NHS privatisation exposed: Scale of treatment for paying patients at NHS hospitals revealed

An investigation by The Independent has exposed the extent of creeping NHS privatisation, leaving experts warning that state patients risk being sidelined as beds are diverted to private users.

Data obtained under Freedom of Information law shows income from private patients at one of London’s best-known cancer-specialist hospitals doubled in six years as the law was changed to allow NHS trusts to do more paid work.

Statistics quietly released by the Government show the situation is not isolated, with the total amount of income NHS England made from private patients leaping by a third between 2011-12 and 2016-17.

There is now growing concern that the NHS is involved in far more private work than previously thought, as much of it is masked from official records by complex operating arrangements with big private-sector health corporations which cream off profits.

It comes as Theresa May prepares for a party conference at which she is vowing to tackle the excesses of capitalism, with Jeremy Corbyn threatening to ride to power on the back of a major public backlash against the private sector.

Prior to the 2012 Health and Social Care Act, passed by the Conservative-Lib Dem coalition, hospitals were only allowed to make 2 per cent of their income from private sources, but with the legislation’s passing the cap was lifted to 49 per cent.

Five years on, The Independent has probed hospital trusts running different operating models for private work, in an attempt to uncover how things have changed.

According to the publicly available accounts of the Royal Marsden in London, a world-leading centre for cancer, the hospital’s income from private patients was £44.7m in 2010/11, about 25 per cent of its total funding.

By 2016/17, private income had risen by 105 per cent to £91.9m, making up nearly a third, some 31.4 per cent, of its total funds.

In response to a Freedom of Information request, the Royal Marsden said it treated 2,451 patients privately in 2016, up 30.2 per cent on 2010. The number of NHS patients being treated also rose, but by just 17.2 per cent.

Asked how many wards were for private patients, the Marsden said it operated “an integrated model of NHS and private care and regularly utilises beds that have been earmarked as private for NHS patients or NHS for private patients based on clinical need or at times when capacity is strained”.

In a statement, the Marsden said it was “first and foremost an NHS organisation”, but said many other trusts were “part-privatised”.

It went on: “We have seen growth both in our NHS and private care referrals and patient flows over recent years.

“The integrated model at The Royal Marsden allows us to reinvest all of the income from private care into the hospital.

“Many other NHS trusts use a private company (part-privatisation) to run their private services and this company will share in the profits. This is not the model the Royal Marsden operates.”

The trust said its “combined model” allowed it to control how services are run and how all of the income is used.

The website for the Christie NHS Trust in Manchester, where the Conservatives are gathering for their conference, has one page entitled “Private Options”, which says: “We offer a comprehensive service for private patients through the Christie Clinic, our bespoke private facility in the grounds of the Christie Hospital.

“Private patients from the UK or abroad can choose to see a colorectal surgeon at the Christie Colorectal and Peritoneal Oncology [cancer] Centre.”

Yet, in response to an FOI request by The Independent, the Christie Trust reported it had not made any money from treating private patients for cancer in the past six years.

The Christie Trust said it “does not treat private patients, self-paying or insured”. “This is the responsibility of the Christie Clinic LLP – a joint venture with the Christie Foundation Trust and Health Care America [HCA Healthcare],” it explained.

Deborah Harrington, of think tank Public Matters, said the speed of the growth of private treatment in some hospitals was “staggering”.

She went on: “One extremely worrying aspect of this situation is the lack of transparency in the way this private income is raised: the Royal Marsden says openly that it treats NHS and private patients from the same facilities, but the Christie runs a joint private company with HCA, and Guy’s [and St Thomas’ NHS Foundation Trust] rents out half its own newly built facilities to the same company, which declares in its advertising that the Guy’s site is part of its ‘campus’.

“We are seeing a blurring of the boundaries between the NHS and these US healthcare subsidiaries.”

Ms Harrington said the new system was effectively the end of the NHS created nearly 70 years ago, in favour of a “two-tier system” with profits gained from NHS-funded facilities going to US companies and “private patients – some UK nationals, some rich foreigners looking for world-class facilities – using the services that should be provided for each and every one of us by the NHS”.

She added: “With staff shortages across the board and increasing NHS waiting lists, there can be no doubt that using NHS resources for private patients is putting the squeeze on NHS services.”

Ms Harrington also said “lives may be put at risk” by the changes, adding that Public Matters was currently looking for evidence that someone had lost their life.

Professor Allyson Pollock, director of Newcastle University’s Institute of Health and Society, said the change in the law during the Coalition years has paved the way for the part-privatisation of the health service.

She said: “It’s not a surprise to see foundation trusts with niche specialities like cancer or cardiac [care] are turning to private patients.

“The problem is formerly these hospitals were almost 100 per cent public. Up to 49 per cent of the capacity – doctors, nurses and beds – can be diverted to private patients. In London … some of these patients will be very wealthy, medical tourists.

“The NHS is being squeezed and inevitably there will be a diversion of funds [from ordinary NHS patients to private ones]. We are losing our NHS. We will lose our NHS unless the Government stops commercial contracting and stops foundation trusts from bringing in private patients.”

She claimed the transformation would be “catastrophic for public healthcare” in the UK and warned that the public are slowly being forced into adopting the American model of healthcare.

According to official figures slipped out quietly by the Government, the NHS in England made nearly £584m from private patients in 2016/17, up nearly 29 per cent from £454m in 2011/12, when the Health and Social Care Act enabled foundation trusts to earn 49 per cent of their income from private sources.

Many of the private patients are being treated by doctors who work for the NHS and are using NHS beds. Several trusts said their cancer wards were used by both private and ordinary NHS patients.

Dr David Wrigley, a GP in Carnforth, north Lancashire, said he knew from personal experience how “fiendishly difficult it can be to get one of my seriously unwell patients admitted to an NHS hospital”.

And, in an article for The Independent, he added: “The fact private patients can jump the queue for treatment flies in the face of the founding ethos of the NHS – that all patients are seen as equal and treated according to need and not the ability to pay.”

Jonathan Ashworth, Labour’s Shadow Health Secretary, said: “The Tories’ 2012 Health and Social Care Act pushed the door wide open for much greater private involvement in the NHS, despite strong opposition from Labour, patients and the public.

“There is a real concern about the capacity of NHS hospitals when so much time is being spent on private patients, particularly with the Tory funding squeeze in the NHS now forcing hospitals to look at outside revenue streams.”

A Department of Health spokesperson said: “NHS hospitals have always been able to generate additional income to improve the services NHS patients receive, but income from private patients has remained at the same low rate over the last five years – and remains well below 1 per cent of trusts’ income.

“Where private patients are treated in the NHS there are safeguards in place to make sure services are not affected and all profits are reinvested into frontline patient care. The public can be absolutely assured that we’re fully committed to a world-class NHS that is free at the point of use.”