Charging NHS patients in NHS hospitals for core treatments

“MYCHOICE” -is “No” Choice for most of us

Have you heard of “procedures of low clinical benefit”? Don’t worry you will be hearing a lot more about them if we don’t do something to stop the privatisation and remodelling of our NHS based on the American private insurance model.

In June 2019, NHS campaigners became aware of a scheme called “My Choice” on offer locally and in other selected pockets around the country. Our local scheme was at Warrington & Halton Hospitals NHS Foundation Trust (“WHHFT). Their definition of My Choice is:

My Choice is By the NHS, For the NHS

”The major benefit is access to outstanding NHS treatments at a fraction of the cost of those undertaken by private providers. The procedures available are extensive and include everything from hip and knee replacement to cataracts, tonsillectomy to breast augmentation.”

We have all heard of private hospitals and people “going private”.  Of people jumping the NHS queue” by paying privately. But this a new scheme altogether. A new and thoroughly terrifying development. This is asking patients to pay for operations which were previously done for free on the NHS and which are not available to them unless they pay, so its not just jumping the queue. They can’t have the operation at all unless they pay up.  In the past, if you had problems with your knee, your GP referred you to a specialist consultant who examined you and decided if you needed a new knee and if necessary put the wheels in motion to organise your operation to be done free by the NHS either in an NHS hospital or at times of high waiting lists sometimes the NHS paid private hospitals to do the operation.

Now, in 2019, after 10 years of successive Conservative/Liberal Democrat coalition and then Conservative governments, the definition of what is provided on the NHS has been changed and restricted. So that many operations are now defined as of “low clinical benefit” and are therefore no longer available on the NHS. 

This is the list of treatement of low clinical worth, recently published in the Guardian. Some trealtments do become outdated but this is not to do with outdated treatements but to do with rationing treatments to contain costs.

In My Choice there is a long price list which includes procedures for knee and hip replacements, cataracts and hernia operations among many others.

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My Choice from Warrington’s website
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If it hasn’t affected these procedures in your local area yet, its only a matter of time.  If your GP is really sure you need the operation, you can try arguing your case via an Individual Funding Request, where a board of medical and non-medical people decide if you are deserving enough.

For example, for hip and knee replacements doctors use a scoring system to assess how much discomfort and lack of mobility a patient has.

By increasing the bar at which a referral for an operation is made the NHS can help restrict the numbers getting treatment.

In the blurb for these schemes around the country, they repeatedly mention having to make “difficult decisions”. This is an oft heard Tory mantra since 2010 and the imposition of ideological austerity which apparently necessitates the poorest and most vulnerable having to be punished for the crimes of global bankers. The ordinary people in this country have taken this punishment for 9 years whilst bankers’ multi-million-pound bonuses have been restored, it doesn’t seem to me that is a fair settlement? 

Under cover of austerity the Tories and Lib Dems attacked public services including the NHS. They cut funding, undermined it, basically carried out the tried and tested Tory privatisation process. Despite living in the 5th richest economy in the world and despite the £billions of public money still being ploughed into the NHS, services have been cut, beds closed, A&E and maternity departments closed and huge debts racked up but there are more managers and accountants than ever producing figures and targets which are mostly missed and yet patients can’t get a GP appointment.

More and more services are being provided by private profiteers such as Virgincare and yet more services have been drastically culled, so are no longer provided by the NHS. They are NHS was meant to be universally available regardless of wealth and connections. It was now provided in a haphazard manner by a hotchpotch of third sector providers. Bevan’s supposed to take away the worry about getting sick and the reliance on philanthropy and charity. And yet in 2019, that is exactly where our NHS is regressing to, a time pre 1948, pre the creation of the NHS.

So now back to “My Choice”, could you afford to pay over £7000 for a new knee or a new hip? More if you need both hips or both knees done? Or over £1600 for a cataract operation? Oh, and don’t forget the £180 consultation fee!

WHHFT produced their prices for a long list of treatments. I don’t think anyone would argue that procedures purely for cosmetic reasons (without accompanying psychological symptoms or disfigurement) should be paid for from your own pocket, if that’s what a person chooses to spend their disposable income on that’s up to them. However, it’s another thing entirely to expect a person to find over £7000 for a new hip to keep them mobile. That’s what is happening already. We have already explained how breast reduction is not an unnecessary operation

When NHS campaigners wrote to the Liverpool Echo and to local MPs, they were outraged, and the story was also picked up by the Daily Mirror.

The hospital trust tried to defend its decision to impose charges and insisted patients would not jump the queue, that they would be added to NHS waiting lists, be seen by NHS staff in NHS wards and operated on in NHS theatres using “spare capacity”.

How often do the media headlines scream out that waiting lists are getting longer, targets are being missed, including cancer targets, people are waiting for scans, to see consultants, that there are 100,000 staff short in our NHS, that we are all somehow “abusing the NHS” by using it too much, that the population has increased and that the elderly are apparently a big cause of these problems due to  “bed blocking”?? And yet Warrington & Halton Hospital FT had “spare capacity”! Presumably there are no waiting list backlogs for surgery in Warrington and Halton hospitals and surgeons are sitting around twiddling their thumbs waiting for work?

Also, what ever happened to the ethical code for doctors and health professionals? The mantra of “first do no harm”. If a GP or consultant or CCG has decided your bad hip doesn’t need replacing because it would be of low clinical benefit to you, and therefore has decided you do not qualify to have it done on the NHS, why then does it suddenly become of sufficient clinical benefit if you pay for the operation yourself? Is this ethical? Either you need the operation in which case it should be done on the NHS according to need, or you don’t need it and therefore no self-respecting surgeon should be willing to do an unnecessary operation whether or not you are prepared to pay for it? 

After a few weeks of sustained pressure from NHS campaigners, setting up demonstrations outside the hospitals, handing out 5000 leaflets all over the Liverpool City Region at music festivals, parks, hospitals, NHS stalls etc and having hundreds of conversations with the public plus getting thousands of signatures on petitions, the Trust was forced to “pause” the My Choice scheme.

It was even discussed by Sir Simon Stevens, the head of NHS England and the architect of NHS privatisation imposing the US healthcare model on our NHS. He mentioned it in a parliamentary committee and said that the “marketing” of My Choice was Misguided”. Note he wasn’t saying the scheme should not have been put in place or that patients shouldn’t have to pay. Just that they got the “marketing” wrong. The reason for this is that Mel Pickup the CEO at Warrington was doing exactly what the Tory government and NHS England plan for all of us. She just didn’t bank on NHS campaigners cottoning on to the experiment. It will be un-“paused” at some point when they think the dust has settled. However,, Ms Pickup announced she was leaving the Trust and was also leaving her post as head of the Cheshire & Merseyside STP. Had she been successful in rolling this scheme out quietly in Warrington, it would soon have been rolled out across the whole of the STP footprint.

Why are some treatments not routinely offered by the NHS? There may be some cases where a treatment is not available because there is limited evidence for how well it works or because it is very high cost and doesn’t offer good value for money for taxpayers and the NHS. If there is a reason to change this recommendation then it goes to a panel for discussion

A fully funded NHS pays for itself in the health of the population and their capacity to continue to work and to care for others. It also contibutes to the general health and happiness of society, The Bevan model of universal health care, free at the point of need, paid for by general taxation,and publicly provided is the most cost efficient model of health care in the world.

The NHS is worth voting for.

Author: Mary Whitby NHS campaigner who first exposed the My Choice scandal

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