Are some NHS surgeons on a go slow to boost their private work?

The NHS is in the headlines once again for all the wrong reasons. Here is a personal anecdote. My uncle has been in hospital for the past six weeks while he waits for a heart operation. He can get up and walk around but he needs to be in a ward for monitoring. As you can imagine he is going stir crazy. One reference puts the bed day cost to the NHS as £255, so that is 47 days x £255 = £11,985 so far. The delay is due to the long waiting list for heart operations. The delays are so bad that the uncle is being shipped off to Dublin for his operation at a cost to the NHS of £26,000 (versus £15,000 for the NHS to do it. These operation costs were provided by a friend who is a senior NHS administrator).

Now the bottom line is he is in a safe environment, he will get his operation, and it will not cost him a penny. But you have to query a system whereby a procedure that should cost £15,000 balloons to £38,000. All over the NHS you hear similar stories of delays or bed-blocking.

I was talking with a local politician who is involved with some of the health boards and I was telling him the uncle’s story. He told me that he suspects many surgeons are on a ‘go slow’ to boost their private work. It works like this: Mr X (surgeons are called Mr not Dr) works for the NHS Monday to Wednesday. On Thursday and Friday he works privately. If the operations cannot be done Monday to Wednesday he kindly offers to do it during his private time (for a large fee of course). It gets even better because the private operations are performed in NHS hospitals with NHS nurses assisting all at no cost to the surgeon.

It costs half a million to a million for the NHS to train a surgeon. But somehow we don’t mind when they take all this largess and do private work. My politician told me about one very industrious surgeon who flies through dozens of operations a week. Needless to say his colleagues hate him as he makes them look bad.

When you see a consultant he can tell you it will be six months till you get your operation. But if you are happy to go private, does next Tuesday suit you?

There are two ways we can look at this:

  1. NHS surgeons should be full time on NHS work, not creaming off the private work. If they go private they should be expected to repay their training costs.
  2. We embrace the market. Surgeons get no salary. They become private contractors and are paid a set fee per operation. This will encourage them to do more operations and clear the backlog.

Can I say my own experience with the NHS has been excellent. I fractured my ankle last year and my treatment was superb. Likewise I have been in and out of hospitals with relatives and the treatment they got was generally excellent. Some doctors and surgeons are greedy sods but most of them are hard-working and committed to the aims of the NHS.

But it is clear there are flaws in the system. The health service is a massive beast that sucks in a huge amount of public money. It is extremely good at deflecting attention from itself (the photos of sick babies and old ladies are wheeled out any time anyone asks awkward questions). But with an ageing population that will see more pressure on the health service, we need to be asking how we can improve the system for the good of all.

We are keen to hear the views of people in the heath service. Share your opinions in the comments below or if you want to write a post (you can do it anonymously) for slugger email brian@sluggerotoole.com 

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  • David Crookes

    Tremendous post, Brian, thanks very much.

  • Korhomme

    I have both worked in the NHS and been treated by the NHS.

    Some consultants are employed on a part-time basis, those who are on such contracts are often ‘maximal part-time’—they give up around 2 ‘sessions’ per week (and their pay is correspondingly reduced), but are still required to give almost all their time to the NHS. The origins of this arrangement go back to before the NHS started. Then, consultants in hospitals like the BCH or RVH were in ‘honorary’ positions—they weren’t paid at all. They worked one or two days for free for the honour—and to make a name for themselves. They made their money entirely from private practice.

    Consultants feared that when the NHS started they would become employees, and therefore under contract to do whatever the administration required of them—there would be no ‘professional freedom’. And it was a socialist government in power when the NHS was created, and many consultants weren’t left-wing. There is always tension between professionals and their managers; the managers want something done, and don’t like it when the professionals tell them it can’t be done/it will cost/whatever.

    In a similar way, GPs are not employees of the NHS, but are self-employed and under contract to the NHS.

    There may have been legal aid, but the lawyers that you might consult aren’t employees of the state, and they would fiercely resist a ‘National Legal Service’.

    The cost of training a doctor is irrelevant; students have to pay for their studies, and when they are ‘in training’ they are also working for the NHS.

    However, your points about how the NHS can waste money on your uncle are well recognise. Much of this falls at the feet of management and politicians who consistently won’t listen to what politicians tell them. Now, I cannot say whether any NHS consultant works privately for two days a week, but it seems unlikely. As far as getting heart surgery in Dublin (or even London) this again is managerial and political. In the past not that many people could afford private services in N Ireland; that they get treated privately today (but paid for by the NHS) is because of a lack of forethought and investment; sadly, longish term planning is not something at which the NHS is good.

