The wonders of private healthcare and of Scottish government

In Britain, a very small proportion of healthcare is delivered by private hospital


These are organisations that provide healthcare for profit, or at least try to (anyone can run a business badly). As a result, they only do what is referred to in the trade as ‘cold surgery’ - in other words operations carried out on a planned basis rather than in response to an emergency. 


These can be relatively low-key operations such as a hernia repair, or something more substantial, like a hip replacement. But what they all have in common is that they are carried out on patients who are, broadly speaking, in good health: they obviously have the condition for which the surgery is needed but otherwise they’re well - they don’t have anything likely to turn into a nasty heart attack, or a major neurological problem such as a seizure or, even worse, a stroke. 


It will come as no surprise that this is the kind of case that is most likely to generate a profit. 


Partisans of private hospitals argue that by handling this kind of work, they relieve the NHS of having to do it. What that argument leaves out of account is that what’s left is the more difficult cases that are likely to be the most expensive. What it leaves even more out of account is what happens if things unexpectedly go wrong, as they have a tedious way of doing in healthcare. 


What if, against all the available indicators, a patient has a heart attack while in the private hospital? 


I came across exactly such a case some years ago, though I won’t mention the private hospital involved, because why should one embarrass the guilty? What happened was that reception staff called for an ambulance. When it arrived, NHS paramedics took the patient into their charge at being shot of all further responsibility for him. 


Because that’s what the private sector does. It cherry picks the easiest cases. And it avoids any of the huge infrastructure costs associated with building centres capable of dealing with the serious problems, with the life-threatening conditions. No wonder the private sector can aim at profitability. 


Why is this important today? 


Because the latest reorganisation of the NHS aims to make it possible for ‘any willing provider’ to deliver healthcare. That form of words led to a bit of a storm of controversy so now the government is saying, ‘well, yes, of course the provider as well as being willing also has to be suitable, properly qualified, and shown to be capable of delivering quality.’ If only they’d said that from the outset I’d have less trouble believing them. But suitable or not, these hospitals are still going to be creaming off the most lucrative cases while avoiding the burden of the difficult ones - for which they’ll have to turn to the public sector for support. 


Anyone in Britain questioning that suggestion need only look at what’s happening in connection with the latest healthcare scandal: breast implants provided by a (now-bankrupt) French company, PIP, using industrial-grade silicone. That’s a bit like putting a load of diesel oil in your body and being told, ‘don’t worry - there won’t be a problem unless the pack leaks.’ Inspires confidence, doesn't it?


And guess who did 95% of the operations? Private hospitals, of course. And who picks up the tab if things go wrong? Oh, yes, you guessed it: the public sector. The private cosmetic surgery companies reckon that they just can’t afford to do the work of removing the implants themselves - it would cost too much. Why, it might wipe out their profits. So they expect the rest of us to cover them for them. 

Leaking industrial grade silicone - just what every woman wants inside her
The private sector can fit them. To take them out, just turn to the NHS

Oh brave new world that has such people in it! 


What a wonderful, liberating experience it’s going to be having all those ‘willing providers’ helping out the NHS. 




Postscript: they order these things better north of Hadrian’s Wall 


This week David Cameron, Prime Minister of the United Kingdom, decided to confront Alex Salmond, First Minister of Scotland, a major part of that same United Kingdom. 


Salmond wants to hold a referendum on independence for Scotland. But because he’s a wily old fox and he know time’s on his side, he wants to hold it in 2014. And, because he knows he might lose the referendum, he wants it to include an alternative possibiliy - maximum devolution, with Scotland running all its own government except for foreign affairs and defence (often the same thing these days) which would be left to the residual UK. 


Now Cameron is calling him out. The referendum must be held in 2013. And, he maintains, it can’t contain the maximum devolution question. 


So Cameron is taking on Salmond head on. Cameron. Self-confident to the point of brashness, indolent when it comes to preparing his ground, convinced that success is his due. Against Salmond. The smartest operator in the UK today. 


I’m looking forward to watching the contest. Cameron might best him. But I won’t be putting any money on that.

Cameron, left, looking for an idea. Salmond looking as though butter wouldn't melt
I know who I'd put my money on