The Private Cancer Lottery Part 2

If you have private health insurance and need treatment, should you accept a cash bung to use the NHS? Most insurers offer this, typically £7,500 in the case of a life-threatening cancer. This makes sense in cases where the NHS has access to treatment or expertise that would result in a better outcome, but the motive of the insurers is simply to save money. A standard course of radiotherapy might cost £15,000, with similar fees for surgery, and the new chemotherapy drugs average £75,000 a year . So insurers can save millions by bribing desperately ill patients to switch to state funded care.

Private insurance varies enormously in cost, depending on your age and the level of cover you want to pay for. If you’ve had it for many years, you will likely have paid far more than and lump sum being offered. If you’re in a company scheme, you might be tempted take the cash. But generally, private patients now go to the back of the NHS queue when they switch sides. The days when a consultant you’ve initially seen privately could bump you up the NHS waiting list are largely

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The Private Lottery

MD recently met a group of NHS oncologists, most of whom did private work and most of whom had private health insurance. The private work allowed them to supplement their NHS income and practice the standard of medicine they’d want for their friends and family (longer consultations, quicker access to treatment). And their private health insurance allowed them to get the care they’d want for themselves and their family. As one put it; ‘NHS waits are increasing and for some cancers, that dramatically reduces the effectiveness of treatment and your likely survival.’

Private health insurance, and self-pay for private care, is on the increase for those who can afford it, or whose employers wish to pay. With nearly 4 million people on the NHS waiting list after 7 years of flat-line funding, private insurers and providers are eyeing a big opportunity that will only get bigger with any drop in national income and loss of EU health workers accompanying Brexit. The Conservatives lifted the cap on the amount of private work NHS hospitals can do, to allow them to reinvest profits in NHS services. But as one Oxford consultant put it; ‘The local private services offer

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The NHS, then and now

Health Secretary Jeremy Hunt was up to his usual cherry-picking tricks at the Tory conference, claiming that the brains behind the NHS was not Nye Bevan, but Conservative health minister Sir Henry Willink and his 1944 white paper. In fact, the idea for a state health service is usually credited to the social researcher and poverty campaigner Beatrice Webb in 1909. Lloyd George introduced state organised health insurance in 1911, but for workers only. Lord Dawson, President of the Royal College of Physicians, reported in 1920 that ‘the best means of maintaining health and curing disease should be made available to all citizens’ and it was William Beveridge who first proposed ‘cradle to grave care’ in his 1942 report. Willink’s contribution was important – garnering cross party support for a consensus that ‘everybody irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the best and most up-to-date medical and Allied services available. The service should be comprehensive and free of charge and should promote good health rather than only the treatment of bad.’ But it was Bevan who fought the vested interests and made it happen in 1948. The Conservatives

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Babylon or Bust

Perhaps the biggest crisis facing the NHS is the shortage of GPs. In 2016, 92 practices closed (including 34 mergers), and many patients now have to wait three weeks for a routine appointment. Health Secretary Jeremy Hunt promised 5000 more GPs by 2020, but in the 3 months to December 2016, there was a drop in full time GP numbers of 445. Numbers of GPs in training were up by just 147 in 2016. NHS England is now desperately trying to import GPs from countries that need them even more than we do, and train 1000 physician associates – who are currently unregulated – to take on GP work. Hunt’s other big hope is to use technology to take the pressure off GP practices.

Telephone triage, where all patients are screened on the phone by GPs to determine if they need a face to face consultation should – according to NHS England –  result in 20 per cent less A&E usage and cost savings of £100,000 per practice. However, when the scheme was tested in a proper trial published in the BMJ, it found that almost half of the patients who had a phone conversation still had

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Winter is Coming

Does the NHS have enough beds to cope with the pressures of winter? Simon Stevens, the chief executive of NHS England says the NHS has ‘six to eight weeks to prepare’ and that the flu season could be bad given the H3 strain outbreaks in the antipodes that are heading our way. Simon says there are up to 3,000 NHS beds that could be freed if social care had the capacity to take patients that no longer need to be in hospital (so-called Delayed Transfers of Care DTOC). And yet NHS Improvement has warned that £1 billion extra investment in social care has failed to reduce DTOCs, and council leaders have written to Jeremy Hunt to say their DTOC targets are ‘undeliverable’.

This seasonal crisis comes on top of the everyday crisis of finding beds for patients in the NHS. The 2014 OECD league tables show that the UK, at 2.8 beds per 1000 people, has amongst the lowest for the number of hospital beds relative to population size, with England pretty much at the bottom. In the last decade, more than one quarter of hospital beds have been closed, with 37,000 fewer general and acute beds

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