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Creep to NHS Privatisation?

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NHS privatisation

One in six hospitals offers private services to boost income, finds a BMJ investigation

One in six hospitals in England have introduced new private treatment options this year, as cost pressures tighten restrictions on some NHS services, reveals a BMJ investigation today.

This includes a growing number of hospitals offering patients the choice of "self funding" for treatments and services that are subject to restrictions or to long waiting times on the NHS, such as IVF, cataract surgery and hernia repair.

In these cases, treatments are offered at cheaper rates than in the private sector.

The BMJ obtained data from 134 acute hospital trusts in England through freedom of information requests and found that:

  • 119 trusts (89%) now offer traditional private care or "self funded" services
  • 21 (16%) added new self funding or private treatment options for 2013-14, and
  • 17 (13%) now allow patients to pay for one or more services at notional NHS rates, under the self funding scheme

Providers told the BMJ that the schemes make care more accessible. But critics say that the growth of self funding has muddied the waters between private care and the NHS by creating a two tier system — particularly in combination with government rule changes that allow hospitals to raise up to 49% of funds through non-NHS work.

Hospitals to have introduced new options for patients in the past year include Warrington and Halton Hospitals NHS Foundation Trust for varicose vein surgery, Epsom and St Helier University Hospitals NHS Trust for liver scans, and age related macular degeneration, and Princess Alexandra Hospital NHS Trust in Essex for imaging services and chemotherapy.

Mid Cheshire Hospitals NHS Foundation Trust has also recently begun offering "self funded" cycles of IVF treatment for patients who have used up their NHS funded cycles.

Many trusts that the BMJ contacted said they did not differentiate between "self funded" and "private" care. But John Appleby, chief economist at the healthcare think tank the King's Fund, said that, regardless of price, care was still being funded from patients' own pockets and was driven by cost restrictions.

Critics argue that self funding not only blurs the lines between NHS and private care but could also disadvantage NHS patients because, unlike more traditional private patients, self funding patients are often treated in the same premises as NHS patients.

The lines are arguably being blurred even further by a new scheme from the private provider Care UK, which recently introduced a new self pay option at four of its 11 NHS funded treatment centres across England.

A spokesman for Care UK said self-pay patients "will not be prioritised over NHS patients." But Nicholas Hopkinson, a consultant chest physician in London, said he opposed self funding as it could lead to an "inferior service" for those not paying.

John Appleby believes that, as self pay schemes expand, they should be strictly governed and separated from NHS care to ensure that NHS patients are not being adversely affected.

The Foundation Trust Network, which represents NHS foundation hospital trusts in England, said that most trusts had systems in place to stop paying patients "queue jumping" ahead of NHS patients when being treated in the same facility, and that it expected more treatments to be available to self funding in the future.

But David Hunter, Professor of health policy and management at Durham University, warns that not only could self funding schemes pave the way for "a two-tier or multi-tier system which is both complicated and inequitable," they could also lead to commissioners and providers focusing their energies on more lucrative procedures to raise additional funds.

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