Money, Money Money

Martin Wicks reports on recent developments in the NHS.

The commercialisation of the Health Service which we have previously highlighted, has been underlined by a couple of developments recently reported in the press. The Financial Times reported that NHS Foundation Trusts are setting up various forms of charity, joint venture or other arrangements with the private sector to bring in extra cash. The deals are designed to get round legislation that bars trusts from earning a higher proportion of their income from private patients than they did in March 2003, when the law creating the self-governing bodies was introduced.

Research from the Public Finance magazine has shown that:

  • the North Bristol NHS Trust is looking to set up a charity to run a new infertility unit where most patients would be private.

  • Chelsea and Westminster is examining the use of a private charitable company to expand its private maternity services.

  • Great Ormond Street Hospital for Children is doing the same to cover income from its international private patients.

  • Basildon and Thurrock is planning a “special purpose vehicle” that would take its private patients.

  • University College Hospital (UCLH) has launched a joint venture with Hospital Corporation of America on an international cancer centre. This has seen HCA take over the hospital’s private patient wing, leasing space and paying for services, and sharing profits from private patients with the hospital.

  • UCLH is looking to expand the same model into neuro-sciences, cardiac services and obstetrics.

The Foundation Trust Network, which represents the 73 foundation trusts, has repeatedly pressed the Department of Health to lift the private patient income cap.

Meanwhile, the Sunday Times reported that Family doctors are being paid for access to their National Health Service patients by a private health company which is charging the patients £145 to screen them for serious illnesses. More than 50,000 patients have been charged for screening at 250 surgeries for stroke, diabetes and heart disease.

Vanessa Bourne, of the Patients Association, asked:

“Are these tests necessary or are they not ? If they are necessary for the patients then why is the GP not offering them on the NHS ? The GP is abrogating responsibility.”

GPs have received two separate payments from the Health Screen Clinic, the private company: an “administration fee” to write to their NHS patients inviting them to undergo the screening tests and a rental fee to hold the screening sessions in their surgeries at the weekend.

The British Medical Association (BMA) has warned that GPs may be breaking the law by using their NHS patient lists to advertise the private screening tests. A letter sent to regional health bodies states:

“The practices are in breach of the Data Protection Act. They hold patient data as part of their NHS contract. It was never intended, and patients are not aware nor indeed have consented to their personal data being utilised for the purpose of advertising private services.”

Dr Ron Singer, a north London GP and spokesman for the campaign group Keep Our NHS Public, said:

“The GPs are using an NHS resource to offer a private service. The NHS data-base, which is owned by the NHS, not by GP practices, is being used in order to have a contract with a private company.”

A senior member of the Commons health select committee has attacked NHS foundation trusts seeking to circumvent caps imposed by Parliament on their private patient income. Public Finance has discovered that at least four foundations are exploring options to establish third-party bodies to run private patient services.

As the bodies will be separate entities, the income will not be consolidated in the trust accounts. Labour MP Howard Stoate said such actions were not what Parliament intended when it imposed the cap in the 2003 Health Act. He called on the foundation regulator Monitor to review the situation.

It’s deplorable that this is happening, but my worry is that this is what foundation trusts were almost bound to do,” he said. “Their raison d’être is to generate as much income as they possibly can. It’s hardly surprising they have found ways around it as they are almost duty-bound to be as creative as they possibly can with what they see as a market system to raise cash. It’s regrettable – it harks back to the pre-NHS days when each hospital was an independent business providing services to whoever they could sell health care to.”

Unfortunately Howard, that is the logic of the market which your government has introduced. The government has given Trusts the right to set up “special purpose vehicles”. It wants them to be “entrepreneurial”. They are following the logic of the government’s market system. The only way to stop them doing that is put an end to the market system and to Foundation Trusts.

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