"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Monday, 22 November 2010

Imagine this...

Imagine this, you have cancer, you are frightened, sick and weak. The NHS picks you up and treats you, you get the best care that money can buy. Everyone is kind, understanding and caring.

Now imagine that the NHS picks you up but puts you aside for a little bit of time - not much, but just enough for someone else to use the facilities first. Prioritisation? Yes, the other person is sicker, weaker, more frightened than you. You wish that both of you could get the treatment at the same time, but you recognise that equipment, drugs and manpower are all limited. This is clinical prioritisation and we accept that it happens, not least because one day we might be so sick that we are prioritised before someone else.

Now imagine that the patient getting the priority is not more sick than you, not weaker and not more frightened than you: they get the priority because they have paid to get it. Can't happen? It used to, and it will again.

In the late 80s a close friend of mine was diagnosed with cancer: he was just 23. Paul discovered a lump in his neck and went to see his GP, she said he should see the oncologist, but said there was a waiting list of several months. Paul was training to be an accountant and since he had worked 6 months with a large accountancy company he was entitled to use their private healthcare policy. On hearing this, the GP phoned the oncologist and an appointment was made for the next day. At that appointment the consultant told Paul that he needed surgery immediately and the next day he was in theatre and had the tumour removed. The magic health insurance document had made a waiting list for an NHS doctor disappear.

Paul then had several weeks of chemo: he would usually ask his girlfriend to drive him to my house the night before the treatment and we would go to the pub for a few beers: our own version of chemo. The next day I would drive him to the hospital, a posh private hospital out in the countryside, rather than to the dowdy inner city NHS hospital used by everyone else. The same oncologist who worked in the dowdy NHS hospital would treat Paul in the private hospital.

One story Paul told me sticks in my mind. At this time MRI machines were experimental (heck, I actually worked in the university department where they were invented!) and very expensive. So five large hospitals had clubbed together and bought one machine to be shared between them. The MRI machine was installed in the back of a HGV lorry which was driven between the hospitals spending a few days at each. Paul's doctor said that he needed a scan so he was put in a private ambulance and taken to the NHS hospital who had the MRI scanner that week. Paul described to me how he was put in a wheelchair and then wheeled past a queue of NHS patients: some in wheelchairs, some on trolleys; some walking wounded and some extremely ill. My friend Paul was pushed to the front of the queue and was scanned straight away. The insurance company were paying a tidy amount of money, so he was prioritised. The magic health insurance document had made a queue of NHS patients disappear. What it could not disappear was the guilt my friend Paul felt as he was prioritise solely because of the payment.

Paid-for prioritisation. It happened in the late 80s under Thatcher.

Paul was horrified by the difference between the care he got as a private patient and how his prioritisation was not clinical. As an accountant he was also horrified by the sheer cost: the insurance company was sucked dry by the private hospital and by the consultants working privately.

He went into remission and enjoyed his life for a couple of years: we had plenty of our form of chemo during those years he was cancer-free. Then the cancer returned. The insurance would not touch him, they had already been sucked dry and he had his treatment by the same oncologist, but now in the dowdy NHS hospital. By now we are talking mid-90s and at one of the low points in the NHS when funding had been slashed and hospitals were suffering badly from poor maintenance and demoralised, underpaid staff. His cancer returned with a vengeance and (to be fair to the NHS) there was very little that could have saved him. He died in September 1994, he was 30.

We are going to see scenes like this again. Lansley has raised the private income cap. This cap was applied to Foundation Trust hospitals by the Labour government and the value is fairly arbitrary: it is the proportion of income of the FT hospital that came from private sources in 2005. However, raising this cap was a clear sign to FT hospitals that Lansley wanted NHS hospitals to aggressively pursue private patients. Sucking the private markets dry? Maybe. But some hospitals (particularly small district general hospitals) do not have the capacity or the specialism to attract large numbers of private patients. private patients are more likely to go to the large tertiary teaching hospitals. If you have the cash to pay for healthcare, you may as well spend it on world-class treatment. If NHS hospitals are supposed to benefit from private patient income, this will lead to two-tiers of hospitals: those with a private income, and those without.

An example of a hospital which can attract private income is The Christie FT hospital in Manchester. This trust has recently partnered with HCA International Limited. HCA will provide £14m and the private patients and The Chrisie will provide the facilities and specialists. The Christie has a high reputation as a cancer centre, describing itself as "Europe's largest cancer centre". Since The Christie cancer centre has an income of £173m the HCA contribution is a small proportion, but the question is whether these private patients will be treated like the NHS patients?

Imagine that you are a private patient and you have spent a substantial amount of money on health insurance premiums. You have cancer so you fully know that this is the last time that you can get the benefits of the insurance since after you have been treated for cancer health insurance will not touch you. Would you be happy if someone else gets the same treatment as you - or even gets pushed in front of you - and has not paid that substantial amount of money you've paid? Of course not, and the clinic will not put you in the position of thinking that you could ever have to wait while an NHS patient is treated before you.

Welcome to the two tier NHS.

Incidentally, who are HCA International Limited? They describe themselves as "the UK's largest provider of cancer care services outside the NHS".  However, there is more about this company that you need to know. HCA stands for the Hospital Corporation of America and Wikipedia describe it as "he largest private operator of health care facilities in the world". HCA is also known for pleading guilty to 14 felonies for overcharging Medicare (government funded healthcare for the elderly) and state Medicaid (healthcare for the poor). According to Wikipendia "In all, civil law suits cost HCA more than $2 billion to settle, by far the largest fraud settlement in US history at the time." I do hope that The Christie has a very long handled spoon to sup with this devil.

The Christie is a fore runner of what almost all NHS hospitals will be like in the next few years. This is what you voted for when you voted for this Coalition government. Oh, you did not know that this would happen? Then tell your MP that you do not want it to happen. Or better still, demand a new election so that we can be rid of this government.

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