Wednesday, May 1, 2013

NHS & Safety Net: Private Health & Exclusions


The talk right now is about privatising the NHS. But it is not that simple. Private AQPs will be there to make money out of your health or your concern for your health.




Great Barracuda, BVI/ ©2009 Am Ang Zhang
A complex access pathway is now created via CCGs and it is really central government's way of shifting the responsibility for your health care. It is rationing in the simplest of terms. 


I believe patient choice is an illusion as I am restricted in terms of where I can refer and what treatments I can use. GPs are now expected to collude with rationing, are sent incomprehensible financial spreadsheets telling us our "activity levels" are too high and in some areas are prevented from speaking out about this, despite the government's weasel words about duty of candour after Mid Staffs. Practices are already being solicited by private companies touting for business, often connected to members of my own profession. But the lie that GPs are now in control of the money will soon be exposed. Most services are to go out to tender, which will paralyse decision-making.

Most disastrously treated patients

Now your doctor, the hospital, your specialist or the employing company has a financial incentive built into the clinical decision-making – even whether or not you are seen at all. Your referral may be to a related company, with both profiting from your care – so was that operation, procedure or investigation really in your best clinical interest? Or you may be told a service is now no longer available. The jargon used is that "we are not commissioned for that". But you can pay. The elephant in the consulting room is the ethical implication of private medicine. In my 30 years as an NHS GP, some of the most disastrously treated patients are those who elected for private care. Decisions were made about them for the wrong reasons, namely profit. Patients are rarely aware of this.


NHS & Faults:
Our NHS is not without faults and often the faults were to do with government. Impossible targets set up by successive governments have one aim: limit access to health care.





I wrote in 2008 in The Cockroach Catcher:


The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by politicians. Some argued that the rot started with Shipman and the move to check on doctors’ competence will soon become law. The sad truth is that incompetence was not Shipman’s problem as he was able to shield the deaths that he created with his expert medical knowledge.  The incompetence was with those that regulated him. He was probably more up-to-date with medicine than most, and expert at euthanasia. Recent scandals relating to Cleveland, Bristol, Alder Hey, Kent Authority, and MMR  all help to erode people’s trust in their doctors and their regulator, the GMC.

Then we have Mid-Staffordshire & Baby P amongst others that demonstrated how if you try hard to meet targets patients died and if you whistle-blow, you die professionally. Successive governments tried to pretend that the problems have nothing to do with their main aim: cutting funding to Health Care of the citizens of the land in the form of covert rationing.

So, a new sales pitch came in: Choice & Competition to improve the quality of health care plus let us involve the privateers as they are good.
Good at what!

Making money: for themselves. Remember Southern Cross and now A4E?
Then we have world class cancer hospital and third world cancer survival. No it did not make any sense at all.

So the decision was to get rid of the NHS as it was but retain the name as a brand.

An earlier Post: Anorexia Nervosa: Private Health vs NHS Safety Net.

In The Cockroach Catcher, in the opening chapter I recalled an Anorexia Nervosa patient that has been “dumped” by her Private Health Insurer.

This patient’s father works for a medical supplies company that continued to insure the family. Even then the Health Insurer chose to limit her treatment to 18 months.

Why? Because there is a safety net: The NHS.

Health Insurers write their own rules.

Why? Because there is a safety net: The NHS

“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candy through the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’

Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.

“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital.  No wonder they were not happy to have her transferred out.  Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements.  I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”

I did not agree to that patient staying on at the private hospital paid for by the NHS. That hospital did not like me!!!


Big blow to Health Insurers in the US

The Obama Health reform is dealing a big blow to Health Insurers as by 2014 they will have to take all comers and cannot exclude pre-existing conditions not to say dumping someone like my Anorexia Nervosa patient. Until then, the State or the Federal Government steps in.

Gov. Arnold Schwarzenegger of California, a Republican gave a rousing endorsement of President Obama’s health plan.  New York Times reported today.

I doubt if any government would follow Obama’s extremely courageous move of legislating against excluding pre-existing conditions but we could watch what happens in a few year’s time. If we can at least secure the position of those already insured we could save the NHS a great deal of money.

Unlike the US we have a safety net: the NHS.




We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.


Let us protect it. 


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