of NHS trained and employed surgeons to carry out operations in small private hospitals, but without having a direct contract of employment with them, prevents the private hospital from being able to effectively monitor their performance.

    9. Further, if private hospitals are not liable for the activities of the surgeons operating in them, they have no incentive to monitor their performance and activities.

    10. In addition, this report shows that in hundreds of cases the failure by private hospital businesses to directly employ surgeons means that it is entirely possible that a surgeon will not have performed an operation in a given private hospital for over a year but would be allowed to do so tomorrow. This poses direct risks to patients as the surgeon is unlikely to be familiar with the hospitals procedures, facilities and staff.

    11. This report also shows that those hospitals with the highest number of surgeons who are granted the right to practise within a hospital tend to have above average rates of adverse incidents for patients. It also shows that some private hospital businesses allow surgeons to be 45 minutes away from the hospital after they have carried out an operation and so are not on site to deal with any post-operative complications. This has been found to be a key factor in the avoidable deaths of patients at private hospitals and is contrary to the Royal College of Surgeons Standards on Unscheduled Surgical Care, which require consultants to be no more than 30
      minutes away. Despite this risk the regulator of the private hospital sector permits this practice to occur.

    12. Second, private hospitals will not be truly safe unless they have adequate facilities to deal with those situations where a patient’s life becomes endangered following an operation and where the hazardous transfer of patients to NHS hospitals ceases. Currently, the great majority of private hospitals transfer patients to the NHS when complications post-surgery arise. We estimate in this report that this reliance on NHS hospitals could have cost as much as around £250m over the course of the last three years, with no evidence that private hospital businesses have paid anything to cover these costs. Whilst the safety net for private hospitals provided by
      the NHS saves lives, its existence is an impediment to a true patient safety culture in private hospitals. If the private hospital business does not have to deal with the consequences of post operative complications it has no incentive to prevent things from going wrong in the first place.

    13. Third, private hospital businesses must end their reliance on a single junior doctor (a Resident Medical Officer), working extreme shift patterns, to provide post-operative care for patients. This report shows that most private hospitals have only one junior doctor in charge, irrespective of the number of patients in the hospital, with some being responsible for up to 96 beds. In addition, the current working patterns of these junior doctors are incompatible with the European Working Time Directive with many doctors working shifts of 24 hours a day (168 hours per week) for one or two weeks at a time.

    14. Instead of relying on an outside agency to employ these doctors – which again allows the private hospital business to seek to avoid liability if they are not properly trained or vetted – the hospitals should employ them directly. There is no good clinical reason why the current Resident Medical Officer model should continue to be used to provide post-operative care to patients in private hospitals.

    15. Fourth, as we have stated before, private hospitals should be required to adhere to the same reporting requirements as NHS hospitals in order to enhance the possibility that the risk of harm to patients can be more easily detected. This report shows again that the notification of adverse patient safety incidents (such as unplanned patient transfers or readmission rates) to the CQC is haphazard, and the quality of the data is unreliable – currently only 63% of private hospitals registered provide regular returns to the CQC as they are not mandated to do so by law.

    16. What data is available shows that there is a huge variability in the occurrence of patient safety incidents across private hospitals but that despite this the CQC does not have the ability to determine where potentially dangerous practices are occurring. Instead where patient transfer rates are 4 or 5 times the national average the CQC has deemed these to be of no concern and has often rated these hospitals as ‘good’ or ‘outstanding.’

    17. The private hospital companies have argued that the data which they have been required by the Competition and Markets Authority to provide to the Private Hospital Information Network (PHIN) address the concerns about data transparency. However, despite the misconception that this data contains patient safety information it is of limited value. It is also information which has yet to be fully collected and published by private hospitals, despite this now being a legal requirement. The organisation which has been set up to publish and validate this data is funded by and governed by representatives from the private hospital businesses.

