NHS Lothian will rely on private hospitals to treat patients for at least the next two to three years, it has emerged.
While the health board is aiming to clear a waiting list backlog of 7200 patients by October, health chiefs say they will be forced to continue relying on the private sector to stop waiting lists immediately shooting back up.
Interim chief executive Tim Davison said NHS Lothian would have to invest in new staff and facilities in order to cope with the hundreds of thousands of new patients it sees each year.
Among the worst affected areas are general surgery, urology and head and neck operations, with pressure growing on local services thanks largely to the ageing population.
The extent of the reliance on private hospitals today raised concerns about the staff cuts carried out by the health board in recent months and warnings of “privatisation by the back door”.
There were also demands to look at the feasability of more evening and weekend operations in local hospitals in an effort to prevent so many patients being sent further afield.
The news came after NHS Lothian agreed to spend more than £10 million treating patients in private hospitals in a bid to clear its current waiting backlog. It will also bring private doctors in to its own hospitals to carry out operations.
Mr Davison: “If we turn off some of this too soon we will simply create another backlog. The scale, I hope, is a one-off but we will continue to require private sector capacity.
“I am no apologist for the use of the private sector but because of the massive backlog we need to clear and because our recurrent capacity is not sufficient, we will require some scale of private sector involvement for two to three years. There is a possibility it will be even longer.
“No health board has attempted to come out of this position before. We need a unique response.”
However, Dr Richard Williams, chairman of NHS Lothian’s local medical committee, raised concerns at a recent board meeting that the ongoing reliance on private providers could amount to “privatisation of the NHS by the back door”.
Dr Williams said: “I have to say I feel uncomfortable with this. I appreciate there’s a short-term crisis that needs to be addressed and we might need to use the private sector to bail us out, but it sounds like this is a plan for long-term reliance on the private sector.
“The preferred option must be NHS Lothian patients getting treatment from NHS Lothian staff. I want an assurance that we will revert back to normal practice once we get over this blip.”
The latest figures reveal that more than 7200 patients in the Lothians are waiting longer than they should for treatment.
Under the new arrangements, many will be contacted directly by the private hospitals, which could offer to pay for travel or hotels to encourage them to take up appointments.
Among the worst-hit are those waiting for general surgery and urology outpatient procedures, with a significant number waiting more than 12 weeks.
Of the patients waiting more than 12 weeks for inpatient operations, around 1000 are awaiting head and neck treatment and approximately 800 need general surgery.
NHS Lothian will investigate ways in which it can increase core capacity in coming years, and monthly progress reports will be given to its board. It is hoped that as its core capacity is increased, reliance on the private sector will decline.
Measures to improve internal capacity in the short-term will include hiring staff, increasing the use of theatre space, increasing bed space and drafting in locum staff from England to work in NHS Lothian hospitals.
As well as the agreements with private hospitals in Edinburgh and Glasgow, £3m will be spent sending more patients for treatment at the Golden Jubilee NHS hospital in Clydebank.
A private company, Medinet, has been drafted in to treat patients in NHS Lothian facilities when they would not otherwise be in use.
It is planned that the company will treat 700 patients by the beginning of August and will work predominantly on routine procedures, leaving NHS Lothian staff to focus on more serious treatment.
The health board has said an agreement has been put in place to prevent Medinet poaching NHS Lothian staff.
Tom Waterson, Lothian branch chairman for Unison, said the policy was based on “the economics of the madhouse”. He added: “NHS Lothian have known about their lack of capacity for a number of years.
“They should have been planning for this and increasing capacity.
“If we have money for the private sector, we should have money available for our own staff.
“We have theatres empty a lot of the time. We need to look at 24-hour full working within the NHS to give patients the treatment they deserve and the use of other NHS hospitals.”
Lothians Labour MSP Sarah Boyack said treating a significant number of patients in private hospitals was a “short-term sticking plaster” and called for a long-term resolution to the lack of capacity in Lothian.
