Private Health profiteering from COVID at NHS exp

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 Root1 15 Jan 2021

Private beds are not being used in the COVID crisis as the NHS is being priced out. Emergency cancer ops that could be done in the private sector are not being done whilst non urgent private ops are being performed instead. This at a time when the toll from untreated disease such as stroke and cancer may lead to a higher death rate than that from COVID. The private sector is gaining hugely from this, AND they have NEVER contributed to staff training. Meanwhile people are dying.

https://www.theguardian.com/commentisfree/2021/jan/14/covid-nhs-breaking-po...

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 elliot.baker 15 Jan 2021
In reply to Root1:

some relevant comments about this on the original HSJ article, you should be able to access without paying if you haven't looked at too many this month.

https://www.hsj.co.uk/coronavirus/exclusive-medical-leaders-seek-to-shame-p...

 neilh 15 Jan 2021
In reply to Root1:

Well the private sector in healthcare is driven by consultants ( who are after all are the key part). Consultants have negotiated their contracts with the nhs to allow them to do private work.

You are really going to have to drive  change at consultant level, and I would suggest that at the moment this may not be a good idea ( they could after all up and leave their NHS contracts).

Its a fine blance if you want to p#ss off  your critical workforce.

UInfortunately this issue has been on the go ever since the founding of the NHS ( when the consultants basically refused to sign NHS contractsback in the 1940's  and a compromise was struck)

Of course not all consultants do private work.Some will only work for the NHS.

Its not an easy one to address and has been rumbling on for 60 plus years.

 Andy Hardy 15 Jan 2021
In reply to neilh:

Nye Bevan famously had to "stuff their craws with gold" at the founding of the NHS, but we have had 75 years since then to introduce measures to sort this out.

Just suppose that you got free med. school, in return for not working in the private sector in the UK. The problem would be much reduced over a generation.

Or anyone on the GMC register has to agree to stop doing private work during war or pandemic - again problem gone. If we can afford £22bn on T&T for next to 0 benefit, we can nationalise health (for the duration)

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 Andy Johnson 15 Jan 2021
In reply to Andy Hardy:

> Just suppose that you got free med. school, in return for not working in the private sector in the UK. The problem would be much reduced over a generation.

Almost all consultants got to that level by benefiting from years of NHS training. What if they had to pay back all/most of the cost of that before they could work in the private sector?

Private healthcare, like private education, is a net loss to society. I wouldn't ban it, but in my opinion it shouldn't be encouraged.

Post edited at 12:05
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 mik82 15 Jan 2021
In reply to Andy Johnson:

>Almost all consultants got to that level by benefiting from years of NHS training. What if they had to pay back all/most of the cost of that before they could work in the private sector?

It's easy to say things like they have to pay back the cost, but something like that would have far-reaching consequences. There is a large demand for private healthcare - this isn't going to go away and healthcare is big business. They'll still need medical staff so you'll either see private hospitals setting up their own training schemes, or sponsoring the best candidates through training then removing them to work entirely within the private sector. 

Anyway, to be honest it's the NHS that benefits from their years of training, by having years of "grunt" work that keeps the service running..

 neilh 15 Jan 2021
In reply to Andy Hardy:

I am sure even in todays environment you would have excatly the same issue.

Basically the consultants hold the upper hand.

Its a bit like a tube train driver.

There are only so many of them in a highly skilled environment.The ball is in their court.

Post edited at 13:04
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Removed User 15 Jan 2021
In reply to Root1:

The private hospitals could provide beds operating theatres and staff. This was in place for the first wave. One issue is the lack of support for anyone complex or sick in most private hospitals so the types of cases would be limited. 

 Andy Hardy 15 Jan 2021
In reply to neilh:

By effectively putting new / trainee Drs in golden handcuffs the problem would be resolved in a generation. 

Or we could impose a temporary ban on private practice for the duration of the pandemic (which seems absolutely reasonable to me)

Or we could do both....

 robhorton 15 Jan 2021
In reply to Andy Johnson:

I think if they've done their specialist training working in the NHS they have probably paid their dues by the time they become a consultant. The usual complaint is about people who go through medical school in the UK but then leave to work in Australia or similar.

 neilh 15 Jan 2021
In reply to Andy Hardy:

As I said I do not think either current or future consultants would agree...and then what would you do.....call their bluff(?)