    18. Fifth – The legislation governing private hospitals should be amended to make clear that all those who are registered with the CQC should be fully liable for all the services which are provided within it, including the actions of surgeons and other healthcare professionals. The Health and Social Care Act 2008 sets out requirements for private hospitals to ensure that they employ properly trained and competent surgeons and other healthcare professionals. However, the difficulties that the victims of Ian Paterson have had in gaining compensation and redress for the harm caused to them shows that this legislation is either unclear or inadequate.
      The fact that the requirements of the existing legislation have not been properly enforced by the CQC raises the question whether the Paterson scandal could have been prevented had the regulator intervened at the time. A simple amendment to the Health Service Safety Investigations Bill currently before Parliament could easily rectify this issue.

    19. Finally this is an issue for the NHS as much as for private funded patients. The risks posed by the current private hospital model do not only affect patients who are funding their treatment themselves or through private insurance. The analysis set out in this report shows that almost half of all inpatients treated in private hospitals are funded by the NHS, as are a third of outpatients. There are now 82 private hospitals in England where the majority of patients are funded by the NHS. This puts the NHS and the Department of Health in a very strong position to require changes to the private hospital business model in order to ensure the safety of NHS patients.

    Key facts about private hospitals in England

    • 500 + – the number of women on whom Ian Paterson carried out unnecessary breast surgery in two private hospitals.
    • £250m – the estimated cost to the NHS of treating patients who have been transferred from private hospitals.
    • 45% – the percentage of inpatients in private hospitals who are funded directly by the NHS.
    • 32% – the percentage of outpatients in private hospitals who are funded directly by the NHS.
    • 82 – the number of private hospitals where more than 50% of patients are funded directly the NHS.
    • 104 – the number of patients who died following a transfer from a private hospital to an NHS hospital.
    • 168 hours – the typical weekly shift of a junior doctor a Resident Medical Officer in a private hospital.
    • 32 – the average number of beds for which a single Resident Medical Officer is responsible in a private hospital.
    • 868 – the number of consultants who have the right to practise at the Harley Street Clinic, a hospital with 100 beds.
    • 45 minutes – The duration, in travelling time, which a consultant is allowed to be away from a number of registered private hospitals in the event of their patient becoming unwell.

    Read the full report at the CHPI website

    Tagged | 3 Comments

    We are so used to the attacks on the NHS from the Daily Mail that we forget that it can be merciless to private medicine too. A critical article by Lois Rogers for the Mail’s on-line edition on June 12th provoked a defensive response from the Association of Independent Healthcare Organisations (AIHO).

    Rogers’ attack begins with the story of a man (a Director of a high-end car company) who underwent surgical removal of the prostate (no small procedure) in a private hospital, only to be told years later that the surgery had not been necessary. According to the Mail’s journalist he is just one of at least 66 people, who believe they were misdiagnosed or underwent unnecessary surgery at the hands of a particular surgeon. For the full story go to .

    Daily Mail

    EXPOSED: How the NHS is paying millions to private surgeons for operations that we may not need – and could even HARM us

    • The quality of care received by NHS patients in private hospitals is under review 
    • Insiders fear countless people are paying for needless, expensive operations   
    • There’s also been a sharp rise in complaints from unhappy or worried patients
    • Those treated in private hospitals are often not compensated  if things go wrong

    By Lois Rogers for The Daily Mail Published: 22:06, 12 June 2017 | Updated: 13:57, 14 June 2017

     This story is the tip of a much bigger iceberg in private hospital care, Rogers asserts, because the private sector has particular problems with lack of scrutiny of what surgeons are doing. Doctors working in private hospitals have a financial incentive to be interventionist about operations. They are not subject to the same monitoring and scrutiny as in the NHS, and private hospitals don’t have to monitor outcome trends to detect substandard surgeons either. Medical insurance cover is also a problem. Rogers believes that many private patients who have undergone unnecessary surgery may never be compensated.

    The Mail article argued that NHS patients should be made aware of these risks before being treated in private hospitals. The article then goes on to mention by name NHS consultants who have been accused of over-treating patients in the private sector.  Unsurprisingly the AIHO was not pleased by these claims and responded sharply, pointing out that surgeons in the private sector are all responsible to the General Medical Council, mostly work for the NHS (where they are scrutinised), and work privately in hospitals that are inspected by the Care Quality Commission. The AIHO says “failings of a handful of rogue surgeons does not represent the high quality and compassionate care delivered day in and day out by the independent sector as a whole”.

