NHS pays for private surgery cash errors

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MOONLIGHTING surgeons who make extra cash by treating their own private patients in NHS hospitals could have been costing the health service hundreds of thousands of pounds because they have not been following strict rules.

An internal audit by NHS Lothian also found that foreign patients who are not entitled to free NHS care could have potentially been treated without being charged because some were given free treatment without the proper checks, while on other occasions staff did not realise they were liable for payment until they were sent home from hospitals, making payment harder to recover.

The health board admitted that it did not know how long the sloppy practices had been common for, but it is believed that they could have been ongoing for a number of years.

The audit into practices surrounding private and overseas patients, which was carried out in March this year, has only been made public under Freedom of Information legislation.

The health board said it had accepted the findings of the audit team and that it was working hard to implement its recommendations, and emphasised that consultants’ private patients had not been treated before NHS patients.

Scottish Conservative deputy leader and health spokesperson Jackson Carlaw said: “It’s shocking to discover what has gone on within NHS Lothian, a health board that hasn’t been without its problems. Allowing foreign patients to have expensive treatment before vanishing overseas is not responsible use of funds, and undermines savings made in other areas.”

Lothians Labour MSP Sarah Boyack said: “It is unacceptable that there has been a breakdown in monitoring the private work done by NHS surgeons. These rules are there for good reason.”

Surgeons who treat private patients in NHS hospitals, despite often earning six-figure salaries from the health service, are required to seek the approval of bosses and usually run their own clinics at evenings or weekends.

A private patient officer is employed by the health board to ensure costs relating to surgeons’ own private patients and overseas patients are recovered.

But the audit found that the private patient officer had only been told about 55 per cent of private cases before patients were treated, and that “undertaking to pay documents” – which private patients should complete to ensure they can cover costs – were signed in only 45 per cent of cases.

Surgeons who carry out private work are also supposed to tell clinical management teams about private patients so that the health board can recover costs from consultants for NHS session time which they spend preparing medical, insurance or legal reports for private cases, and so they can approve private work in advance.

But 20 per cent of consultants who were known to carry out private work made no mention of it on their job plans and the auditors also found that the clinical management teams were only told about 39 per cent of private cases.

The clinical management team is also duty-bound to check consultants carrying out private work have appropriate clinical negligence insurance, but no evidence was found that checks were ever made.

In 20 per cent of cases where overseas patients received free treatment, they were accepted despite them not having a full set of documents.

In 2010-11, NHS Lothian received around £1.5 million from private work, not including IVF treatment, and a further £357,000 from overseas patients.

But further private work may have been carried out but not been charged for.

The auditors found one overseas patient at the Western General whose liability to pay and previous treatment at the Royal Infirmary had not been identified on records.

Susan Goldsmith, NHS Lothian’s director of finance, said: “Internal audits of this nature are designed to look at potential risks and create control measures that deal with these risks before they arise, and ensure that our systems are as good as they possibly can be.”