Health & Science blog

So what, exactly, has the private sector in the NHS done for us? The governments’ much spun “Choose and Book” scheme is alleged to offer patients greater choice in the venue of their care – including private providers – when booking hospital appointments.

It has been unpopular with GPs because the software has been slow, because it has been difficult for a GP with expert knowledge on the local patch to know as much about more far-flung equivalents and because it costs a lot to do something that there seems little clinical reason or particular desire for.

And so, to a recent BMA News report that a GP in Yorkshire had tried to access a hernia repair for one of his patients at a private hospital run by Spire Healthcare. Hernia repairs are usually one of the more straightforward operations, and are commonly performed.

However this patient was not accepted by Choose and Book: Dr Andrew Green, the GP making the referral, says the system returned a message that it could not refer a patient “who is receiving psychiatric treatment”.

The Department of Health say that “providers are allowed to opt out when there is Department of Health guidance for Extended Choice Network providers not to treat patients with unstable psychiatric disorders who are receiving psychiatric treatment”.

This is at odds with what the Choose and Book software allows, which seems to object to any mental health problem at all. It is rather discriminatory – both about what mental illness means, and how it should be treated.

All doctors have basic training in psychiatry, surgeons too. Yet the whole of the referral system essentially seems now to come down to a tick box protocol, not a professional decision-making partnership with the surgeon and/or GP, psychiatrist and patient.

But we have come to expect such haphazard nonsense when involving the private sector with the NHS.

What about the costs? The medical newspaper Pulseis reporting that Assura, who have multiple GP practices including a network of walk-in Darzi centres – GP-led health centres awarded under Lord Darzi’s nationwide tender process – have made losses of 4.5 million before interest and taxes.

The same paper reports that two thirds of the Darzis have failed to register their target number of patients; and while I am no fan of targets, it does show that the level of dissatisfaction with GPs working in normal practice has been underestimated to the extent that it has destabilised the very expensive Darzi set up.

And the payment to the centres has been vastly in excess of the funding made available elsewhere – up to seven times the usual amount a practice gets paid per patient.

Then there are private companies offering diagnositics testing in London, and where the contract value has risen despite the waiting lists becoming longer . And the other outcomes of the farming out of surgery, such as the inquest this year into Dr John Hubley  who bled to death after a gall bladder removal: that independent sector treatment centre didn’t have enough blood to resuscitate him, and almost unbelievably, not enough swabs.

More recently Clincenta, a private health company and part of the construction firm Carillion, which has contracts with the NHS in London to the tune of £144m, has had its day surgery centres closed “in the interests of patient safety” after “a number of incidents”.  We await news on that one.

There remains an amazing belief that anyone who is capable of managing business, will also be good at providing healthcare.

Healthcare is not the same as business. What you do, what you decide, how you calculate and how you organise and think are not based on business principles.

They are different skills with different values and a strict professional ethical code. The government must realise soon that the NHS would do better were it supported, and not continuously devalued and sent to pick up the bits that the private sector deems not cost effective enough to dirty their hands with. We all deserve better, do we not?