    The AIHO insists that the ‘independent’ (private) sector is actively working with NHS England to bring the level of reporting of surgery in line with the NHS’s own. Independent hospitals are already required to provide detailed data on every private episode of care, and they are beginning to publish performance measures for 149 common procedures at over 250 hospitals. More will soon follow, according to the AIHO, including measures of consultant performance in 2018.

    This spat matters. Treating NHS patients is big business for private hospitals. 530,000 surgical procedures were carried out on NHS patients in the private sector in 2016. A third of all NHS-funded hip and knee replacements are now being carried out in private hospitals. The NHS paid the private sector £8.7 billion for services last year, amounting to 28 per cent of private hospitals’ income. The private hospital sector constitutes a source of spare surgical capacity for the NHS, and are in effect in the NHS’s public domain (as distinct from the state-run public sector) when they do NHS work. They are, then, like GPs, dentists, pharmacists and other contractees to the NHS, and they have to perform according to NHS rules. That is why the Mail – always ready to occupy the moral high ground – sees them as fair game for the critical journalist.

    Tagged | Comments Off on Daily Mail attacks private medicine

    Bernie Creaven, executive director of  BMI Meriden Hospital, Coventry  ordered an immediate four-week postponement of operations on NHS patients referred to the hospital, which will be extended to a minimum of eight weeks by September.

    In a letter to the hospital’s consultants dated 13 July, seen by The Independent, Ms Creaven said the imposed delays were to discourage patients thinking of going private from opting for treatment on the NHS.

    Private hospitals receive taxpayer money for treating NHS cases, but can make larger fees if the patients go directly to them for treatment.

    “I believe time to access the system is the most critical factor for private patients converting to NHS patients,” she wrote. She added that “other aspects of differentiation” would be introduced over the next few weeks to make NHS treatment at the hospital relatively less attractive”.

    The 52-bed BMI Meriden Hospital in Coventry charges self-pay private patients from £8,500 for a hip replacement. The NHS cost is from £5,485.

    In her letter to consultants, Ms Creaven says: “Over the past few months I have had numerous discussions with consultants regarding the lack of differentiation between NHS and private patients and there is significant anecdotal evidence to suggest that the lack of differentiation has had a negative effect on our private patient referrals.

    “I now wish to implement with immediate effect a new rule which will mean that operations on NHS Choose and Book patients will not be able to take place until at least four weeks following their outpatient consultation. Also, in each subsequent month, I will extend this by another week until September and the time will be eight weeks from initial consultation. I believe that this time to access the system is probably the most critical factor for some private patients converting to NHS patients.”

    A spokesperson for BMI Healthcare said: “We treat both NHS and private patients to the same high standards of clinical quality.”

    I suppose this is what they call a free market in healthcare?  The patients are not the consumers.  They are the commodity from which profits are made.




    Tagged | 1 Comment

    A discussion document prepared by a sub-committee for the S.M.A. Central Council

    Published by The Socialist Medical Association 13 Prince of Wales Terrace, London, W.8 6d.

    It is not necessary to be a socialist to realise that the National Health Service is being strangulated by lack of money. A vast sum is required to develop its potential into a service capable of utilising the increasing possibilities of modem techniques and discoveries for the treatment and prevention of disease. Money is required to train sufficient doctors, nurses, technical and administrative staff; to build and equip hospitals and health centres; to launch an effective occupational health service; to finance home welfare services, and so on. As socialists we must continue to campaign for right priorities in our national expenditure.

    We know well enough that socialism is impossible so long as the basic principles of capitalism remain untouched. Whilst the class structure in our society persists, our health programme pays little more than lip-service to the idea of equal opportunities for all. We must be prepared to watch and attack practices which prevent the National Health Service living up to its original ideals. In no other feature is this danger so marked as in the phenomenon of the hospital waiting lists.

