To think it’s so wrong that if you have money you can jump NHS waiting lists?

[ImaHogg]

I have some gynae issues. I had a scan in September 2020 and a telephone consultation with a gynaecologist. I was told that I need a hysteroscopy with a biopsy and to remove some polyps.
Obviously due to Covid I, alongside so many others am now on a waiting list. I (and my gp) have chased many times but just get told they have absolutely no idea when my procedure will be.
I am getting problems from the issues I have and have had enough so rang my local private hospital to ask if they do this procedure (can not really afford to go private but I am getting desperate and wanted to know how much it may be). I was told they don’t do this procedure at this hospital but there may be an ‘alternative’! They would talk to the gynaecologist and get back to me.
They rung back to say they had spoken with the gynaecologist and he would be happy for me to have a consultation at the private hospital (£150) then I would need an ultra sound scan (I would have to have this done at the private hospital even though I have a copy of the NHS one from September, same gynaecologist), then he would be able to do the hysteroscopy but at my local NHS hospital - wtf!!
So basically for a fee of £2000 I can skip the NHS waiting list, skip the luxury surroundings of the private hospital and have the same procedure at the same NHS hospital that I have currently been on a 8 month waiting list.
So if you have money you can push back NHS waiting lists even further by flashing the cash!

I had my tonsils out privately via my df bupa 40 years ago!
Nephew didn't have them out privately, he had a private consultation to say he needed the operation, cost €250 then he was referred public was able to skip 2 year waiting on the public list.

It is definitely possible to skip the NHS queue.

You have a consultation privately by the same consultant you would see in the NHS. They decide tests/course if treatment and refer you back to the NHS list, but your tests will have been carried out sooner because a private consultant requested them.

I know this is correct because I have done it 3 times. Each time I needed urgent spinal surgery but the waiting lists for the initial consultation were around 1 year.

I paid between £120 —£200 for an initial private consultation and referred back to the NHS immediately for tests and surgery. It cut the total. Wait for the eventual surgery by over 18.months each time.

If you are at risk or further serious damage and desperate you'll do anything possible to preserve good health and reduce pain.

YABU

It’s no different to anything else. The only way it would be unreasonable is if it was a matter of life/death and if you would die uncles you could afford private.

This isn’t such a case. It’s like anything in life, the more money you have, the better access to services.

It’s totally common for doctors to also work as private clinicians to bump up their earnings. I don’t think it’s unreasonable for them to do this at all.

due to covid there is an issue with many private appointments not being able to take place, those that rented the nhs rooms at the weekend for example

"No you cannot jump the NHS waiting list, you can go private. It shortens the NHS waiting list for others"

But surely the fact that the procedure is taking place in an NHS hospital, using a slot that could be used for an NHS patient means that the waiting list for NHS patients is not shortened. Whilst that space is being used for a private patient and NHS patient can't use it.

@gildalily

"No you cannot jump the NHS waiting list, you can go private. It shortens the NHS waiting list for others"

But surely the fact that the procedure is taking place in an NHS hospital, using a slot that could be used for an NHS patient means that the waiting list for NHS patients is not shortened. Whilst that space is being used for a private patient and NHS patient can't use it.

No. Lots of NHS hospitals rent out theatres as an income string. We don't have the resources to staff all theatres at all times.

@Locc

It is definitely possible to skip the NHS queue.

You have a consultation privately by the same consultant you would see in the NHS. They decide tests/course if treatment and refer you back to the NHS list, but your tests will have been carried out sooner because a private consultant requested them.

I know this is correct because I have done it 3 times. Each time I needed urgent spinal surgery but the waiting lists for the initial consultation were around 1 year.

I paid between £120 —£200 for an initial private consultation and referred back to the NHS immediately for tests and surgery. It cut the total. Wait for the eventual surgery by over 18.months each time.

If you are at risk or further serious damage and desperate you'll do anything possible to preserve good health and reduce pain.

But that's not pushing the queue down for others.

You get the tests done sooner, but then re-enter the NHS as if you'd had the tests done via the NHS- you don't skip to the top of that queue. For lots of issues, the queue is longest for the tests.

And you aren't taking someone's else's slot, the Dr isn't seeing you at the expense of an NHS patient.

@gildalily

"No you cannot jump the NHS waiting list, you can go private. It shortens the NHS waiting list for others"

But surely the fact that the procedure is taking place in an NHS hospital, using a slot that could be used for an NHS patient means that the waiting list for NHS patients is not shortened. Whilst that space is being used for a private patient and NHS patient can't use it.

