Top surgeon: NHS services face ‘creeping privatisation’

Medic claims year-round bed crisis means patients are being turned away

ONE of Scotland’s top surgeons has warned of the creeping privatisation of the NHS as he claimed a year-round bed crisis means health boards are no longer able to treat patients in their local hospitals.

Colin Howie, president of the British Orthopaedic Association, said patients with pre-planned surgery were routinely being turned away due to a lack of capacity and increasingly being sent instead to private hospitals or the NHS-run Golden Jubilee national facility in Clydebank.

In a claim that was strongly rejected by the Scottish government, he said a process of health privatisation seen south of the Border was already under way in Scotland.

Mr Howie spoke out after it emerged more than 800 patients had pre-planned operations cancelled at short notice in the first six weeks of this year.

It also came as ministers unveiled plans to send more patients to the Golden Jubilee hospital.

“We no longer have a short winter bed crisis,” Mr Howie said. “Surgical cancellations happen throughout the year because of a lack of facility. It is a bed crisis.

“The use of private hospitals and the Golden Jubilee is becoming routine and significant for many mainland boards throughout Scotland because the system can’t cope with the pressure following bed reductions.”

The Scottish government said it could not give figures for the amount spent on sending cases to private hospitals in recent months but in 2013/14, fewer than 7,500 out of 1.5 million inpatient or day cases were treated externally.

However, Mr Howie said that in key specialities such as orthopaedics and urology the proportion was far higher.

The health service is said to be under far greater pressure than at the same time last year, and NHS Ayrshire and Arran said that 50 orthopaedic cases had been referred to a private hospital recently as a result of pressure over beds.

“Most private hospitals in Scotland have a substantial proportion of their work coming from the NHS at short notice,” Mr Howie said.

“Many patients travel from one city or town to another for surgery because of local capacity issues, patients from Aberdeen coming to Edinburgh; patients from Edinburgh going to Glasgow.”

While he backed standards at Golden Jubilee, Mr Howie said that specialist care should be on offer throughout the country.

Instead, he claimed patients were regularly turning up at their local hospital only to see their procedure cancelled, while several units have suspended planned admissions altogether.

He said some patients desperate for operations refused to leave hospitals or went straight to A&E to demand treatment after being told that their operation would not take place.

He added: “Each missed admission costs the health service double the amount of money necessary to deliver that item of care because of the missed opportunity and the cost of purchasing alternate care in the private sector. An unnecessary expenditure at a time of fiscal austerity.

“This is exactly what happened in England at the beginning of the privatisation of the health service. The process has started in Scotland.”

Health secretary Shona Robison said last week that the number of surgical beds had been cut as a result of a shift towards day surgery, which does not require overnight admission.

It was announced yesterday that an additional 300 joint replacements a year would be carried out at Golden Jubilee, at a cost of £1 million, taking to total number of procedures carried out annually at the national hospital to 4,500.

A spokeswoman for the Scottish government said: “This government has repeatedly stated our commitment to keeping the NHS in public hands, free at the point of use, as demonstrated by our action to bring Stracathro Hospital back into public hands.

“In 2013/14 over 1.5 million inpatients and day cases were seen by NHS Scotland – and fewer than half a per cent of these cases were treated in the private sector.

“In fact, Audit Scotland recently recognised that the spending in the private sector has reduced over the last year – falling by nearly £5 million .”

Colin Howie’s diagnosis is direct and disturbing. According to the president of the British Orthopaedic Association, the National Health Service in Scotland is a victim of the disease known as creeping privatisation. Bed shortages, he says, mean patients are increasingly being sent to private hospitals for their operations and that the problem is no longer one of the winter months only. There is not a winter bed crisis, says Mr Howie, there is a bed crisis full stop.

The evidence of the crisis has become clearer in recent weeks. Figures obtained by The Herald earlier this month showed almost 30 patients a day are now having their operations cancelled due to bed or staffing shortages and that the situation is getting worse. The figures showed that in Tayside alone, 88 operations had been put off since the start of the year, which is more than double the number of operations cancelled in the area over the whole of the 2013/14 financial year.

We also know that the pressure on Scotland’s hospitals is no longer confined to the winter months, with the figures for last summer showing that in July and August, 3,309 patients had to be looked after in the wrong department for their condition. Last July, 1,706 patients were also stuck in hospital even though they were well enough to be discharged.

The result of all this strain on the system, says Mr Howie, is that the use of private hospitals is becoming routine and significant for many health boards throughout Scotland. He has no issue with the standard of private care itself, but he says the use of private hospitals means patients are having to go away from their home areas to be treated and that such a situation is not sustainable or cost-effective. He also believes it is a symptom of a deeper problem with our national health service: the lack of beds when they are needed.

The use of private hospitals is nothing new of course, and, in principle, it should not be a threat to the fundamental tenets of the NHS in that patients at no point are being asked to pay for their operations. Whether private hospitals are used or not, the central, cherished idea of the service is that it is, and must forever be, free at the point of delivery and the Scottish Government’s re-iteration of its commitment to that principle is welcome.

However, the former health secretary Alex Neil said the use of private care should be a last resort rather than routine, but that is far from the case and the Scottish Government has not kept Mr Neil’s promise that it would be a temporary phenomenon. In fact, although the number of private operations is a very small percentage of the total, there is no sign of an end to the practice. Quite the opposite: it continues to be necessary because of the persistent beds crisis in the service – a crisis which is still a long way from being solved.

Until the Scottish Government tackles that crisis, the use of private hospitals is very likely to continue, and the crisis will not be solved until there is a clear strategy based on reliable evidence about where the National Health Service is not coping and why. When an operation is cancelled, it is often because the bed is being used by a patient for whom there is no available care in the community and that is caused by a lack of co-ordination between social care and care in hospital. Until the Scottish Government fixes that particular problem, the NHS’s reliance on private hospitals is likely to continue.