    We set out here to ask whether hospital waiting lists are really necessary? Could they be abolished? In what way does private practice effect the waiting lists ?

    Types of Waiting Lists

    Hospital waiting times are of three types:
    (1) the time out-patients wait to see consultants;
    (2) the waiting time for a first appointment for an out-patient;
    (3) the waiting time for admission.

    These times vary throughout the country, from region to region, hospital to hospital, speciality and consultant. The first, the wait in out-patient departments, has been almost eliminated in well-organised hospitals; in others patients must resign themselves to a half-day or even a whole day spent on each visit. Many refuse to attend at all but request their general practitioner to arrange a private consultation —if they can afford it! Clearly, if the waiting time were cut down, money would not flow so readily to consultants, and one wonders whether the greatest effort is always made to organise an efficient appointment system which would eliminate waiting.

    In many parts of the country patients wait weeks or even months for a first out-patient appointment, and sometimes months and even years for a bed. These waiting times and the reputation they have created are together responsible for a great part of the demand upon the private sector and private insurance schemes. Consequently the efficiency of the non-paying services is threatened and patients must suffer even longer waits, whilst those seen privately “jump the queues”, often not even into pay-beds.

    The Evils Caused by Waiting Lists

    The evils which these waiting times cause are even more widespread than would at first appear. The most serious, of course, is the medical aspect. Possibly vital time is lost awaiting the out-patient appointment and again awaiting admission, when early attention might at least facilitate treatment, at most prevent death. The psychological effect of waiting is difficult to assess but probably greater than is usually estimated. In this respect it is unlikely that any disease should be classed as “not urgent”. Likewise waiting lists may cause hospital patients to believe that those with money to pay receive not only quicker but also better attention.
    Many “minor” complaints which could be easily cured in hospital are no longer referred at all. A conscientious general practitioner knows that by sending these patients he would only swell the waiting lists. Also it might in fact add to his patients’ distress to know that treatment could be given but is not possible “at present”. So numbers of people throughout the country, in addition to those actually counted on the waiting lists, are condemned to carry on in unnecessary discomfort. We may find, in addition, a very awkward situation created by the demand for legal abortions in departments already carrying a heavy waiting list.

    Not the least of the evils is the stress on the hospital staff. It is usually lay staff who must bear the brunt of enquiries from anxious general practitioners, patients and relatives, and who are obliged to operate a system which they know to be unfair and suspect to be avoidable. Without the waiting lists many administrative workers would be freed for other duties. Medical staff, too, are often dis¬tressed to have to turn away patients whom they would admit if a bed were available. From time to time the newspapers make the most of inquest reports which cast blame on casualty officers for failing to admit patients who subsequently die. In fact, hospital doctors are faced day after day with decisions which depend primarily on lack of beds and not on medical necessities.

    The Causes and Prevention of Waiting Lists

    These are some of the evils of the system. What are the causes and prevention? No one can deny the difference which more money spent on the Service would make. More beds, more operating theatres, more staff, new and better equipped hospitals—all these are needed. But the growth of private practice and private insurance schemes are vested interests which depend for their existence on the maintenance of waiting lists. Most of the “private patients” of today would gladly accept National Health Service treatment if waiting lists were abolished. But because of the interests vested in them waiting lists may be kept longer than is necessary, even with our existing resources.

    How can hospitals be run more efficiently without much additional cost, and how can patient-turnover be speeded without detriment to the patient?

    Computer statistics make it easy to estimate average duration of hospital stays for varying diseases, and whilst obviously no hard lines can be drawn, it is clearly possible to pinpoint hospitals where bed- usage falls far below average. When beds are empty because of lack of nurses it is almost certain that matron belongs to the “old school” where “discipline” is a first priority. Many hospitals still insist on resident nurses although adjacent flats or other accommodation would give greater freedom. Enough encouragement is not yet given to married nurses to return to work because there are still matrons who refuse part-time workers or who will not allow off-duty times compatible with family life. Male nurse recruitment and promotion is not yet sufficiently encouraged.

