I’m interrupting normal service (a piece on what ‘hardwired’ might actually mean, and another on re-evaluating Milgram’s research, supported by some recent research, are on their way) because a recent news story appalled me, and I’m also a bit concerned that it hasn’t been more widely circulated.
The story was broken by The Independent on 21 July: http://www.independent.co.uk/life-style/health-and-families/health-news/private-hospital-told-doctors-to-delay-nhs-work-to-boost-profits-7962582.html
It reveals how the chief executive of a private-sector hospital doing NHS work devised a policy of artificially delaying treatment of NHS patients in the hope of coercing them into ‘converting’ to more profitable private patients.
Bernie Creaven, executive director of the private BMI Meriden Hospital, Coventry, had ordered an immediate four-week postponement of operations on NHS patients referred to the hospital, which will be extended to a minimum of eight weeks by September.
In a letter to the hospital’s consultants dated 13 July, seen by The Independent, Ms Creaven said the imposed delays were to discourage patients thinking of going private from opting for treatment on the NHS.
Private hospitals receive taxpayer money for treating NHS cases, but can make larger fees if the patients go directly to them for treatment.
“I believe time to access the system is the most critical factor for private patients converting to NHS patients,” she wrote. She added that “other aspects of differentiation” would be introduced over the next few weeks to make NHS treatment at the hospital relatively less attractive.
In her letter to consultants, Ms Creaven says: “Over the past few months I have had numerous discussions with consultants regarding the lack of differentiation between NHS and private patients and there is significant anecdotal evidence to suggest that the lack of differentiation has had a negative effect on our private patient referrals.
“I now wish to implement with immediate effect a new rule which will mean that operations on NHS Choose and Book patients will not be able to take place until at least four weeks following their outpatient consultation. Also, in each subsequent month, I will extend this by another week until September and the time will be eight weeks from initial consultation. I believe that this time to access the system is probably the most critical factor for some private patients converting to NHS patients.”
Ben Goldacre, whose tweet about this was the first I saw of it, comments “If an individual Dr did what @BMIHealthcarePR did, wd get struck off, no?” I think it’s possible. Were medics involved?”. Well, yes, they were: the letter was to the hospital consultants. Maybe one of them was the whistleblower: perhaps that’s the one who shouldn’t be struck off. Let’s hope that BMI healthcare don’t lay them off instead.
People close to me pointed out that this is only the logical extension of the despicable ‘go private and jump the NHS queue’ practice which we’ve long been familiar with, which is true, but I think there’s a qualitative difference here. Treatment is being withheld for no other reason than to convert patients. Not because there aren’t beds, nor available staff, or even that higher-paying patients come first: the policy is to automatically deny necessary medical treatment, even if it could be easily provided: to stand by and say ‘even though you’re fully entitled to treatment, and the NHS will pay us fully for that treatment, we’ll not do anything for you for several weeks unless and until you pay extra’. It’s definitely not crossing over the line to deliberately inflicting damage on patients so you can benefit from treating them, but it seems to me to be getting horribly close to that line.
Note that MS Creavon promises that “other aspects of differentiation” will be applied, whch sounds dangerously threatening when you consider it’s an extension to unnecessarily denying treatment . Withholding analgesics? Less thoroughly cleaned wards? (oh, sorry: private enterprise has imposed that in NHS hospitals already).
As I said at the top, it’s also shocking how little the story’s been picked up, considering that dopey misreported stories about ‘hardwired racism‘ can run round the world in 24 hours. The only other mention I can find online about it (on 23 July) is a piece from Labour Left: http://www.labourleft.co.uk/bmi-nhs-treatment-scandal-lansley-protests-too-much-the-devils-in-the-detail/
They say that the Department of Health has put out a statement:
Minimum waiting times that do not take account of healthcare needs of patients are unacceptable. Decisions on treatments, including suitability for surgery, should be made by clinicians based on what is best for the patient. This applies regardless of whether a hospital is run by the NHS or the independent sector.
We will therefore be contacting BMI to ensure that NHS patients are not disadvantaged.
– but point out, rightly, that as long as you have organisations whose only motive is profit supplying services for the public sector, this kind of thing will happen. Ms Creavon was operating in the best traditions of the private sector to maximise surplus value for her bosses and their shareholders (and probably for herself, too: it would be a step towards public accountability if we could see her management targets). That’s what these organisations were set up to do. As has been very obvious lately, the idea that the private sector can do things either more cheaply or better than the people who are working for the public good doesn’t work out in practice. What this case shows, though, is that the private sector is good at finding inhumane ways of exploiting people to maximise profit – and the poor old, much-maligned public sector probably isn’t up to controlling their abuses. As the NHS is increasingly privatised, expect to see more of this.