NHS saw opportunity for income generation from first child gender clinic in Belfast

Thanks. .I was trying to unpick the word ‘profit’. It would be reasonable for the NHS in NI to factor in revenue from the Republic and reasonable for the Republic to select treatment in NI rather than elsewhere in Europe, for language reasons if nothing else.(Set aside the fact that many believe it is one country!) Thus it would be sensible the NHS to include potential profit when costing new services.

Yes, there are policies in place for cross border health care.

Patients from both jurisdictions can have treatment in each other's public health system, paid for by their respective health services. 20 years ago it was more often patients coming from the ROI to have treatment in NI Health Trusts, nowadays they're more likely to have treatment in private hospitals here.

Various NI Health Trusts, in an attempt to reduce the ridiculously years-long waiting lists here, are sending patients to private hospitals in Dublin for certain procedures.

I've read (in the papers) that patients from the gender service in ROI were sent to the Tavistock for 'treatment' but since Brexit, and the closure of the Tavistock GIDS, I believe that their options are now European countries that are part of the EU reciprocal health cover agreement.

I haven't come across any reporting that addresses whether or not ROI patients will be sent to the new GB regional replacements for GIDS.

Follow the money. First in the promotion of this butchery.
Then in the lawsuits which will inevitably follow.

I don’t know the answer but in NI isn’t there a certain amount of buying and selling of specialist services with the republic. So a specialist unit (though not a gender clinic) might be financially justifiable if some patients will be coming from the south or from Donegal.

ps. I should have added that the official rationale for deliberate under-funding of specialist services in Service Contracts was that the ECR income-generation target, to top-up the funding, would enable "wider access", ie. for patients not covered by the Service Contract.

For example, using easy figures:

Service Contract for 100 patients

• funded for 90 patients
• to meet 90% of the cost of delivering the service to 100 patients
• ECR target in the Service contract = 10 patients
• to top-up the missing 10% of funding.

The Service Contract should be set at a level that predicts the number of patients needing the service within the Contract area, so there should not be any extra patients needing to be seen within the Service Contract area who miss out.

That is the theory. In practice, there might well be more patients needing to be seen under contract than can be accommodated, eg. 95 rather than 90.

The extra 5 cannot be seen in-year, however, otherwise the service would be missing ECR x 5 and would be underfunded by 5%.

I don't know how it works these days but there was also always an overall "productivity target" of NHS deliberate underfunding of (in my time) 3% to 4% annually recurring.

Year 1 = 100% funding
Year 2 = 100 - 4% = 96% (the new 100% funding)
Year 3 = 96% - 4% = 92% (the new 100% funding)
etc.

That was (is?) a way of cutting NHS funding by stealth, leading to recruitment of lower grade staff and/or on shorter hours, selling-off of estates assets, building repairs delayed for years, etc.

I find it absolutely sickening that NHS funds are now frittered away on highly paid EDI staff and that staff time is diverted from actual work to time spent on dubious non-clinical training, staff "affinity networks", etc.

Apologies - drifted off into an underfunding tangent then a rant!

The internal market goes back much further than Cameron: 1989 under Thatcher with the 'Working for Patients' white paper that introduced the "Purchaser Provider Spilt".

navigator.health.org.uk/theme/working-patients-white-paper

Also in 1989, in preparation for the National Health Service and Community Care Act 1990, the Dept of Health published a document called "Financial Turbulence in the NHS". This identified nine low-incidence, specialist services that would go to the wall unless they were protected by special purchasing arrangements coordinated at Regional level.

They included Regional Genetics, Regional Drug and Alcohol Services, Specialist Wheelchair Services, Communication Aid Centres and "Gender Identity Services". (I can't recall the exact term they used for "Gender Identity Services" and I can't recall what the other four services were.)

These were often referred to as "Fire Station Services", ie. you are rarely if ever going to need a Fire Engine turn out but if you do it is important that there is one available.

The purchasing and then commissioning arrangements changed over time. Service Contracts (a fixed sum for an agreed level of activity, re-negotiated annually) were supplemented at some point (well before 2013) by Extra-Contractual Referrals (ECRs), ie. funding for individual patients, negotiated case by case, where there was no existing contract.

ECRs were "income generation", ie. income over and above Service Contracts, but they did not represent excess income over and above what was required to deliver the activity specified in service contracts.

