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One in six hospitals expands private care

‘Self-funding’ is private care in all but name, says the King’s Fund

Louise Prime

Wednesday, 17 July 2013

A sixth of hospitals in England have this year introduced new private funding options, a BMJ investigation has revealed. The report, published online today on bmj.com, found that an increasing number now offer the ‘self-funding’ option, which is much cheaper than usual private care but, say commentators, simply a euphemism for the same thing.

As some NHS services – such as in vitro fertilisation, cataract surgery and hernia repair –have become increasingly difficult to fund on the NHS, and waiting lists for these procedures have lengthened, some hospitals have brought in new private treatment options, the BMJ discovered. One of these is ‘self-funding’, whereby patients are offered treatment at cheaper rates than those in the private sector.

But critics warn that because self-funding patients are being treated on NHS premises, the schemes could disadvantage NHS patients by taking up NHS places, and could even lead to an inferior service.

The BMJ reported that of the 134 acute hospital trusts in England that it questioned, 119 (89%) now offer traditional private care or ‘self-funded’ services; 21 (16%) added new self-funding or private treatment options for 2013-14; and 17 (13%) now allow patients to pay for one or more services at notional NHS rates, under the self-funding scheme.

Providers claim that self-funding schemes “allowed patients to access restricted treatments at a cheaper rate than in the private sector, making care more accessible”, and are fair because patients are treated exactly the same as NHS patients – and any income is ploughed back into the service.

But critics are concerned by the schemes’ potential impact. The King’s Fund’s chief economist John Appleby said: “It is essentially paying privately to get some healthcare provided by the NHS. It is a private scheme.”

He went on: “[If you] say you will provide it if your local commissioner has taken on some sort of rationing decision, such as they will only provide a certain number of cycles of IVF or they have age limits, then of course you are buying something extra, you are buying access to the service. You are also jumping a waiting list.”

He insisted that such schemes should be strictly governed and separated from NHS care, and that trusts operating them should be required to show that they do not adversely affect NHS patients.

The Foundation Trust Network’s regulatory policy consultant Frances Blunden told the BMJ that the schemes wouldn’t “necessarily” have a “significant impact” on NHS treatment. She said: “In most circumstances they [trusts] tend to run self funded and NHS alongside each other, so people don’t queue jump – which must be the great concern – and people who are self funding get the same structures around waiting lists and so on ... You would have to rely on the integrity of the organisations and that they are fully committed to the NHS and to providing good patient care.”

But David Hunter, professor of health policy and management at Durham University, remains concerned that self-funding schemes could lead to “a two-tier or multi-tier system which is both complicated and inequitable”, and even to commissioners focusing on the more lucrative procedures.

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