Considering the steps the govt took to alter the limits on taxes for pensions contributions after the doctors etc took them to task, it reaaly shows where the power is.

It is not with the gov or the nhs.

 jimtitt 15 Jan 2021
In reply to Andy Hardy:

> By effectively putting new / trainee Drs in golden handcuffs the problem would be resolved in a generation. 

> Or we could impose a temporary ban on private practice for the duration of the pandemic (which seems absolutely reasonable to me)

> Or we could do both....


It probably would be solved, NHS patients would get overworked trainees and doctors so incompetent they couldn't get a job in the private sector!

There are other ways to cope in Covid, for example in Germany where I live the private hospitals are paid to provide intensive care beds for Covid patients (who are state insured) in order to free up capacity in the normal hospitals. Even in normal times the health system uses the private system to take up the slack in when there is a bottleneck, all you need to do is coordinate the private/ public sector better and get away from the them and us complex. 

My wife is a doctor and sees both private and publicly insured patients, when they make an appointment nobody knows.

 nufkin 15 Jan 2021
In reply to robhorton:

>  The usual complaint is about people who go through medical school in the UK but then leave to work in Australia or similar.

Does the NHS not make up for this by stealing away medical staff from countries with less well-funded health systems?

 robhorton 15 Jan 2021
In reply to nufkin:

Possibly - my main point really though was that someone who has worked in the NHS long enough to become a consultant has probably "paid" for their training.

 Andy Hardy 15 Jan 2021
In reply to neilh:

> As I said I do not think either current or future consultants would agree...and then what would you do.....call their bluff(?)

> Considering the steps the govt took to alter the limits on taxes for pensions contributions after the doctors etc took them to task, it reaaly shows where the power is.

> It is not with the gov or the nhs.

What is the motivation to become a consultant? To save lives, or to make a killing 😉

Fwiw I would not be proposing that they take a pay cut (they would be paid NHS rates while working in the NHS during the pandemic)

 summo 15 Jan 2021
In reply to Andy Johnson:

> Almost all consultants got to that level by benefiting from years of NHS training. What if they had to pay back all/most of the cost of that before they could work in the private sector?

> Private healthcare, like private education, is a net loss to society. I wouldn't ban it, but in my opinion it shouldn't be encouraged.

Some might say they paid it back in their first few years doing the hours of two or three people, every week. 

Many of consultants will work in a part of medicine where they won't be of any benefit fighting covid, but if they can save a life treating cancer privately isn't that a good thing? 

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 Stichtplate 15 Jan 2021
In reply to neilh:

> I am sure even in todays environment you would have excatly the same issue.

> Basically the consultants hold the upper hand.

> Its a bit like a tube train driver.

> There are only so many of them in a highly skilled environment.The ball is in their court.

Highly skilled? 22 weeks to train as a London tube driver versus 13 or 14 years to become a consultant. Highly unionised more like.

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 mondite 15 Jan 2021
In reply to jimtitt:

> There are other ways to cope in Covid, for example in Germany where I live the private hospitals are paid to provide intensive care beds for Covid patients

Not an option in the UK where the very few of the private hospitals have intensive care beds and then not that many. Which is part of the current problem with the system. If something does go wrong they just get to hand the patients over to the NHS to try and sort out.

 jimtitt 15 Jan 2021
In reply to mondite:

About 13,000  private and 14,600 public here (pre-Covid), jerked it up to something like 46,000 last year though.

In reply to Andy Hardy:

> By effectively putting new / trainee Drs in golden handcuffs the problem would be resolved in a generation. 

Or we could fund the NHS to a degree that private work is less appealing. I don’t mean that in terms of raising wages, but improving the standards and wait times of services and the resources available to do the job. It’s often not the pay slip that makes people decide to look at private work. 
 

Removed User 16 Jan 2021
In reply to Stuart Williams:

This seems to have morphed into a discussion about doctors’ contracts. In 2003 the government changed consultants’ contracts because they thought they were all off at the private hospital instead of doing NHS work. What they discovered was that the great majority were doing a lot of unpaid hours for the NHS. It’s also worth pointing out that a consultant would need to commit to 44  hours of NHS work each week in order for their NHS employer to permit them to undertake private work.

