To pay or not to pay

I’m a firm supporter of our publicly funded health service and would stand by my belief that if and when I or any of my family should need help, I would look to the NHS as the first point of call. After all, Aneurin Bevan created a health service which was free at the point of use, so why choose to pay for healthcare? Thankfully I’ve not been in the situation where I have needed to call on the NHS but what if I was – the Auditor General’s previous report on Elective Waiting Times in NHS Wales identified that many patients wait long times for elective treatment, would I be prepared to wait?

I’d always assumed private practice only ever happened in private hospitals, so in our recent review of The Impact of Private Practice on NHS Provision, I was quite surprised to find out that private practice activity also takes place in our local NHS facilities across Wales. To be precise, just over 7,000 instances of private practice outpatient and inpatient activity were recorded in 2014-15. That’s not a lot when you compare it to the 4 million outpatient and inpatient cases that take place every year but still useful to know that the potential exists for me to go private locally, when my nearest private hospital is over 40 miles away!

But should private practice take place in the NHS? Surely with the financial challenges that our public services are currently facing, every spare bit of capacity should be used to treat people on NHS waiting lists.

Stethoscope on pile of money

Well, the principle underpinning private practice in the NHS is that it should not impact on NHS provision, and a number of health boards have dedicated units in which private practice activity place to minimise this risk. And, there is a bigger picture to consider. The ability to undertake private practice can help attract consultants to NHS posts. Additionally, NHS bodies can generate income from private practice work that takes place within their facilities. So maybe private practice in the NHS is not such a bad thing!

Like everything that has a risk however, it needs to be managed and our review has identified that NHS bodies are not managing private practice as effectively as they could. Weak guidance and unreliable data are some of the key challenges that we have tasked them to address – if NHS bodies don’t know about the true picture of activity, then they can’t be assured that it is not impacting on the NHS.

So if I did choose to “go private” for my care, I may be able to afford the initial outpatient consultation but any further treatment may be pushing the limits on my bank account, with prices for surgery going into the thousands. But if I paid for an initial private consultation and then chose to have my treatment on the NHS, would I be seen quicker – after all, I’d have already seen the consultant?

Stethoscope on a pile of £20 notes

Well I’m not the only one to ask this question! It was as a result of the Public Accounts Committee asking this very same question which led to us undertaking our review into private practice.

Guidance in England is very clear that patients in this scenario should enter the NHS waiting list in line with others who had received their outpatient consultation through the NHS. But here in Wales, the guidance is not so clear and can lead to an inconsistent approach being adopted.

The inability to identify these patients made it very difficult for us to answer whether private patients who move to NHS care get seen quicker than those who choose to have all of their care in the NHS. We did manage to identify a small cohort of patients who had been seen privately in the NHS but we weren’t able to draw definitive conclusions. The challenge now is for Welsh Government to help NHS bodies identify these patients and for themselves to be assured that access to NHS treatment is equitable whether you choose to pay for an initial consultation, or not.

You can read the full report on private practice can be found on our website (external link).

About the author:

anne-photoFollowing a career in the NHS as a Clinical Governance Manager, Anne Beegan has worked for the Wales Audit Office and its predecessor organisations since 1999. Anne is a Manager within the health team and is responsible for a range of NHS projects.

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