That is, Service Contracts did not cover the full cost of delivering the contract and ECR targets were set as part of the contract in order meet full costs.

(I am putting all this in the past tense because while I worked in that system for 20 years, writing Service Contracts, doing annual Marketing Planning exercises and discussing potential ECRs with referrers, I have no idea if that is how the system still works.)

Anyway, this is the way that the NHS worked for decades and was certainly standard practice long before 2013, the date cited in the article.

All that the article "exposes", which I do not imagine was ever a secret, is that the Health Service in Northern Ireland in 2013 was using the same system of Extra Contractual Referrals as the NHS.

The only thing that would be surprising would be if other specialist health services in Northern Ireland did not rely on ECRs to top-up Service Contract funding in order to meet the full costs of those services.

Yes & no. During the New Labour era there was far greater enthusiasm for EBM & as ever, the Treasury wanted pretty metrics that showed short-term "value for money", that's how so many people get unsuitably funnelled into 6-week "treatment packages" for complex longterm psych issues. The Tavi, as a psychoanalytic service, was under threat, just like the Royal Homeopathic Hospital, because neither looked good to either Treasury or EBM.

Gender had stacks of papers so to the untrained political eye, it satisfied "has evidence", it had defined, physical "treatments" & looked sciencey. For Tavi management it was an ideal fig leaf with which to protect the Tavi as a whole, both by generating income & by making the Tavi look more "medical" than purely psychoanalytic.

Lansley's 2012 Health & Social Care Act did balkanise the NHS, introduced insane levels of admin, & divorced the Secretary of State for Health from real responsibility for what happened in the NHS, which is a lot of the story of how things got so mad - it gave a whole slew of administrators more power, left them fighting for dwindling resources, & conveniently diffused responsibility.

Many of the same things seem to have played out in NI, particularly with respect to responsibility.

Edited for text I somehow managed to delete first time round.

This is reminding me of the board papers from the Tavistock, talking about the marketing opportunities arising from the BBC Programme "I Am Leo".

Thompson left the BBC and is now working for The Newsletter and he is regularly covering Genderism and its effects on the law, the public sector, and children and women's rights in his journalism. He's a tenacious journalist so I'm glad to see someone in NI taking this seriously.

There's a couple of new names around on this board who've been reviving threads from a decade or more ago. All that's making me wonder is - which stories are they trying to bury? This thread seems like something some people might prefer to go unnoticed. [BUMP]

Stephan Nolan was the presenter but David Thompson is the Irish journalist who did all the leg work on the Nolan Investigates Stonewall podcast.

https://www.bbc.co.uk/sounds/brand/p09yjmph

Journalist David Thompson - wasn't he involved in The Nolan Show's investigation into Stonewall?

www.bbc.co.uk/sounds/brand/p09yjmph

It looks like a non-story to me as it's is just the way that the NHS works. It's the reason that the Tavistock GIDS mushroomed because patients from all over the country were being referred & the Trusts cross charged by the Tavistock so that GIDS was a significant chunk of overall income for the Tavistock.

Edwin Poots was the minister in charge at the time and he's on record now as opposing puberty blockers, cross sex hormones and surgery for children. However, the journalists investigating this issue are showing that either Poots was involved in giving the go ahead for this happening to NI kids or he wasn't paying attention to what was going on under his management while this was all being set up.

Poots doesn't come out of this situation well in either way. Nor does the Belfast Health Trust because they have been maximalist in their adoption and promotion of Genderism.

I don't think Northern Ireland has a internal market in the same way as England has though, our health service is not the same - we don't have "right to choose" for example.

I've always taken issue with payments for certain things within the NHS.

At one point NHS trusts lost money for high CS rates.
There's been lots of women threatened with removal or actually removed from GP lists because they declined having a smear and GPs were given money for have a certain % of their patients take up a test (waves - yep I was threatened). This practice has since been outlawed but I believe still persists.
And there's a whole lot more.

I've recently had an issue with DS. Long story about protecting budgets between areas basically. Complaint upheld and they are changing systems.

As others say though this is an experimental treatment on children though. This is a whole other level of low.

It's appalling.

Horrendous. But not surprising in the slightest.

He was on the Nolan Investigates Stonewall podcast I think.

But when judging this it absolutely matters what those services are. Selling stroke care, appendectomies or nose jobs raise vastly different moral issues to selling sterilisation to troubled children.

Completely agree. Medical institutions 'may money' by selling services.