Should the NHS be allowed to sack doctors who work for the private sector ‘on the side’?

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Posted Sep 20 2016 by Dave Darby of
NHS or private healthcare?

There was a story on Radio 4 this morning about NHS doctors who work in private healthcare ‘on the side’ now having to declare their income from private work under plans from NHS England to ensure that they’re not short-changing taxpayers.

Great – but I’d take it further – if doctors want to work for the private sector, don’t let them work for the NHS. It’s not like there’s not enough work for them to do in the NHS, and doctors certainly earn enough – it’s just greed. Plus – in the private sector there’s a risk that greedy doctors might prescribe unnecessary drugs or treatment for profit rather than the benefit of the patient. As greed is the only reason to work in the private sector in the first place, then I suggest that this risk is high. Private healthcare drains the NHS of doctors and resources, and increases waiting times – and it also increases the hours that doctors work, when they’re already complaining that they’re overworked. But from the perspective of the private sector, it’s great, because they’re using NHS doctors, trained using taxpayers’ money, to create incentives for better-off patients to move to private care.

My partner is an NHS consultant – she told me that the private sector loves to employ NHS doctors, because private patients know that they’ve been subject to a high level of scrutiny.

There are two main arguments against preventing doctors who work in the private sector working for the NHS:

1. I / a friend / a family member was / were treated privately for a long-term condition that would have taken years on the NHS because of waiting lists. It reduced my / their suffering significantly; and

2. It takes away doctor’s freedom to do what they like. I’m a libertarian and people should mind their own business.

The first argument is easy to dismiss on grounds of selfishness. I / my loved ones are alright Jack – never mind that other people will have to wait even longer now, because resources were diverted away from the NHS to treat them.

The second argument seems to have some validity initially – but only initially. I tend towards the libertarian end of the spectrum myself, but the NHS is different – a matter of life and death, if you like. I’m not suggesting that we interfere with doctors’ freedom to work in the private sector if they want to – I’m just also suggesting that the NHS be free to terminate the employment of doctors who choose to do so. The choice to do private work should rest entirely with the individual doctor; but equally, the choice to not employ them again if they do so should rest entirely with the NHS.

It should be apparent even to diehard libertarians that the NHS is a good idea, because: a) if someone is at risk of death or chronic pain, in a civilised country, speed of treatment, or even whether they receive treatment at all, should depend on urgency not wealth – shouldn’t it? Free universal health care is the mark of a civilised country, isn’t it? By that measure, the US is by no stretch of the imagination a civilised country, which sounds about right; and b) it results in better healthcare for your buck (or quid). In the US, around 18% of GDP is spent on healthcare – twice as much as in the UK, but resulting in an inferior product.

Even most right-wingers in the UK support the NHS. I’ve never really understood the argument of the right in the US (apart from pure ideology) who denounce ‘Obamacare’ as a step towards free universal healthcare like the NHS. If only! What they’ve actually got is a scam to enrich insurance companies. In the US, unlike in the UK, patients can never be sure that a doctor is prescribing something for their benefit or for the benefit of his or her wallet. God knows what their reaction would be if a US National Health Service were seriously suggested. I don’t think that even the argument about better healthcare for less money would work – bizarre for such a money-conscious country.

There are things wrong with the NHS – it’s preyed on by drug reps; the ground floor of my partner’s hospital is dominated by Costa Coffee and vending machines selling Coke and Mars bars (what they’re doing in a place dedicated to health is beyond me), but it outperforms the US system every time, and it has no problems that can’t be solved by funding it properly.