Unpopular Revolution

Commentary, Healthcare & Welfare, Frank Field

Up went the cry of “Over my dead body.” A recent front-page story in the Times that the government is planning to bulk-buy more private care for patients provoked the ritual negative response from the unreconstructed National Health Service lobby (NHS). Equally depressing was the government’s furtive approach; it should have been proudly trumpeting its plans and thinking more widely.

It simply is not true that buying in private care is a sell out of NHS principles, nor that it is a mere sticking plaster that cannot make much difference to waiting lists.

Five years ago a constituent who was going blind contacted me. It would be at least a year before an NHS consultant could see him, by which time his cataracts would have destroyed his sight. The same consultant could see him in a couple of weeks provided he came clutching £3,000 to pay for private treatment.

My constituent set me thinking. Where was the cheapest place in the world to have a cataract operation? The web divulged this secret: £50 in India at a hospital with an international reputation. I immediately suggested to the government that they use some of the millions pouring into the service to establish NHS International, which would allow patients on waiting lists in Britain to go abroad if they so wished. The bill for flying out a patient, with a partner, putting them up in a local hotel, and paying the hospital, would be a fraction of NHS costs.

But the government was reluctant to act at first. Ministers said the NHS International idea was absurd. Who had ever heard of sick people going abroad for operations? But most people in hospital are not so sick or frail that they cannot travel; rather hospitals are bulging with people in great pain waiting for hip replacements. Or, like my constituent, going blind.

I followed up with a trip to France to see which hospitals would be interested in taking NHS patients. My first difficulty was that the French hospital administrators could not comprehend the term “waiting list”. Operations can be delivered within a matter of days of a referral. France and other European countries have a surplus of operating teams. I discovered that they would be interested in coming here to work in the NHS.

The story soon came full circle. I visited a mobile cataract operating theatre in my constituency run by a South African company for the NHS. It took six weeks for the local trust to reply to the letter I had written on behalf of my constituent and inform me he would have to wait 65 weeks. Now, thanks to this mobile team, my constituents can be referred from their opticians to the hospital and have the operation in half the time it took the trust to respond.

The government must follow up on this success with three other reforms. Since the length of waiting lists varies from consultant to consultant within a hospital as well as between hospitals, the government should establish a website, let’s call it easy.op.com, detailing information on the length of each waiting list. Patients would be able to access it themselves and choose to join the shortest queue.

Secondly, some of the new funds being pumped into the NHS should be earmarked to bring more foreign teams into this country. It would be efficient spending because, like the South African team in Birkenhead, they can provide operations more cheaply than the NHS. The aim must be to bring enough teams over here to ensure that waiting lists for day operations in the NHS are abolished before the next general election.

The third reform centres on opening up fully the European health market for NHS patients. At present any of us can complete an E112 form and have our NHS operation over the Channel. But the government does its best not to publicise this health passport. Instead of hiding the fact that NHS patients can go to Europe for treatment, the government should positively encourage it. It should spearhead a campaign advertising how NHS patients can access treatments in Europe.

The reforms I advocate here could be put into operation immediately. They would also put patients in the driving seat. That is where they have to be if the government is to reform successfully what is Britain’s only loved nationalised industry.

This piece is based on a column first printed in the Financial Times, March 23rd, 2004.