Creating a Two Tier NHS

Reports trickled through yesterday that Lansley has slipped a sneaky potential amendment through in the pre-Christmas rush that allows NHS Foundation Trusts to increase potential provisions for private patients from a current average of  2%  to a maximum 49%.  This post on Though Cowards Flinch sharply points out the this is a total income rather than based on the number of beds which is an important distinction.

The details are explained well in this post at NHS Vault which I recommend highly because there is a lot more detail than I’ve garnered. My response is a undoubtably less erudite than both the previous posts but based unapologetically on my gut instincts and experiences of working in and around the NHS.

We are supposed to be foolish enough that this will be better for everyone. Lansley is quoted as saying in the Times (paywall)

“We are committed to giving hospitals greater freedoms, which is why we will allow foundation trusts to expand the range of services that they offer.

“This does not represent privatisation of the NHS — it simply gives to foundation hospitals the same freedoms non-foundation hospitals have had for years.

“Services for NHS patients will be safeguarded because foundation hospitals will still have as their core legal purpose a duty to provide services to them. The amendment we are making provides further reassurance on this duty.”

Let’s just explore firstly his immediate defensiveness. He knows the accusations of privatisation are going to laid at his door with this policy.  What looks and smells like privatisation, is privatisation. ‘No top down reorganisation of the NHS’ – wasn’t that the manifesto promise? But from looking at the promises both of the Lib Dems and the Conservatives we can see that coalition government has given both parties free rein to abandon anything resembling a promise made.

Private patients, he claims,  will pay for the improvement that can take place in NHS hospitals. I, like many,  worry. There are a few details that seem to gall. I work in and around a lot of specialist hospitals and a lot of my concern lies in this area.

We have, this week, seen a case in point about the difference in choice that already exists within the NHS this week.  Lansley  is a great advocate of pushing choice in health care. Think of Papworth Hospital in Cambridgeshire which was chosen by the Royal Family to treat the Duke of Edinburgh for his heart problems. There were closer hospitals but they used a helicopter to fly Prince Philip to this ‘world-class’  specialist unit and no doubt unleashed the top consultants to treat him. Perhaps its an unfair example but a 90 year old Bill Smith of Norfolk doesn’t have the same choice and doesn’t have the same options.

Now, a Papworth Hospital .. or a Great Ormond Street Hospital will be able to flex its international reputation and maximise the amount of beds that can be taken by high paying private patients – possibly from overseas.  The obvious result is that while they CAN spend this income on the NHS services, it can also be pushed into advertising for these private patients and strictly commercial activities, meaning there is less money for NHS patients who will become ‘second class’.  Private patients may requires higher quality facilities which will be upgraded with these funds and the likelihood of much trickling down to the geriatric wards in King’s Lynn are minimal because Foundation Trusts are discreet bodies and the  money will not necessarily flow from richer Trusts in richer areas to poorer Trusts in areas that do not have the ‘world class’ facilities.

We are seeing a divide being created in our national healthcare system. It’s worth remembering that public money has created these ‘world class’ specialist hospitals that will be used by private patients. Money has been tipped into infrastructures that were designed to meet the public good and will now be shifted to private profit.

I also wonder how this will affect the psychiatric services particularly where I work. Will there be an expectation of an income from private patients and will those hospitals who don’t take a ‘quota’ lose out because they will have a tighter income stream? Finally, what will this mean for the recruitment and retention of NHS doctors. Will there be a shift towards doctors taking more private patients – of course, because there will BE more private patients but where will this increase in private patients come from? They surely can’t all be coming from overseas and insurance policies unless insurance policies become more widespread. Maybe this is the way we are all heading.

This government is couched in a divide and rule policy. this government does not have a mandate to rip apart the ‘national’ health service and replace it wholesale with a market system which will discriminate on the basis of ability to choose and ability to pay.

This is what they are bound to do though. They are ripping apart the ‘National’ Health Service and building a system that meets the needs of Conservative Party donors.

We are all in this together? I think not.

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