UK investigation finds ‘creeping NHS privatisation’

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An investigation in the UK has exposed the extent of creeping National Health Service (NHS) privatisation, leaving experts warning that state patients risk being side-lined as beds are diverted to private users. The Independent reports that data obtained under Freedom of Information law shows income from private patients at one of London’s best-known cancer-specialist hospitals doubled in six years as the law was changed to allow NHS trusts to do more paid work. Statistics quietly released by the government show the situation is not isolated, the report says, with the total amount of income NHS England made from private patients leaping by a third between 2011-12 and 2016-17.

There report says there is now growing concern that the NHS is involved in far more private work than previously thought, as much of it is masked from official records by complex operating arrangements with big private-sector health corporations which cream off profits.

Prior to the 2012 Health and Social Care Act, passed by the Conservative-Lib Dem coalition, hospitals were only allowed to make 2% of their income from private sources, but with the legislation’s passing the cap was lifted to 49%. Five years on, the report says, hospital trusts running different operating models for private work have been probed, in an attempt to uncover how things have changed.

According to the publicly available accounts of the Royal Marsden London, a world-leading centre for cancer, the hospital’s income from private patients was £44.7m in 2010/11, about 25% of its total funding. By 2016/17, private income had risen by 105% to £91.9m, making up nearly a third, some 31.4%, of its total funds. In response to a Freedom of Information request, the Royal Marsden said it treated 2,451 patients privately in 2016, up 30.2% on 2010. The number of NHS patients being treated also rose, but by just 17.2%.

Asked how many wards were for private patients, the Marsden said it operated “an integrated model of NHS and private care and regularly utilises beds that have been earmarked as private for NHS patients or NHS for private patients based on clinical need or at times when capacity is strained”.

The report quotes the Marsden as saying it was “first and foremost an NHS organisation”, but said many other trusts were “part-privatised”. It went on: “We have seen growth both in our NHS and private care referrals and patient flows over recent years. The integrated model at The Royal Marsden allows us to reinvest all of the income from private care into the hospital. Many other NHS trusts use a private company (part-privatisation) to run their private services and this company will share in the profits. This is not the model the Royal Marsden operates.” The trust said its “combined model” allowed it to control how services are run and how all of the income is used.

The report says the website for the Christie NHS Trust in Manchester has one page entitled “Private Options”, which says: “We offer a comprehensive service for private patients through the Christie Clinic, our bespoke private facility in the grounds of the Christie Hospital. Private patients from the UK or abroad can choose to see a colorectal surgeon at the Christie Colorectal and Peritoneal Oncology (cancer) Centre.”

Yet, in response to an FOI request, the Christie Trust reported it had not made any money from treating private patients for cancer in the past six years. The Christie Trust said it “does not treat private patients, self-paying or insured”. “This is the responsibility of the Christie Clinic LLP – a joint venture with the Christie Foundation Trust and Health Care America (HCA Healthcare),” it explained.

Deborah Harrington, of think tank Public Matters, said in the report that the speed of the growth of private treatment in some hospitals was “staggering”. She went on: “One extremely worrying aspect of this situation is the lack of transparency in the way this private income is raised: the Royal Marsden says openly that it treats NHS and private patients from the same facilities, but the Christie runs a joint private company with HCA, and Guy’s (and St Thomas’ NHS Foundation Trust) rents out half its own newly built facilities to the same company, which declares in its advertising that the Guy’s site is part of its ‘campus’. We are seeing a blurring of the boundaries between the NHS and these US healthcare subsidiaries.”

Harrington said the new system was effectively the end of the NHS created nearly 70 years ago, in favour of a “two-tier system” with profits gained from NHS-funded facilities going to US companies and “private patients – some UK nationals, some rich foreigners looking for world-class facilities – using the services that should be provided for each and every one of us by the NHS”. She added: “With staff shortages across the board and increasing NHS waiting lists, there can be no doubt that using NHS resources for private patients is putting the squeeze on NHS services.” Harrington also said “lives may be put at risk” by the changes, adding that Public Matters was currently looking for evidence that someone had lost their life.

Professor Allyson Pollock, director of Newcastle University’s Institute of Health and Society, said in the report that the change in the law during the Coalition years has paved the way for the part-privatisation of the health service. She said: “It’s not a surprise to see foundation trusts with niche specialities like cancer or cardiac (care) are turning to private patients. The problem is formerly these hospitals were almost 100% public. Up to 49% of the capacity – doctors, nurses and beds – can be diverted to private patients. In London … some of these patients will be very wealthy, medical tourists. The NHS is being squeezed and inevitably there will be a diversion of funds (from ordinary NHS patients to private ones). We are losing our NHS. We will lose our NHS unless the government stops commercial contracting and stops foundation trusts from bringing in private patients.”

She claimed the transformation would be “catastrophic for public healthcare” in the UK and warned that the public are slowly being forced into adopting the US model of healthcare.

Many of the private patients are being treated by doctors who work for the NHS and are using NHS beds. Several trusts said their cancer wards were used by both private and ordinary NHS patients. Dr David Wrigley, a GP in Carnforth, north Lancashire, said he knew from personal experience how “fiendishly difficult it can be to get one of my seriously unwell patients admitted to an NHS hospital”.

The Independent report

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