    Improvement of organisation in every sphere of hospital work through consultation by all grades of staff can greatly increase efficiency. Surveys have shown that high staff turnover produces low patient turnover! Thus good staff relationships, for instance through Joint Staff Consultative Committees, are essential.

    Some hospitals send short notice for admission to patients who have been waiting months or years and finally may be prevented from coming in because of absence, family commitments, treatment elsewhere, or even death. A preliminary letter could save this waste in bed-occupancy. Some consultants clearly make less use of beds than younger ones with more modern ideas, and, although criticism is not usually possible, the use of statistics should make adjustments easier.

    We have knowledge of consultants who bar the appointment of new consultants to their hospitals although they are overworked and have long waiting lists, and it is hard to believe that this is for any reason other than the fear of competition for their private patients. Regional Boards must insist on the appointment of new full-time consultants where needed. When appointed part-time, consultants can see private patients in the remaining time. There are special income-tax concessions which at present favour part-time consultants and which could easily be amended by the Chancellor of the Exchequer. Efficiency in hospitals would be increased by having full-time consultants only and the private patient system would not be perpetuated.

    The method of allocating a fixed number of beds in a ward to individual consultants (known as “the firm”) must go. Increasing use is being made in up-to-date hospitals of the principle of “progressive patient care”. Staff and equipment are concentrated in a special ward for patients requiring “intensive care”. When less attention is required the patient can be moved to another ward less fully equipped for “intermediate care”, and finally when ambulant moved again for “self care”. This method is both economical on staff and beneficial for patients who no longer need lie in beds adjacent to those desperately ill or coming round from anaesthetics.
    The visiting hour is now frequently regarded as a necessary evil by the authorities. It is possible that, instead, use could be made of relatives visiting; for instance, assisting in feeding or other duties. In addition to relieving the nurses this could help to teach the relatives how to cope on the patient’s return home. A change of heart and habit might first be needed, however!

    Some hospitals already have computer analysis of daily activities and it becomes apparent even in efficient hospitals that a very great improvement in bed-occupancy and use is possible. Nurses and theatres can be more economically deployed, the type of case for admission more carefully selected, and many tests can be performed prior to admisison both to the benefit of the patients and the economy of bed-occupancy.

    Treatment outside Hospital Wards

    More general use should be made of the “day-patient” method of dealing with minor operations. In some hospitals this method has long proved successful, and again statistical evidence should be supplied in pressing more hospitals to adopt such procedures. An efficient ambulance service is a pre-requisite to such methods of treatment.

    Indeed, we believe that the best attack for the elimination of waiting lists would be a programme for better facilities and use of out-patient departments for investigation and treatment, and “open access” arrangements to general practitioners for use of X-Ray, laboratory tests, etc., thereby saving consultants’ and patients’ time. Since lists for out-patient attendance remain generally static it is reasonable to believe that these improvements could greatly reduce, if not eliminate lists altogether.

    The better use of Health Centres as well as of out-patient departments must also be borne in mind. Many consultants would welcome the opportunity of closer co-operation with general practitioners. In suitable areas consultant sessions at Health Centres could eliminate the need for hospital out-patient attendance entirely for some patients. The presence at Health Centres of district nurses and other ancillary staff could make possible more and more treatments at home—not, we maintain, as a make-do method but as a desirable step forward into the future. We commend the greater use of statistics in the field of general practice, which will reveal for the first time the natural course of disease and make possible the knowledge of the most efficient, desirable and economic forms of treatment.

    Another attack in the same direction could be a reduction of bed- occupancy for patients for whom hostels and half-way houses serve equally well. After recovery from operations there is frequently no need for full hospital treatment although the patient may not be ready for home, or the home may be unsuitable. Use could perhaps be made of existing buildings for this pre-convalescent type of patient. Such accommodation could also serve patients requiring treatment of a special nature such as radiotherapy, but who live too far away to travel daily to hospital. Good nursing and medical care might be required, but less intensive than at hospital.

