In todays news: reports that some NHS trusts were setting “minimum waiting times” which were “too long” for elective surgery. The reason being that if you wait long enough people will drop off your waiting list, either by going private or dying. That there even exist minimum waiting times set by the trusts should be a cause for concern, let alone how long they are.
For me this is personal: last year I had minor elective surgery – I started off in the NHS but then decided to use my private medical insurance. I wasn’t going to die of my condition, the worst-case was an emergency circumcision; however I was in discomfort, a bit of worry and occasional pain, and as time progressed things were getting worse.
So the idea that the NHS was waiting for me to drop off their waiting list pisses me off somewhat. If they’d said at the earliest possible instance “please piss off”, I would have done so immediately. Of course they didn’t tell me to piss off because had it become public they would have suffered from some opprobrium.
My private medical insurer had me treated within a month from first presentation, the only reason it wasn’t quicker was that my surgeon was going on holiday for two weeks and I decided not to make the time before he went – it could have been under two weeks. The NHS would have taken 4 months – I know this because through an administrative error I received an appointment for my operation on the NHS as I returned to work.
The behaviour of the trusts in this instance is entirely rational, as is that of my private hospital. The trusts have been paid already, if I don’t have an operation then they’re “quids in”. My private hospital, on the other hand, wants me to have an operation, because they won’t get paid until I have it. This is actually the problem with fully private medical systems: for people that can afford treatment it is in the interests of the provider to provide as much medical treatment as the patient can pay for.
The problem with the NHS is that it is a highly cost effective system directed at providing universal second-rate care. It will remain so because anyone proposing a change radical enough to make it better will be assailed by people who “Love the NHS” and want to “Save the NHS”. Notice here they don’t care about your treatment, they care about the service provider.
Don’t love the NHS, it is a public corporate entity, it can’t love you back. Only people can love you.
2 comments
Hi. I don’t entirely agree with this. Yes of course you will be seen faster privately as the doctor wants to line their pocket and there is greater supply of private surgeons than demand. In the NHS these days, with contracting the way it is, if a good speedy service is not provided, the tender is often lost. There is a big incentive to meet local and national targets and quite severe penalties if you don’t. I work in mental health and we have become very efficient in getting people into treatment fast (a good thing clearly!). And patients would not get a better service privately. Often private doctors and surgeons offer more expensive or additional procedures because they want the money (have seen this first hand and the results when the poor patient comes to the NHS to be repaired afterwards). So its swings and roundabouts really. Private definitely is not better though.
I think my core point was that the NHS follows it’s incentives, as does the private company. The NHS had a positive incentive to wait for me to drop off the list, I’m pretty confident they were providing care entirely within their targets – but that wasn’t a great comfort to me.
And what’s with “lining the pockets”? Salaries for doctors and particularly consultants in the NHS are not at all bad and they were paid for my care, even if they didn’t, ultimately, provide it.
You say: “Private definitely is not better though” – for my case this is just absolutely untrue, I was treated more quickly, in better surroundings in the private sector. I struggle to see how, clinically, I was worse off in the private sector in my particular case.