Read the explanations up thread. The ‘slot’ is not being used for a private patient at the expense of an NHS patient.

@Cocolapew

You absolutely can go private for your consultation and then be bumped up the consultants NHS list, I'm surprised people think this doesn't happen. I know loads of people who have done it

I'm a qualified doctor and I've worked in senior management for many different NHS trusts and this hasn't happen in my experience.

I have experienced a few situations that may appear dubious because the patient has moved sideways out of the private pathway. The typical scenario is 2 people/families in outpatients talking about their treatments. Patient A took 18months but patient B took 9 months and boasts that they were private for some of it but you probably don't know the whole story or the logic behind it.

Each stage of the NHS clinical pathways has waiting lists. So the above example patient B pays privately for diagnostics and consultant assessment but can't afford or declines the major treatment. That patient would effectively leapfrog the people waiting for those earlier processes and join the NHS queue for the major treatment 9 months earlier.

It's not entirely fair but only in the way that capitalism isn't entirely fair.

There are two alternatives to stop that happening and both of them are unethical.

1. Force the patient to restart the NHS pathway which is a waste of public resources and time.

1. Have someone make an assessment and hold back the patient, but this is hugely complicated. Who would pay for this person. How would they judge this? Locals averages? National? What about policies related to clinical need and treatment suitability or other organisational issues. Waiting lists aren't always as simple as first in first out.

And I should also add that in reality the NHS absolutely HATES things outside of the norm. You could save time but you will pay in blood, sweat and telephone hold music minutes to get your private treatment recognised in order to bypass NHS stages.

What is wrong with system is that when the NHS was founded medical professionals were given too much sway and leeway re working practices - I think that on qualification they should decide which route to take re employment ie private or NHS - not a combination of both to suit their financial needs. ...I will always be a dreamer - hopefully not the only one

I agree with you. I work in a day surgery unit and whilst the surgeon and the anaesthetist are paid privately the rest of the staff treating these patients are being paid by the NHS.

I suppose it depends on how much you want to get the procedure done quickly. I know which I'd choose.

@Ostara212

Private wards can cater for emergencies straight away (as they do in private hospitals) you still go to recovery etc as part of the operation recovery. Obviously recovering from an emergency - but non life-threatening condition such as appendicitis or broken arms/legs is different from major life-threatening emergencies such as internal bleeding, sepsis etc.

If you're in because of a major emergency and need ITU/ high dependency etc then of course you'd use the NHS, but at the point where you need routine care you can choose to switch to private (or not) if you have the money or the insurance.

My point is that sometimes people say 'I have private healthcare' in A&E. There's no queue jumping at that point, and in fact it can cause a delay in treatment while the paperwork is sorted and the Consultant found to discuss your treatment with you.

Private hospitals are often smaller and do not have the same facilities as large NHS hospitals, a lot of consultants work both privately and for the NHS.
My DM had a mastectomy about 15 years ago. She enquired about going private but it would have been the same consultant at the same hospital, as if she was NHS but she would get a private room afterwards. She chose to have it on the NHS. Presumably they book certain times and clinics for private patients which are not used for NHS apts. Often consultants will see nhs patients in the afternoons and private in the morning, for example so by having a private consultation in the morning, you would have freed up an afternoon slot for an NHS patient?
Several GPs in my surgery also do private work. They are not available for apts on x morning or y afternoon because they are somewhere else. So if you booked to see them privately at those times, you wouldnt be making an nhs patient wait longer because they dont have apts then anyway?

Some consultants don't do private work so you can't "jump the queue" by seeing them privately and then getting them to refer you back on the NHS.

Also, once you're in the NHS system it's usually more efficient to stay in it.

Although I am sure that covid has made waiting lists worse, I think the main delays are in (a) seeing a GP and getting referred in the first place and (b) seeing a consultant and having any relevant tests. After that, you usually get done fairly quickly depending on the type of procedure.

What we really need is access to private GPs who can see and refer us right away.

The other thing you get is someone on the NHS saying you need something and then you see something else and they say you don't, so you then somehow need to get back into the system to see the person you originally saw, to get the procedure done. It has happened to my mother twice. Fortunately because it was to do with eyes, she was able to get rereferred by an optician (GP refused to see her or even speak to her on phone "because of covid") and she had the first procedure done and is now waiting for second one.