    Local Authority Services

    Many hospital beds could be vacated earlier if local authorities supplied home services which would enable patients ready for discharge to be cared for adequately. Home helps must be better paid so that supply meets demand. Night home helps would make possible more home nursing for patients anxious to be at home. Expensive though this may sound it is cheaper than the cost of hospital accommodation. Meals-on-wheels, laundry, supply of equipment are all supposed to be available but would need to be more easily attainable throughout the country.

    Who benefits from Private Practice?

    The consultant who accepts the fee benefits financially. The insurance companies thrive. The hospital does not benefit because the actual money paid for accommodation goes back to the Exchequer. The benefit to the private patient himself is of very doubtful value. Apart from the fact that he avoids waiting times he has very few genuine advantages. On the contrary, the best treatment may well be more difficult to attain for the private patient than for the ordinary hospital patient. It is important to realise the truth of this because private practice flourishes on the myth that better service for payment is available.

    Modern medicine needs expensive modern equipment and requires team-work by medical, nursing, and ancillary staff. Isolation in private wards prevents the advantages already mentioned of progressive patient care. The consultant in charge of the paying patient is, of course, paid for his services, but every additional doctor he might call in for advice is also entitled to a fee. The consideration as to whether the patient can afford this additional expense and whether it is wise to bring in another, perhaps “rival”, consultant plays its part in treating paying patients. Payment should be made for X-Rays, laboratory tests, physiotherapy, and so on. The National Health Service patient has access to all these more readily than the paying patient.

    Very few consultants would honestly deny that the best way to treat a patient is to be free from all considerations of money. It is strange that this principle is accepted readily for university teaching. Even the medical professors in Teaching Hospitals are freed from “the burden” of private practice. What is acknowledged as best for progressive university teaching can surely be seen to be best for medical care, both in respect to hospital and the general practitioner service. No university lecturer suggests that he will give better lectures if his students paid him individually or that he would hold special private sessions for “paying students”. In this context payment sounds ludicrous.

    Patients attending Teaching Hospitals should realise that “lack of privacy” caused by medical student teaching can be to their own advantage. Consultants teaching students must explore every channel for reaching the right diagnosis and instituting the best treatment. Consultation in isolation as in private practice can lose this advantage.

    Awareness of these facts is essential if the public is to attack the pernicious evils which seriously undermine the efficiency of the Health Service.

    What can be done?

    (1) The Minister can agree to appoint only full-time consultants in future.
    (2) The Chancellor of the Exchequer can arrange that tax concessions favour full-time practice. Payment of tax-free private insurances should not be permitted as a “fringe benefit”.
    (3) The general public can bring pressure to bear against any unfair practice. Question such statements, whoever makes them, as “Your case is urgent, you will have to wait . . . months as an ordinary patient, but you can come in at once if you pay.” All urgent cases should be admitted urgently regardless of pay, and the statement is often an effort to obtain more paying patients. In many hospitals pay-beds are not full and legally should not be reserved if urgent cases are waiting.
    (4) Complaints can be made by individuals, or better still, through organisations such as Trade Unions.
    (5) Complaints can be made at all levels, i.e., Hospital Secretaries, Regional Hospital Boards, Member of Parliament, Minister of Health.
    (6) Precise facts must be given; no fear should be entertained about giving names. Reprisals are not one of the weapons in use in the Health Service.
    Finally, either as individuals or as organisations join the Socialist Medical Association who will continue to fight on your behalf.
    For we maintain that, as long as there are waiting lists, private practice will grow, and as long as private practice flourishes, waiting lists will persist. The ring must be broken.


    To the Hon. Treasurer, S.M.A., 13 Prince of Wales Terrace, London W.8
    I apply to be enrolled as a member (Rule 3) and agree to subscribe per annum to the Funds (Rule 6) and I accept the Constitution and Objects of the SOCIALIST MEDICAL ASSOCIATION.
    Signed …… …
    Name …. …………….
    Hospital or place of Work.
    Professional Association or Trade Union.


    Student Members 7/6 per annum

    Doctors, Dentists, Opticians, Pharmacists and Veterinary Surgeons, qualified more than 3 years … £4 per annum

    Other members … £2 per annum
    Associate Members £1 with Journal 10/- without Journal
    Associated Organisation 30/- per annum

    Full Members who are retired may pay half their minimum when working.

