Private firm will operate entire NHS hospitalBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1060 (Published 22 February 2010) Cite this as: BMJ 2010;340:c1060
All rapid responses
The clear division between the National Health Service (NHS) and
healthcare provision has become blurred. This week, the NHS Trust funding
Hinchingbrooke Hospital has withdrawn from the bidding leaving the
looking for exclusively private financial support. Private finance
(PFIs), waiting list initiatives and the outsourcing of some NHS services
private facilities have been used with the intention of improving care for
Until recently, an individual’s financial circumstances have had no
their treatment within the NHS. However, Mike Richards’ report (National
Director for Cancer in the UK) lead to the publication of guidance: ‘NHS
patients who wish to pay for additional private care’, by the Department
Health in 2009.
AndGuidance/DH_096428) It permits cancer patients to purchase additional
care (chemotherapeutic drugs) without compromising their NHS care.
In many specialities there is conflict between patient benefit and
of services. A surgical procedure, which is regarded cosmetic, may have
considerable physical and psychological benefits. Rationing may limit its
availability: for example prominent ear correction is provided only to
in NHS, bariatric surgery to people of a certain body mass index, breast
reduction surgery to women with physical symptoms. Some clinically
patients may wish to purchase additional care, if they fall outside the
guidelines set for rationing purposes.
As this is now permitted in oncology I wrote to the Secretary of
Health for clarification of the guidance as it applies to other
responded that clear separation of NHS and private services was
Upgrading an NHS device:
“Specific legislation is in place….it allows patients to upgrade a very
number of NHS devices, such as wheelchairs. The guidance does not allow
patients to upgrade an NHS device, or to have an upgraded device inserted
during an NHS procedure or operation.”
This makes it clear that a patient cannot pay an additional cost for a
implant, which is not available on the NHS.
Complications of private treatment in the NHS:
“The NHS should not subsidise private care. The NHS should not be
to meet any predictable costs resulting from the private element of care.
NHS should, of course, continue to treat any patient in an emergency."
emergencies can be treated on the NHS, any other complications should be
referred to an alternative private setting.
Location or Setting of NHS and Private Care:
“In order to safeguard the fundamental principles of the NHS, the guidance
makes it clear the NHS care should be delivered separately from private
Departing from this position should be considered only when there are
overriding concerns of patient safety. Combining NHS and private care
undermine public confidence in the NHS and could lead to a two tier
with patients on the same NHS ward routinely having different care
to their ability to pay, not their clinical need. Private and NHS care
kept as separate as possible.”
The NHS budget is straining to meet increasing demands, especially
increasing national debt and pressure on the Government to reduce public
spending. Some form of rationing is inevitable.
A patient can pay a ‘subsidy’ to improve their treatment for cancer,
continuing to have their other cancer treatment within the NHS. They can
purchase chemotherapeutic drugs, which could potentially prolong their
even though they are not approved by NICE or available on the NHS.
they cannot pay a subsidy to improve their treatment by paying for
procedures, which are clinically indicated, but limited by rationing. The
practice of some surgical specialities in NHS hospitals has become
and the training of future surgeons is increasingly limited to ‘permitted’
One solution would be to allow patients to pay for some services. If
feels the patient would benefit from a procedure and the Primary Care
refuse funding, the patient could have the option of paying a means tested
subsidy for the procedure. This would allow a greater number of patients
benefit from procedures, which their GP and surgeon recommend. Those
who cannot afford exclusively private care would be able to get the
psychological and physical benefits of some previously unattainable
treatments. The NHS would benefit from increased income, the patients
would benefit from having their needs met and trainee surgeons would
benefit from increased exposure and training in a broader range of
In summary, the recently published guidance, only allows purchase of
NHS treatments in very specific situations. Would it benefit our patients
the NHS if these subsidies were allowed in other fields of medicine and
surgery? With the ever increasing possibilities, sense of entitlement and
demands in modern healthcare, perhaps individuals subsidising their own
healthcare may lead to improved, sustainable treatment for all.
Conflict of interest: The author has completed the Unified Competing
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no relationships that may have an interest in the submitted work in the
previous 3 years. 3. Spouse and children have no financial relationships
may be relevant to the submitted work. 4. JS has no non-financial
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