The issue highlighted by the Guardian, and originally raised by senior medical managers in London, is the willingness or otherwise of private hospitals to make their facilities available for treatment of NHS patients during the current wave of the pandemic 

 neilh 16 Jan 2021
In reply to Stuart Williams:

Mmmm

You need to look at what happened over drs/ consultants stopping working overtime 2 years ago and the changes to the limits on pensions contributions to see your view is a complete fallacy.

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In reply to neilh:

No, I don’t need to do anything just because you tell me to. Nor does that offer any evidence that tells me I should disregard the numerous conversations I’ve had with people about their motivations for moving to private practice.

It may well not hold true for medics, who can be a strange breed. But I’m content saying that in other healthcare fields the motivation is frequently more about job satisfaction than money. 

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 chris_r 16 Jan 2021
In reply to Root1:

I don't believe that anyone in the UK goes into a career in healthcare if money is their main motivation in life.

Doctors are generally highly driven, straight-A students who could excel in a number of fields if they hadn't chosen to study medicine. In my view we need a system where GPs & dentists can get on with the job of treating patients without having to think about the income into their privately-owned practice, and the factors that attract consultants to private hospitals are understood and addressed.

J1234 16 Jan 2021
In reply to Andy Hardy:

> Nye Bevan famously had to "stuff their craws with gold" at the founding of the NHS, but we have had 75 years since then to introduce measures to sort this out.

Nigel Lawson is famously quoted as saying, "The NHS is the closest thing the English have to a religion" but a more full quote is "the NHS 'is the closest thing the English have to a religion, with those who practise in it regarding themselves as a priesthood."

> Just suppose that you got free med. school, in return for not working in the private sector in the UK. The problem would be much reduced over a generation.

> Or anyone on the GMC register has to agree to stop doing private work during war or pandemic - again problem gone. If we can afford £22bn on T&T for next to 0 benefit, we can nationalise health (for the duration)

I can understand where you are coming from, however this opens up a whole can of worms about conflicting rights and power balance, and lets face it, people cannot even agree on compulsory vaccination or wearing of masks, so I am not really sure how telling people such as consultants what they should and should not do will work, as they truly are globally mobile, and could sling their hook to another country whenever they chose to, unless you are suggesting they have to repay all debts before leaving.

J1234 16 Jan 2021
In reply to neilh:

> Basically the consultants hold the upper hand.

Absolutely

> Its a bit like a tube train driver.

>

Hmm, the US air traffic controllers thought that and Regan soon put them straight, I listened to an ATC on the radio the other day who stood against Regan, and it destroyed him financially. Training someone to drive a train is not analogous to training a consultant.

Post edited at 13:29
 Badgers 16 Jan 2021
In reply to Andy Johnson:

Does that mean that anyone who makes personal profit stemming from their education (secondary school, further and higher education) that they did not pay the full economic cost for (i.e. almost anyone with a job) must repay their education costs?

I'm not supporting anyone working in the private sector for non-emergency work at the moment (just off the back of a week on covid ICU and have many more weeks stretching ahead - feeling particularly sensitive about everyone mucking in at the mo!). But I do think that there would need to be equivalence between professions if restrictions to working life are considered. 

New consultant contracts (for many years now) are fixed 10 p.a.s (i.e. 40hrs minimum a week). The old style, I'll work 4 days a week NHS and 1 day private has not been an option for some time. 

 Badgers 16 Jan 2021
In reply to Removed Userthetwin:

And in addition, the individual responses of the medical, nursing and AHPs to the second surge has been pretty incredible.

All of our cancer surgery is happening down the road in a large private hospital whilst our theatres have intubated covid patients in. The surgeons are either operating urgent cases down the road, or on our ICU proning patients, putting in lines, emptying bins, changing bed sheets, being dogs bodies for v stretched ICU nurses.

Watched an eminent vascular surgeon and a liver transplant surgeon restock temporary ICU equipment trolleys, do the bins and fetch and carry yesterday. 

 Dax H 16 Jan 2021
In reply to mondite:

> Not an option in the UK where the very few of the private hospitals have intensive care beds and then not that many. Which is part of the current problem with the system. If something does go wrong they just get to hand the patients over to the NHS to try and sort out.

Take the cream, dump the crap. Easily solved though, legislation that says if you want to run a private hospital it will have the same facilities or better than a NHS one. 


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