    No date. Probably around 1970.

    Tagged | Comments Off on Hospital Waiting Lists

    So much has been written and broadcast about terrible standards of care in some NHS hospitals in recent years, most notably but by no means only at Mid Staffordshire, that it would be easy to gain the impression that it might be safer to be treated in a private hospital. The profit-making concerns who run private healthcare have probably benefitted significantly from recent NHS scandals.

    However, as our experience at Action against Medical Accidents (AvMA) and the report from the Centre for Health and the Public Interest (CHPI) points out, whilst there is no denying the urgent need for improvements to the promotion and regulation of patient safety in the NHS, there is little or no compelling evidence that the private sector is any better.

    In fact I would argue that a combination of a false sense of security based on the assumption that if it is private and paid for it must be better, together with the gaps in the regulatory system and patients’ rights in the private sector, create an unnecessarily risky environment. It is also a credible argument to say that where there have been the worst problems with safety in the NHS some have at least in part been a consequence of imposed competition and fragmentation through part privatisation. Take the problems with GP out-of-hours services for example.

    There has at least been progress with the regulation of private healthcare in England now coming under the same regulator as for the NHS – the Care Quality Commission (CQC). In theory, a private hospital has to demonstrate that it meets the fundamental standards required by the CQC just as much as the NHS. However, a deeper look at the system reveals an uneven playing field.

    As the CHPI report points out, the same requirements to report incidents do not apply to private providers as they do to the NHS, which in itself makes it hard to monitor how safe or otherwise private services are. Information about clinical negligence claims against private providers are not publicly available, as they are in the NHS. The CQC has, to meet ministerial and public expectations, prioritised inspecting and monitoring the NHS. Bizarrely, as recently as this year the Government passed the Care Act, which exempted providers of privately funded care from the new criminal offence for providing false or misleading information to the regulators. As if this could only happen in a publicly run service.

    Patients themselves have fewer rights in the private sector. Whilst there is a general requirement to operate a complaints procedure, unlike the NHS complaints procedure, those used by private providers afford no statutory rights to the complainant and there is no recourse to the Health Service Ombudsman in the case of private care. There is no statutory requirement to provide for independent advice and support with complaints which is the case with the NHS. Consequently it is much harder to hold a private provider to account. Even taking legal action for clinical negligence against a private provider is more problematic than with the NHS, where everything is overseen by the NHS Litigation Authority. A claimant against a private provider can be faced with complications over whether it is the hospital or the individual surgeon or sub-contractor who is liable.

    AvMA’s experience confirms many of the CHPI report’s conclusions. In our experience the chief risks in the private sector have been where there are insufficient facilities and consultant cover to cope with emergencies; insufficient continuity of care or after care; and the lack of a critical mass of experienced doctors in situ as well as the aforementioned gaps in regulation.

    All too often, in addition to the patient who is harmed through no fault of their own, it is the NHS which ends up picking up the pieces (and the tab) when things go wrong in private healthcare. It is time to shine just as bright a light of scrutiny and regulation in the private sector as we have begun to in the NHS.

    Tagged | 1 Comment

    This discussion paper was presented to the the Socialist Health Association Central Council November 2013 but not considered.   It is not agreed policy. This is a revised version.

    This set of principles is founded on the presumption that the SoS has ultimate powers of direction over providers of NHS services and that Part 3 of the H&SC Act is repealed.

    There should be no support or any form of incentive for privately provided care, through tax allowances or any form of subsidy.  There must be strong professional guidance about the circumstances when non NHS provided health care options should be offered and proper independent expert advice available to all care users on their rights and options (including, where appropriate, advocacy).

    Private Medical Practice

    The NHS should continue to be a provider of privately funded health care where this can bring benefits to the NHS.  There must however be proper guidance over separation of accounting to ensure transparency.

