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  • Posted September 20th, 2016

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

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

    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.

    The views expressed in our blog are those of the author and not necessarily lowimpact.org's


    • 1John Harrison September 21st, 2016

      A few points:

      Why assume consultants working privately detract from the NHS? Surely it’s like they’re working overtime but being paid directly? The NHS has no shortage of customers so not worried about competition. If people use private healthcare, it relieves pressure on the state service. Should we sack the cleaner with a second job?

      A friend of mine is a plastic surgeon – she does boobs, liposuction, facelifts etc privately in a clinic she part owns. Then she does a month each year un-paid working on burn & acid attack victims abroad. Should her partners sack her for moonlighting?

    • 2Dave Darby September 21st, 2016

      Good question. I had a think about it, and came up with the list below for starters. The NHS is underfunded, and is being slowly privatised. This isn’t accidental – the corporate sector and its neoliberal politicians are doing it deliberately. We need to be vigilant if we want to keep the NHS, and I thinkt that allowing the things below to happen is scandalous and extremely dangerous for the NHS.

      1. some private procedures will be carried out on NHS premises using NHS equipment and staff, which can’t be used by NHS patients at the same time. It’s just queue jumping by the better off.

      2. private sector costs are reduced because if a private patient develops complications, becomes seriously ill (or runs out of money), or if the treatment becomes unprofitable, they are dumped back on to the NHS for the taxpayer to pick up the bill.

      3. the private sector uses doctors that have been trained, and have their standards maintained by the NHS, using taxpayers’ money.

      4. in the NHS, doctors are always looking to cut costs, and won’t prescribe drugs unless absolutely necessary. That’s not true in the private sector – there are often / usually kickbacks from drug companies, to stimulate more drug sales – not for the benefit of patients, but for the benefit of the shareholders of the private practices and the drug companies.

      5. every hour an NHS consultant, trained using taxpayers’ money, works in the private sector, is an hour that he or she is not using his or her skills in the NHS for the benefit of all of us – which means longer waiting times, and damages the reputation of the NHS.

      6. often, NHS consultants work in the private sector when they’re on call for the NHS – but they can’t be reached, and even if they can, they’re not available.

      7. doctors in the private sector often carry out (profitable) procedures that would be considered unnecessary or even risky in the NHS – sometimes resulting in the patient needing follow-up treatment in the NHS – using bed / resources / doctors’ time that would otherwise be freed up for other patients.

      8. the private sector isn’t so interested in difficult or unprofitable treatment, and patients who fall into that bracket get passed on to the NHS – improving results in the private sector and making the NHS look worse than it really is.

      9. the private sector (including insurance companies) can get access to NHS patient records, built up over years, at the taxpayers’ expense.

      10. if something life-threatening happens during private treatment (e.g. a heart attack), they just dial 999 and an NHS ambulance arrives at taxpayers’ expense.

      11. the private sector relies on its image as efficient, fast, reliable etc, but in reality it relies on the NHS. This unrealistically burnishes its own image at the expense of the NHS – and ultimately allows neoliberal politicians to slowly dismantle it.

      12. a lot of the things above, in combination with underfunding by neoliberal politicians, means longer NHS waiting times – which then benefits the private sector even more. It’s a grim downward spiral for the NHS.

      The situation is different for your friend, who is doing unpaid charity work. But NHS consultants are paid well. What possible reason is there for doing private work as well? I can only think of one. Note that I’m not calling for a ban on private medicine. Let people pay if they want to, but stop the private sector being a drain on the NHS, and an excuse to privatise it. Otherwise we’re headed towards the US system – in fact we might be anyway. The NHS is a fragile and wonderful thing, and it’s not guaranteed that we can hold on to it.

    • 3John Harrison September 22nd, 2016

      I’m not sure all your points actually hold up but I agree the NHS is at risk. It seems that every reform and shake up has actually made things worse rather than better. As a doctor said to me, somewhat tongue in cheek, in the good old days people worked hard, smoked like chimneys and drank like fish. They retired at 65 and then dropped dead having paid lots of taxes and cost but a little in their short old age.

    • 4Dave Darby September 22nd, 2016

      That’s definitely one way of reducing the strain on the NHS. Not sure I fancy it myself though.

      Just discovered that I’m not alone in this view – an NHS consultant said more-or-less the same thing in the Graun in May – https://www.theguardian.com/society/2015/may/05/ban-nhs-doctors-from-private-work-hospital-consultant-says

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