  • hugh mccloy

    What you are saying here is exactly what Jim Wells was saying before DUP took health. There is an agenda here, break it down and sell it off

  • Brian O’Neill

    What difference does knowing his name make? You hear these stories from several sources. It is a general rule across all our public sector that very few ever go on the record. The core question in all this is if a surgeon can treat you privately within a few weeks why does it take months for the same surgeon to treat you on the NHS?

  • Eamon Hanna

    Very good post and sympathy to the relative. I met a
    prominent media-friendly medic recently (he knows my SDLP politics) and he said
    pointedly “politicians should be kept away from the NHS”. Nonsense:
    it was a (magnificent) politician, Aneurin Bevan, who set up the NHS and even
    he couldn’t quite overcome the doctors’ trade union, the BMA, so he
    “stuffed their mouths with gold”.
    As John Hume used to say about the late Sir Charles Brett, first
    chairman of the International Fund for Ireland, who said that politicians
    shouldn’t even express an opinion on its operations, “does he know that
    politicians (mainly Hume) thought the whole idea up?”

    I know of reliable stories of people waiting for an
    operation with Mr. X, the surgeon, and it’ll be 9 months but if you “go
    private” he can see you next week. Same surgeon, same facilities, just
    a rip-off.

    Doctors are just as susceptible to venality, corruption and
    abuse of their special position (admittedly obtained very often through high
    intellect, long training and hard work)
    as any other occupational group.They also deserve to be very well paid,
    though the multiple of the average UK doctor’s annual wage (approximately four
    times the average UK wage) is way out of kilter with the EU average.

    Legal aid per capita in NI are the highest in the world. in
    the Republic last week there was a report saying that legal costs on insurance
    claims were the highest in the world and one of the parting shots from the OECD
    when the Republic exited the bailout was “sort out the costs of your
    medical and legal professions”.

    As a social democrat, I got a bit of a jolt recently from a
    reported remark from Bill Gates that “I don’t like paying taxes”.
    Since the man has given away billions, I don’t think that betokens a reluctance
    to part with money. Also, this is a guy
    who doesn’t like inherited wealth [“like choosing the 2002 US Olympic team from
    the children of the guys who won the gold medals for the US in 1972”].

    Maybe he was expressing the idea that, in some cases,
    spending resources rather than taking it out of the broad board of public
    taxation could be a better way of obtaining value for money? Getting good value
    for money is one of the hallmarks of excellent public services

    Last words of hope from Carmel Hanna, my wife and former MLA
    and SDLP Health spokesperson, and a
    woman of robust common sense , “the
    most socialist initiative a democratic government has ever undertaken
    (setting up the NHS) has also been the most enduringly popular”.

  • Brian O’Neill

    Thank you for taking the time to comment. ‘The cost of training a doctor is irrelevant’, with many doctors jetting off to Austrialia etc I think it is fair to bring up the question http://www.telegraph.co.uk/health/healthnews/10995371/Thousands-of-doctors-planning-to-leave-NHS-to-work-abroad.html

  • T.E.Lawrence

    I fully understand yours and patients frustrations Brian but you state “2. We embrace the market. Surgeons get no salary. They become private contractors and are paid a set fee per operation this will encourage them to do more operations and clear the backlog” It could also encourage them to clear off to other countries to perform operations to the highest bidders. Then we would have created a bigger shortage of surgeons ?

  • Brian O’Neill

    I am not saying I favour that option. I was just pointing out that we have this weird private/public hybrid system at the moment why not make it one or the other? There is nothing stopping doctors and surgeons going abroad at the moment, in fact a lot of them are: http://www.telegraph.co.uk/health/healthnews/10995371/Thousands-of-doctors-planning-to-leave-NHS-to-work-abroad.html

  • Zig70

    Gp’s who make few decisions without referral and get paid more than directors of multinational corps. Docs that work part time on near full pay and the worse is using NHS facilities for free on NHS time. The very worst thing is that market forces would see these leeches team up with the insurance industry to rip us off doubly.