    All Trusts must report in their accounts the level of income and expenditure from private patient activity in a prescribed manner which would cover income through Joint Ventures and similar organisational devises.  The calculation of expenditure on private patients must include a contribution for the NHS costs in training the staff involved and the finance costs of the equipment used. In addition, the “profit” derived from treating private patients must be greater than the “surplus” which would have arisen from treating NHS patients with similar conditions.
    Any plans by an NHS provider to significantly change the level of private patient activity must be consulted upon and supported by appropriate HWBs and (if there is one) the Governing Body.

    Private Provision of NHS Funded Healthcare

    Healthcare must remain a predominantly publicly delivered service, and the public provision of social care should be strongly supported.  All providers of care must comply with minimum standards around workforce terms and conditions, training, development and supervision as well as quality standards.

    Commissioners/planners should review all care services on a regular basis and include in that consideration proper engagement with service users.  Reviews should be published.  Where they are satisfied that the service provided is appropriate they should support it (preferred provider).  Any proposed change to care services should be examined also for its wider impact on other services – a whole system test.

    Where a service from the current provider cannot be improved to the required quality standard or where a new service is required which is currently not provided then competitive procurement including private providers may be used. Organising a new service through supporting development of current NHS providers would also have to be considered.

    Commissioners and the HWB must ensure that all providers of NHS care have public and patient involvement embedded in their governance.

    It is unlikely that any service will be procured using a contracting arrangement unless:-

    • the service is largely independent of other services
    • the quality requirement can be properly specified in a legal contract
    • there are already a number of recognised providers of such a service.

    The national procurement regime (as permitted under EU Public Procurement Directive) for care services should ensure that there is no compulsory competitive tendering (old EU Part B services).

    There should be a test of suitability applied to prospective private care providers applied through continuing registration conditions or through contracting.  Major changes in capitation (for example) could enable contracts to be terminated.

    The relationship between commissioners/planners and public providers should be through “NHS Contracts” which are not legally enforceable but rather subject to arbitration.

    Where a public body has a legal contract with a private provider that contract must ensure full openness and transparency – with no “commercial confidentiality” outside the actual procurement process.  FoI would apply to such providers. Contracts and procurement requirements should specify ability to ensure continuity of care (which might include some financial bond being required) and knowledge of local conditions and services and populations would be an essential condition.

    The price paid for services to any non public providers should be the same or consistent with the price that would have been paid to a public provider for the same service.


    Care UK sees an opportunity to make money out of NHS rationing decisions

    Care UK GP Newsletter

    Care UK GP Newsletter

    Charges advertised to doctors for people not eligible for NHS treatment:

    Care UK Tariff

    Richard Blogger’s articles about NHS hospitals doing private work

    Tagged | 2 Comments

    Almost one in five NHS patients seen in secondary care now treated by private firms, after Labour’s ‘patient choice’ reforms led to an expansion in the independent healthcare market, a report by the Nuffield Trust and the Institute of Fiscal Studies concludes.  But as John Lister writes “These figures are evidence of private sector expansion but need to be treated with caution: they only relate to elective treatment – and in fact the study only looks in detail at three elective treatments (hip replacement, gall bladder removal & hernia), with a grand total Independent Sector Treatment Centre provision of 24,000 episodes between them.

    By contrast the NHS dealt with 9.8 million elective admissions and 5.2 million emergencies. ISTCs did 12,000 hip operations: the NHS handles 856,000 operations on “bones & joints” each year.

    0% of emergencies are seen by the private sector, and on none of the categories of elective treatment analysed do the figures go above 17%: gall bladder ops are just 6%.

    The percentage of outpatient activity in the private sector is even smaller: so to claim that 20% of NHS patients are “now treated by private firms” is just grossly inaccurate and misleading.

    All this use of private providers is expensive, wasteful and undermines the proper provision of a comprehensive health service. It is a terrible legacy from a Labour government that could have spent the money and the time to strengthen public sector provision and protecting it against the ravages of the Tories and their LibDem sidekicks.

    But let’s not allow the false, defeatist picture to be generated that suggests the NHS is already largely privatised. This does not help us defend what are still vital public services, few of which would be offered by private providers unless they could screw additional funding from government over and above the NHS tariff.

    Tagged , | 2 Comments