Sunday 23 June 2019

Is it still necessary to feed NHS doctors a Private diet of Gold?

Aneurin Bevan   Pic. Wikipedia
The NHS was set up largely from a solely private health service, and needed to recruit many private doctors and did so. The NHS still encourages private medicine and private  Some private services used by the NHS today such as contract cleaners and groundsmen may not worry us, but others should. Greed is great incentive, especially when a system feeds you "easy money".

Aneurin Bevan set up the NHS in 1948 after demands for reform and contributions from other politicians. It was to be a single tier system, providing adequate health care for all, and free at the point of delivery.

When the NHS was set up doctors were allowed and encouraged to see patients privately as well as being given generous NHS salaries. This was to get them all on side and persuade them they would not lose out financially.

The “stuff their mouths with gold” strategy as it was known is, I believe, now destroying parts of the NHS as there is a perverse incentive to encourage private practice, theoretically leaving private practitioners free to engineer longer waiting lists to encourage business and also to use the NHS to "fish for patients" eg. by advising them that they may only get timely treatment if they pay extra for it. 
 When I was a young doctor in the 1980s Consultants who worked privately were paid 1/11 th less than full time consultants, often abandoning their private work for the 2 years before they retired to get a full final salary pension, many then continuing  private work in retirement.

Nowadays newer staff contracts give private senior doctors working in the NHS a full NHS salary and no deductions for working privately.

 I lost my own career some years ago for objecting to my private colleagues using NHS time and facilities for free to treat private patients at Prince Philip Hospital, Llanelli, all approved by the management. I thought it was appalling, especially when my own urgent patients were discharged home before getting their operations, to make way for those paying privately who mostly had waited a very short time and had less serious conditions.

 Ironically their private treatment was then subsidised further by the NHS management who provided the consultants with free use of hospital facilities and equipment for their private patients. I suspect the private patients did not get this discount and paid the market price for their operations, further packing the wallets of my colleagues. Of course not all doctors work privately but in some branches of medicine such as Orthopaedics, Ophthalmology, General Surgery and Anaesthetics, participation in the private sector is very common. 

I fear sometimes that little has changed since I was forced out of my job following my whistle blowing and I wonder about the supposed core promise of the NHS “free at the point of delivery”. I think that is much more important  than the "stuff their mouths with gold" principle, necessary to bribe the medical profession in 1948 but really? Do we still need to bribe very well paid public sector workers ?

A while back a friend asked me to “take a look” at her elderly dad who had had a knee replacement some years before and now was in terrible pain. I did not have his medical records but could see that the knee replacement he had was not functioning properly at all. I advised him to seek help from the local orthopaedic department who did the operation, but he has been continually “fobbed off” and nothing was done to actually solve the problem of his malfunctioning and painful knee joint.

Recently he turned to the private sector in desperation. He saw a new consultant surgeon, who he tells me, looked at his knee and medical records and declared that the “wrong type” of knee replacement was put in originally and he needed this worn out joint removed and a complete new artificial joint put in . It would cost him £20,000.

I don’t have £20,000” said the man. “Well, you can borrow it”, said the surgeon. The gentleman indicated the pile of notes he had put on the table for the consultation, £180.

 “I had to borrow all of that to see you today.” he said The surgeon took £40 off the pile and handed it back to him. A small discount, but no resolution to his problems of pain and mobility.

The NHS has failed this man by not treating him for his serious and life changing problem . For him there was no “delivery” of the proper treatment the NHS should be giving him and as he can’t afford private surgery. His only options currently are to put up with his pain and discomfort for good or go back yet again to the hospital doctors who have so far failed to offer him curative treatment. in the hope they will eventually offer him the operation he needs on the NHS.

Now that is surely not what Aneurin Bevan had in mind?  The NHS is a mature and much loved organisation. Its time to change the diet of private practitioners from public funding support to healthy independence. Surely all private practice can be housed in private hospitals and clinics and doctors paid by the NHS only for NHS sessions actually worked? 

Dr Siân Caiach. 

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