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Private income is expanding in NHS Trusts

The NHS as a public service was once the envy of the world and recognised as one of the greatest humanitarian achievement of the 20th century.

The NHS, as we knew it, is in crisis with many hospitals on black alert (hospitals at full capacity, closed to further admissions), routine operations being cancelled including cancer surgery, a lack of provision of mental health services, a social care system that is collapsing due to privatisation, and general practice in meltdown. But brand NHS is alive and strong: the NHS is now commercial, it's a global competitor, earning private income to subsidise the public sector and ensure the creation of a two or three tier service. This is the return to the pre-1948 concept of healthcare for the poor as charity. The NHA is fighting against this because we believe the NHS should be for all, equity is its foundation stone, not charity. An ideological commitment to a publicly funded NHS does not require private income streams.

We need your help to build an accurate picture of the extent of privatisation within the NHS!

In order for us to build up a picture of the extent of privatisation within the NHS we need your help. Please use this template for a Freedom of Information request to your Trust or Foundation Trust then forward the response to us at info@nhaparty.org.

It will help us build a more accurate picture of what is going on in the NHS which becomes more obscured the more it is privatised.

The NHS - a global brand

Have you heard about Healthcare UK the 'International' NHS? Not the sarcastic name which is used by those who believe health tourism is undermining the NHS but the real thing. The NHS is now a global competitor, selling its 'trusted brand' across the world, in selected markets. It is sickening to read its publicity brochure and annual reports extolling the virtues and success of the famous NHS model of health whilst we have patients dying on trolleys, being denied care according to a postcode lottery and the 'transformation' to a US style system well under way.

Here is a quote from the blog of the CEO of Healthcare UK, the global marketing arm of the NHS, about last year's International Expo "We hope to show not just why an NHS organisation, be it a large acute hospital or a small community care provider, should consider international work, but exactly how they might go about it and learn from others already out there and doing it. One good example of this is the joint session between the Department of Health and NHS Improvement, which will look at how the NHS is already generating commercial income and how the centre can best support others to do the same."

The NHS dash for cash - privatisation in your local hospital

An article in The Times on New Year's Day 'NHS in dash for private cash' reported that the Royal Marsden in London will earn 45% of its income from private patients and other non-NHS sources this financial year and wants to raise its income from private patients to £100m.

The Coalition's Health and Social Care Act (2012) removed the limitations on private patient income previously imposed on Trusts, but in order to soothe Liberal Democrat fears about the clear expansion of privatisation they created Section 164.

"An NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes."

This is the '49%' rule which means that almost half of an NHS Trusts' income can be earned through the private patients and non-NHS sources referred to in The Timesarticle. The 'dash'  is very uneven, with some Trusts generating large amounts and others none, or seemingly none, in some cases.

In August 2014, a little over a year on from the implementation of the Act The Guardian reported that private patient income was increasing in what was seen as 'creeping privatisation'.

Here are the comparisons given in that article with an update from the accounts for the year end March 2016:

Trust                                            2010-11       2013-14       2015-16

University College                   £7.3m           £10.3m        £21.4m
Moorfields                                 £16.1m         £21.3m         £23m
Papworth                                    £4.9m          £6.4m         £7.45m
Royal Surrey                              £3.6m           £4.6m        £4.9m
Chelsea & Westminster          £10.7m          £13m           £17.4m

Some of the largest private patient incomes shown in the March 2016 accounts are in London Hospitals:

the Royal Brompton is just over £39m

Moorfields is £23m (as above)

Great Ormond Street is £47.88m

Royal Marsden is £83.1m

The NHS - a proliferation of private healthcare companies

Some Foundation Trusts have set up their own private companies within the Trusts, which compete with the traditional private sector for their clients, often boasting that their service benefits from its close working relationship with the established NHS hospital with which it is associated.

The Westminster Unit of Guys and St Thomas' Private Healthcare, for example, starts the introduction to its services with"The Westminster Unit is available to private patients, assuring them of expert clinical care in comfortable surroundings,secure in the knowledge that all the technical expertise of Guy’s and St Thomas’ NHS Foundation Trust is available should it be required." (our emphasis).

Almost all of the Trusts which offer private healthcare claim that the income from their private patients is used to support their NHS services. But it seems likely that the reverse is true, as Trusts must divert resources towards those who can pay.

One trust which shows no private patient income on the March 2016 accounts is The Christie in Manchester. The Christie set up a joint venture in September 2010 with Health Care of America (HCA) which means that the income the Trust receives is shown as profit share rather than income from private patients.

The Christie is also one of two specialist cancer centres which will run proton beam therapy units. These are paid for from government funding of £250m with an additional £20m in charity fundraising. This raises the question of whether the Christie/HCA private patients will also have access to this treatment. And if so, how will it be accounted for? What are the true costs to the NHS of offering these expanded private services?

With increasing waiting lists for treatments across hospitals in England, with the double shock last week of the deaths in the Worcestershire Royal Infirmary and the Red Cross being called in to respond to the 'humanitarian crisis' in the NHS, these are questions which need urgent answers. It isn't just about the money received - it is a question of the use of resources. Doctors, nurses and other clinical staff are required for these expanding private facilities whilst the NHS services literally next door in most cases struggle to fill their rotas.

NHS England proposes to give preferential access to capital funding to those trusts that beat their financial targets. We think it likely that the Trusts which are most successful at expanding their non-NHS income will then, paradoxically, become eligible for the most additional public funding - through Transformation and capital funding.

Dr Ranj Singh - who many parents will know from Cbeebies -asks,

"is a revenue stream now generating nearly £300m a year in London alone actually an essential asset for an institution calling out for money, or will it, as others fear, lead to a two tier system where those who can't pay are increasingly left behind?"

He also discusses the private income streams with Prof. Allyson Pollock and points out that the Homerton in East London has doubled its private income in 5 years from £500,000 to £1m. Prof Pollock points out that it is the resources needed to staff and maintain the private provision that is draining the NHS, which is not compensated for by the private income stream.

(Inside Out London, 16/01/2017 www.bbc.co.uk/iplayer/episode/b088p2n5 via @bbciplayer)

We need your help!

In order for us to build up a picture of the extent of privatisation within the NHS we need your help. Please use this template for a Freedom of Information request to your Trust or Foundation Trust then forward the response to us at info@nhaparty.org.

It will help us build a more accurate picture of what is going on in the NHS which becomes more obscured the more it is privatised.

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