Review

Cut it out!

Private eye, heart amd hip: surgical consultants, the NHS and private medicine
John Yates
Churchill Livingstone, 1995, £14.95

We should give thanks that John Yates is as clear thinking, highly principled and plain stubborn as he has turned out to be. For without these qualities, he could not have so carefully assembled the jigsaw which he presents to us in this small but important book.

It is well known that, by tradition, NHS consultants are also allowed to undertake private practice, so long as that does not conflict with their main duty to the NHS. Remarkably, while this compromise was reached with the medical profession in 1945, it took until 1990 before the chief officer of the NHS gave any clear and explicit guidance on exactly how much private work during the working week this might be. Worse, as Yates shows, is that even with such formal guidance, nobody seems to know nor care how much private work is done by individual consultants, or whether this does conflict with their NHS work.

Yates documents wide variation in the amount of time individual consultants spend in the private sector, and, shockingly, an enormous degree of variation in consultants’ operation rates within the NHS. For example, he calculates that, for his sample of 30 consultant ophthalmologists, an average of 3.2 operations per consultant per week are carried out. While it is hard to believe that workload can be so low, the figure is not far from the Audit Commission’s estimate of 4.5 for the same specialty. Yates asks whether it is coincidence that specialties with the greatest amount of private practice also have the longest NHS waiting lists.

This is at heart a deeply moral book, concerned to expose and change the blatantly unequal access to health care which has been encouraged by the growth of private medicine. Let us hope Yates can prompt politicians to action.