  • hugh mccloy

    It is fair enough to bring it up, though how many jet off because they cannot get work here, I know of 2 straight away. That is the problem of some of the cuts it cut doctor training posts so home grown have to go elsewhere to get trained and dont come back as there is no solid future here for them other than locum work

  • Korhomme

    I had seen that article in the Torygraph. Two major points:

    Firstly, many people are trained at government expense. It’s said that the best training for a tax advisor is to work for HMRC, get the training and expertise, and then leave and go into the private sector (I don’t know if this is true, but it’s certainly understandable).

    Secondly, and following on: why are doctors and nurses a special case? They work during their training (and yes, they get paid to work); what is wrong with an individual trying to make the best for him/herself? The impression that this argument gives is that somehow medics and nurses have a ‘moral duty’ to remain in the NHS and support it. In the past, it was certainly true that many such staff worked very long hours for either no pay, or pay at say one-half or one=third of their basic rate. (Not time-and-a-half, half-pay for overtime.) Who else do you know that did that? Admittedly, things are different today; hours are regulated through the EC, though overtime is often ‘expected’. Further, in the past what could be done out of hours was quite limited; today, so much more is possible; working at night no longer means that it’s possible for the docs to sleep through it—indeed, many Trusts have removed doctors’ rest rooms, saying that as they are always working, such rest rooms are unnecessary.

    And following that: yes many people are emigrating. And why? Well, apart from the climate (and no body surely says that the climate is better in N Ireland than Australia), surely it is the work/life balance. Not just the pay, but the ability to have a life outside medicine—this wasn’t so easy in the past: do you work to live, to live to work?

    If I had my time again, I’d seriously consider emigration. I would have funded my training through course fees and taxation; why should I feel any obligation to remain, to prop up a service which is failing in so many ways, and in which there is now so many levels of management that they can’t see the wood for the trees, and certainly can’t see what future needs there will be.

  • Brian O’Neill

    fair points well made. I suppose the question we need to ask is why are so many medical staff leaving the profession and what can we do to make their jobs better.

  • Korhomme

    Thank you, Brian.

    I worked, firstly, for a Trust where the management listened to the staff, and worked with them. But, this Trust was amalgamated with another with an entirely different culture—command and control. I was then told what I was expected to do, and that if I didn’t like it, I could leave.

    I think that many problems in the NHS are related to managerial culture. Command and control may be the way that officers work with squaddies, but it won’t work with professionals. Managers need to recognise that professionals are experts in their field, and to listen to them. Equally, professionals need to recognise that management in the NHS have an almost impossible task, applying very limited resources to very large problems, and trying to get the most treatment/care for the most.

    It’s about changing the culture, recognising the strengths and weaknesses of others; talking and communicating, and building trust. And until managers, civil servants and politicians are big enough to see this, there will always be problems.

  • barnshee

    “It’s said that the best training for a tax advisor is to work for HMRC, get the training and expertise, and then leave and go into the private sector (I don’t know if this is true, but it’s certainly understandable).”

    Hmm– partly true If you want to use one – make sure they are ALSO formally qualified accountants (ACA or ACCA) otherwise don`t risk it— there are a lot of useless arses poiishing seats in HMRC

  • barnshee

    1 Charge the consultants FULL costs for the services,buildings and equipment used
    2 Treat consultants the way subcontractors are treated elsewhere– subtract tax from their earnings and forward it to HMRC

  • chrisjones2

    ..buying populism with other peoples money is very easy

  • chrisjones2

    Great…anjd when they leave what do you do? Some trusts have paid fortunes to agencies for locums as they cannot recruit staff

  • chrisjones2

    Yeah…why don’t we lock them all up in Medical Gulags where they will work on bread and water

  • chrisjones2

    Same surgeon, same facilities, just a rip-off.

    Not a rip off. Real life.

  • chrisjones2

    there are a lot of useless arses poiishing seats in HMRC …while the good ones go private

  • chrisjones2

    I am sorry but if we cut off the doctors and lawyers where will all the children of Stoops go to work? There are only so many farms left and they cannot tale them all

  • chrisjones2

    Because she / hes only part of a much bigger system …one cog in the wheel. If there is no NHS bed for you or theater space or Nurse etc etc you have to wait

