Public watchdog bites the NHS--again
Authors: P. Johnston
Journal: BMJ (1986)

A recent article in the BMJ,  watchdog bites the  (7 June, p 1537), described several occasions on which the National Audit Office (NAO) had severely criticised the NHS. Well, the NAO has bitten again. In its latest report on the level of  for private resident patients in the NHS the Comptroller and Auditor General, Sir Gordon Downey, disclosed how several health authori? ties were not charging the full cost of major operations undertaken on private  And he reported one which considered that the underrecovery of costs was such as to jeopardise its continuation at present levels of those types of treatment to NHS patients. The NAO report was still warm from the presses when the Minister for Health, Mr Barney Hay hoe, issued  consultative paper aimed at tackling the problem. He pointed out that  review for determining  was begun last year following criticism that  were not related to the cost of the treatment received by individual private  The consultative paper put forward two main options?either to introduce higher national  for expensive procedures or to devolve to health authorities the setting of charges, subject to costs being fully recovered. I am inviting the views of the health authorities, the medical profession, and others concerned on these or other alternatives to the present system, Mr Hay hoe said. The BMA has welcomed the inquiry. Comments were asked for within three months so that any changes can be implemented by next April. This will mean that by then two years will have passed between the problem being identified and anything being done about it. In fact, the concern in some quarters goes back considerably further. Last year Labour's health spokesman, Frank Dobson, wrote to the Commons all party Public Accounts Committee alerting it to the problem. In his letter he referred to comments by Sir Gordon in 1981, when he noted that charges did not recover the total costs attributable to private patients. Mr Dobson?who declares an interest as an arch opponent of private medicine?even called in support of his arguments the concerns expressed by representatives of commercial hospitals. They have long argued that pay beds in the NHS have been subsidised by the health system funded by the taxpayer. Mr Dobson quoted Ron Stalker, chief executive of Portland Hospital, saying as long ago as 1983: Charges for private patients in NHS hospitals are completely unrealistic. It's  quarter of the real cost of treatment. Not only are babies treated free, even adults aren't charged properly for the use of an operating theatre, and the only charge for x rays is the consultant's fee. The criticism was borne out by the NAO report. Sir Gordon said that the DHSS had received complaints from 10 health authorities about their inability to recoup the full cost of operations because  for pay beds were set centrally for different classes of hospital. For example, North Staffordshire reported that open heart operations entailing replacement of  heart valve were being carried out at  loss. Hillingdon was not recovering open heart surgery costs; and in Trent  to private patients from overseas did not cover the costs of the Stereotactic Radiosurgery Centre. Mr Dobson described the whole business as scandalous and suggested that private patients were shopping around the NHS for urgent or expensive treatment that they could get at a bargain basement price while using commercial clinics for more routine operations. We will not be satisfied until all NHS subsidies to private patients come to an end, he declared. But, despite the grist to Mr Dobson's mill supplied by the NAO, the government remains committed to the principle of charging for private pay beds. Mr Hayhoe pointed out that private patients bring valuable extra resources to the health service with an income in England last year of ?61 million. Nevertheless, something is being done about the undercharging ?though not as swiftly as the unwitting observer might have thought.