Of course, if you have the money, are anxious to get something sorted out and are sure that the treatment you are getting is the right one then it's your choice.

However, @OwlTwitterings, doctors are trained by the NHS, on taxpayers' money. They are then free to choose to continue working for the NHS or to go private, the amount they choose for both is up to them. Obviously, the fewer hours they work for the NHS, the longer the waiting lists for those whose only option is to use state healthcare (as some time and expertise is diverted to private patients). This has a significant impact on waiting lists for common routine operations e.g. hip and knee replacements. I personally think it's unfair that this resource can be exploited by private care. It is a public good, and only when the public has been adequately served can private care really be considered ethical. if medics had to pay for their entire seven year training themselves it would cost hundreds and thousands of pounds.

The shortage of staff is not helped by the lack of state money invested to train and employ NHS staff, including doctors in sufficient numbers to treat the population, or by a pandemic that has limited non urgent care. Also, when the NHS has to contract out to a private service, like the MRI scans that someone mentioned above, they have to pay for it out of their limited funds, further complicating their budgeting.

Another point - and then I'll get off my soapbox - and full disclosure as my parents both worked all their lives for the NHS as a doctor and a nurse - there has been a huge rise in private, botched ops that have to be rescued by the NHS, especially things like cosmetic and laser eye surgery.

@BigWoollyJumpers you are correct, the NHS is extremely good value for money, one of the best in the world, and so much more cost effective than privatised care systems like the US where it's basically a trade off between insurance companies and big pharma.

I've had several scans etc done privately at our local nhs hospital. They are done in the evening, I've had one at 8pm, obviously the hospital is closed then, to nhs patients.

@NursieBernard

I agree with you. I work in a day surgery unit and whilst the surgeon and the anaesthetist are paid privately the rest of the staff treating these patients are being paid by the NHS.

That's not true.

Labour costs should be recharged back to the NHS.

Staff don't receive the money directly but the taxpayer shouldn't be footing the bill unless Boris Johnson is the finance director there

And I should also add that in reality the NHS absolutely HATES things outside of the norm. You could save time but you will pay in blood, sweat and telephone hold music minutes to get your private treatment recognised in order to bypass NHS stages.

So true.

Also, when the NHS has to contract out to a private service, like the MRI scans that someone mentioned above, they have to pay for it out of their limited funds, further complicating their budgeting

This is however the more cost effective option, as the NHS doesn't have the initial capital costs, nor the maintenance and running costs, and may even charge ground rent.

And @NursieBernard I'd recommend that your colleagues speak to the NMC or HR if that job puts them under extra pressure.

Many trusts pay private staff Recruitment and retention premium on top of AfC rates and this money comes form the private patient income.

When PP are slotted into NHS elective lists there are only 3 parties who benefit, the patient, the anaesthetist and the surgeon. Although the Hospital Trust will receive payment it is not used for the benefit of NHS patients on the waiting list who might have had that theatre slot instead.

It's not shocking.
I've been looking into surgery after major weight loss. I have fatty lipomas, some of which are causing a lot of pain (I have 20 in my abdominal region)
NHS says that it believes lipomas rarely cause pain, and think I'm after a cosmetic procedure, so much dragging of feet.

Between the tummy tuck and associated liposuction, I think I'll get rid of most of the lipomas-and where all of the painful ones are!

Doing my research into surgeons, most operate in the local NHS hospitals in a capacity for the NHS. Some are based within private surgeries on NHS grounds and use NHS facilities, but also operate in private hospitals too.

It's not irregular for consultants to be based in 2/3/4+ different locations.

If you are happy to go with that Gynae, search his details online, you're likely to find him based in another location. Price isn't always hugely different.

I'm shocked at how long the waiting list has been for you though, MIL had to have the same procedure you mention, she was referred and had it within a few weeks (recently!)

@NoSquirrels

We could all pay more taxes and stop bloody voting Tory as a country and then the NHS might have a fighting chance. Most people don’t want to pay higher taxes.

MANY people cannot afford to pay more taxes, the rents on their insecure AST housing swallows up 50%+ of their take home pay.

We have waited 10 years for my daughter to see a psychiatrist, to no avail. I have used all my savings and she starts treatment as soon as her blood tests are back, following a diagnosis in under 2 weeks. I did what I had to do for my daughter and would do it again.