  • Brian O’Neill

    Send me an email please korhomme to brian@sluggerotoole.com

  • Eamon Hanna

    Don’t be a fool, try to engage with serious points,

  • Eamon Hanna

    If it’s real life market principles, that can work both ways. There is one medical school in NI, at QUB, and entrance requirements are stratospheric: I know of a caring and empathetic young woman who got 10 A*s, 4 As at A level (perfect academic record), “failed” the aptitude test and didn’t get in. Also, there’s some evidence that QUB has a preference for ‘relevant’ graduates with a non-medical degree, in subjects like chemistry, who can then do a shortened four year course. That is broadly the situation in the US and QUB may want to emulate it. It’s highly likely that a student who got 2 As and a B at A level or even an A and 2 Bs could make just as good a doctor as the “perfect” stellar student. After all, the ‘Economist’ published a report into German medical education which assessed the position after several years of education. The former West German system relied solely on academic performance and the former (communist) East German system took other ‘softer’ attributes into account. Surprise, surprise, the docs from the East were found, if anything, to be better because of those ‘soft skills’.
    A few years ago the Ulster University was proposing a medical school for Derry. Whatever happened to that? If there’s a shortage of doctors, we just have to train more doctors, though I acknowledge that is a longer term solution. An undergraduate medical education is very expensive-£50k++ a year-and dentistry is even more expensive. It’s not unreasonable to expect medics who get a Rolls Royce education to have to enter into a contract to commit to a number of years to the NHS, at decent terms and conditions, of course. The EU Working Time Directive has already enforced a lot of external changes to doctors’ hours.
    Another thing I would suggest is that politicians have to, on the basis of their democratic mandate, assert the rights of the public interest over the Royal Colleges (physicians, surgeons, anaesthetists, obstetrics and gynaecology, etc) over post graduate medical education and training. At the present, the Royal Colleges can, in certain circumstances, have more power than a Health Minister by refusing or withdrawing accreditation to an acute hospital to the point where than hospital has to close down. That has happened in NI and a lot of people believe, rightly or wrongly, that some hospitals have closed down because medics are reluctant to move out of Belfast. As GBS said, all professions are a conspiracy against the laity (the general public) and they’ll all scream and get pompous about professional independence and integrity but it heart a lot of it is about denying the legitimate rights of the public interest. Same applies to lawyers, accountants and other professional beneficiaries of the public purse
    Three last points.
    1. Cuba, which is an unsavoury place in many ways, and I would not want to live there (but I would like some of their sun). has health outcomes which are only slightly worse than in NI. Yet, the cost of Cuba’s health service is, per capita, around one tenth of NI’s and they have doctors to spare to send all over the developing world. Why??????
    2. Think outside the box. I know another young woman who got 2 As and a B in chemistry at A level and didn’t get in to QUB. She went to Prague, is getting an excellent medical education and will soon be an EU-recognised doctor. Yes, it’s costing her family, but why is the overall cost so more here? Vested interests, I would suggest.
    3. I was talking the other night to an A+E surgeon who worked in Massachusetts General, one of the best hospitals in the world. In that state there is an acute hospital, with all services, for 100-150k of the population. Here, the rule of thumb is one for 250,000 of the population, which implies 7-8 acute hospitals. There could be more, the rule of thumb is not sacrosanct.

  • barnshee

    “when they leave what do you do”

    And where will they go?– home and sit in the garden?

    The NHS provides all the resources and equipment that they need and use. Call their bluff.If they are so confident– let them fund build and staff their own hospitals and charge for their services

    And when they arrive back looking for work -tell them the rules of the game have changed.

    “as they cannot recruit staff”

    The medical schools each year turn away 1000’s of qualified candidates Support actions like these

    http://www.bbc.co.uk/news/education-30711724
    and in a relative few years the supply of medics will be resolved

  • aber1991

    “Last words of hope from Carmel Hanna, my wife and former MLA
    and SDLP Health spokesperson, and a woman of robust common sense”

    Obviously a man who does not want to do his own cooking – totally under his wife’s thumb.

  • Eamon Hanna

    Guilty as charged, M’Lud. In mitigation I would add that I have been an excellent sous-chef in our two person domestic team for over four decades.

  • aber1991

    If she is a woman “of robust common sense”, why did she marry you?

  • Eamon Hanna

    Been wondering about that for many years. Think it was my good looks.

  • aber1991

    Have you never asked her? Perhaps you did and she explained that she was drunk – or desperate – or both! Still, you managed to get a wife. I never did. I was so handsome there were hordes of young women lusting after my body and I just could not decide which to take. Moreover, if I had selected one of them, all the others would have been broken hearted. I was too kind to do that.

    Like yourself, I have always been a very modest man.