She added: “This is the result of cuts in NHS Lothian staff and a lack of capacity to provide services to meet patient demand in key areas. The priority has to be to ensure that patients get access to the treatment they need within the waiting times they are legally entitled to.
“We need clear action so that investment can be made in the services which are most under pressure. We can’t wait another three years before this issue is fixed.”
Speaking at the health board meeting, George Walker, a non-executive board member, backed the waiting lists plan and the proposal that all hospitals within a 97-minute drive of central Edinburgh are classed as “reasonable” locations to send patients.
It means people who turn down treatment offers at hospitals within a 97-minute drive could be put to the back of waiting queues.
He said: “I think it’s an excellent plan and more importantly it’s an honest plan. It’s a very sensible and pragmatic way ahead.”
Free and available to all
The NHS was officially born on July 5, 1948, when healthcare professionals were brought together to deliver free treatment financed by taxation and available to all.
In 1952, prescription charges of one shilling were introduced.
The 1962 Hospital Plan set out the pattern for the future of the NHS, approving the development of district general hospitals.
Despite all this work, the 1980s Black Report concluded that the poor were still much more likely to die early than the rich.
In 1990, the NHS Community Care Act meant health authorities would manage their own budgets.
NHS Direct was launched in 1998 and has become one of the largest single e-health services in the world.
In January 2009, the NHS constitution was published, stating no-one should wait more than 18 weeks for treatment.
In April 2009, the Care Quality Commission was launched to help regulate the quality of services.
North and south divide
The differences between the NHS in Scotland and England were highlighted in a recent report by the National Audit Office.
The spending per person in Scotland is higher, at £2072, than in England, where it is £1900. England has 70 GPs per head of population, Scotland has 80.
The average taxable income of a GP in Scotland was, at the most recent count, £89,500, while the average in England was £109,400.
When it came to treatment, the report showed that the average length of hospital stay (in acute beds only) was 4.3 days in England and 5.7 days in Scotland.
In terms of emergency admissions treated, the number of emergency admissions per 100,000 people was 9994 in England and 9917 in Scotland.
Figures showed that for elective procedures (from referral), the England performance standard was 95 per cent of patients receive inpatient treatment within 18 weeks. In Scotland, the same target figure was 92 per cent.
‘Appalling decision’ to close
LIVINGSTON MP Graeme Morrice has slammed the “appalling decision” to close the children’s ward at St John’s Hospital for three weeks from Monday because of staff shortages.
In a letter to Health Secretary Nicola Sturgeon, Mr Morrice said his constituents would face huge disruption and blamed the SNP government for a lack of nurses and midwives.
The Labour member wrote: “People in West Lothian witnessed local SNP politicians lining up over recent months to claim that there was no threat to paediatric services at St John’s.
“I support the stance taken by West Lothian Council that any reduction of paediatric services at St John’s is completely unacceptable, even if only for a temporary period, and endorse the call by council leader John McGinty for you to step in and halt this temporary closure.
“I very much hope you will now demonstrate some decisive leadership on this vital issue and prevent any loss of paediatric services.”
Mr Morrice has written to NHS Lothian interim chief executive Tim Davison, urging him to rethink.
He said: “Given the great anger and dismay that the announcement has provoked, I urge you to take steps to find an alternative solution.”
Dr Dean Marshall
Dalkeith GP and chair of the BMA’s Scottish GP committee
THE NHS is too crisis-driven. Everything is done for the short term. We do not plan for the future.
A few years ago, NHS Lothian had a review of services – but basically it was cuts.
Prior to the building of the new Edinburgh Royal Infirmary, the BMA – and myself among them – told them it was too small and their plans were not robust. They ignored us.
Most patients probably don’t have a major issue with being treated at a private hospital unless they are being asked to travel outside the Lothians.
But the obvious question is: why do we have a lack of capacity?
The answer is that despite being told at the time that plans for the health service were not future-proofed, they went ahead any way.
It was so predictable, now it has happened.
Tim Davison is being very honest. But what is the plan for dealing with it?
We need a plan which has a medium and a long term.
We should be investing money in the NHS, not spending it on private hospitals.