Dr Phil Hammond column

"Is that you, doctor?"

"Yes, I'm over here."

"Sorry about the pot plant."

"Never mind. Now, Mr, um ... er, how are the cataracts?"

"Honestly, doctor, they're so bad now that I can't read, I can't watch the telly and I keep scalding myself with the kettle. Last week, I fell down the stairs and stayed on the floor for two whole days."

"Well, I'm sorry about that, but as I told you a couple of years ago, the waiting list for cataracts is horrendously long and there is really nothing I can do about it. This is the NHS, after all."

"I thought you had to treat me within 18 months."

"Whatever gave you that idea?"

"The Patient's Charter."

"Ha, ha, ha, ha, ha, ha, ha."

"Are you alright, doctor?"

"I'm sorry. I just came over a bit light-headed. No, the Patient's Charter was the last lot's idea. They got waiting lists down for a little while but when they realised they weren't going to be re-elected, they gave up, fed the NHS to the market and bingo, we've just had the largest rise ever with 1.2 million waiting for treatment."

"So how much longer will I have to wait?"

"Let's have a look at the list ... only another 18 months."

"Oh, dear."

"Quite. Of course, you could have it done tomorrow if you pay for it."

"But I'm not a rich man, doctor. All I've got is my nest egg and I was hoping to visit my son in Australia."

"There is no point going all that way if you can't see him."

"I suppose you're right."

"And let's face it. What's a nest egg for if not to give you the marvellous gift of sight?"

"Yes, but I don't like private hospitals. They're full of dippy nurses and there is no one to save you if something goes wrong."

"You don't have to go to a private hospital. You can be treated right here in an NHS hospital by the same surgeon using the same equipment as you would be if you went for free, only it's a thousand times quicker if you pay."

"What about if I saw another consultant on the NHS?"

"You could do - there are four full-time eye surgeons in this hospital - but they've all got horrendous waiting lists."

"How much time do you actually spend operating on NHS patients?"

"Four hours a week."

"That's outrageous."

"No, it's normal. The Audit Commission found that the average full-time NHS surgeon does between three and six hours at the table."

"So we pay taxes to employ loads of full-time surgeons."

"More than ever before."

"So they can operate on us for half a day a week?"

"Precisely. It's an odd system but there is nothing I can do about it. The managers won't give me any more operating time because there isn't the money to pay for it."

"So why not halve the number of surgeons and use the money saved on salaries to buy extra theatre time and eliminate waiting lists?"

"I think you'll find you're over-simplifying things."

"Who controls the waiting lists - the managers or the doctors?"

"We do. That way, we can ensure patients are treated according to clinical need."

"And you can ensure the lists are kept nice and long so patients are coerced into going private?"

"I don't like your tone."

"But you do like private work?"

"Look, I've sacrificed my marriage and my liver to become a consultant in this bloody hospital. Do you honestly expect me to survive on pounds 50,000 a year?"

"I suppose not."

"So you'll go private?"

"Well..."

"Splendid. So that's pounds 1,200 for the op, pounds 1,000 for the room, pounds 600 for the dressings and a deposit of pounds 50 for the bananas."

"Thank you, doctor, for all you've done."