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NHS waiting times grow while surgeons work for the rich

NHS surgeons are moonlighting in the private sector while waiting times to see them grow ever longer, new evidence suggests.

Dr John Yates, former adviser to the Department of Health on waiting lists, claims that many NHS surgeons are spending more time each week on their private work than national guidance permits, while health service managers, ministers and the medical profession turn a blind eye. He has called on the government to gather detailed evidence on the working practices of NHS surgeons and to clarify guidance on what is acceptable.

Dr Yates, from the health services management centre at Birmingham University, points out that the amount of private work is greatest in those specialties in which NHS waiting times are the longest. While private sector waiting times are measured in days, NHS waits are likely to be weeks or months.

NHS consultants on “maximum part-time” contracts are allowed to spend one session (a half day) in private practice each week, under guidance established by Sir Duncan Nichol when he was NHS chief executive. John Yates calculates that a conservative estimate for the average amount of time an NHS surgeon spends operating in the private sector is 2.3 hours per week, with anaesthetists spending an average of 4.5 hours per week.

But the total amount of time doing private work is likely to be much greater than this for many surgeons, when time spent on pre and post-operative care and seeing patients in private rooms is taken into account. A telephone survey carried out by Dr Yates’ research team, posing as private patients, showed that many NHS surgeons working in orthopaedics and ophthalmology spend two or more sessions per week seeing patients in their rooms (see chart below).

The average waiting time to see these surgeons in the private sector is only two weeks. At the same time, average NHS waiting times for an outpatient appointment have risen from 16 weeks in 1984 to 25 weeks in 1994 in orthopaedics, and from 15 weeks to 19 weeks in ophthalmology. In 9 per cent of NHS clinics, the waiting time just for an outpatient appointment is over one year.

While around 10 per cent of the population are privately insured, about 20 per cent of all elective surgery is done in the private sector. For hip replacement, over one quarter of all operations are done privately.

‘Payment not only ensures faster treatment, but more treatment’, said Dr Yates. ‘Those who can afford to pay simply get treated at a higher rate than those who cannot afford to pay.’

Dr Yates wants to see a thorough review of the relationship between NHS and private work, and ‘an explanation of why ministers, department officials, NHS managers and auditors have been so reluctant to address this issue’.

Labour have also demanded that the health secretary, Virginia Bottomley, investigate his evidence to ensure that NHS patients are not being disadvantaged.

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