How go private for that vital operation and get the NHS to pay for it: Everything you need to know about a little-known scheme

How go private for that vital operation and get the NHS to pay for it: Everything you need to know about a little-known scheme
By: dailymail Posted On: October 21, 2024 View: 113

A radical plan has been put forward by private hospitals to invest £1billion to 'rescue the NHS' and help to clear its record waiting lists. It would involve firms such as Bupa, Circle Health Group and Practice Plus Group putting up money to improve NHS services in exchange for Government contracts.

It has already proved controversial, with critics labelling it an 'NHS privatisation plan' and an 'expensive gimmick'.

However, experts say many patients are unaware that private hospitals already offer treatment to NHS patients – and every year thousands of those appointments go unused.

The NHS regularly pays for patients to have common procedures done privately, such as hip replacements and eye surgery.

But according to a recent NHS report, carried out by former surgeon Lord Darzi, fewer than half of patients know they have the right to choose independent providers.

The NHS regularly pays for patients to have common procedures done privately, such as hip replacements and eye surgery

The Independent Healthcare Providers Network (IHPN) says patients typically need to travel less than 25 minutes by car to cut three months off their waiting time.

So what do you need to do to get a private op paid for by the NHS? And is it worth it?

Q: I have never heard about this scheme – am I eligible?

A: Everyone is eligible, no matter your age, where you live or the treatment you need. If your GP needs to refer you for a physical or mental health condition, you have a legal right to choose which hospital or service you go to. This includes the NHS and many private hospitals that provide services to the NHS. Patients can even choose the clinicians they want to be seen by.

'This scheme has been available for decades but not many know about it,' says David Hare, boss of the IHPN. 'Our data shows more than 10,000 appointments made available by the private sector for NHS care are not being used.'

Doncaster-based GP Dean Eggitt says: 'Patients and GPs must be more proactive about the scheme.

'We don't often get patients asking about it, especially at the first encounter – only when they have been sitting on a waiting list.'

The only restrictions are that this service is not available for emergency care and there must be a justification for your choice.

For example, a private hospital might be closer, provide shorter waiting times or offer a treatment that is not available on the NHS.

You may, however, be refused your right to choose if you have missed prior appointments and if you are suggesting a treatment plan that doesn't align with your clinician's diagnosis. 

Q: I want to take advantage of this – where do I start?

A: Once your GP or consultant has decided you need a referral, they should discuss treatment options. 'The key to patient choice is the GP,' says Mr Hare.

'They will discuss what is best for you and whether that is NHS care or going to a private provider.

'However, we currently have no assurance that patients are being asked to consider their options.'

Experts say it is important patients raise the possibility of a referral with their GP. 'If you want to exercise your right, you have to stand up for yourself,' says Richard Wells, of the Private Healthcare Information Network.

'If you suggest a private provider that offers NHS services in your area, and your clinician agrees this is the best option, they should take care of the referral and ensure appointments are made. However, if you are asking for a procedure outside of your area, it is likely you will be asked to arrange the appointment with the private hospital yourself.'

Janet Lovell paid £10,000 for her first hip replacement operation at a private hospital, but the NHS picked up the tab for her second one

Q: Will there be an additional cost to me or the NHS?

A: There is no additional cost to you and you aren't putting an extra burden on the NHS.

'These appointments do not cost the NHS any more – private providers are putting their hands up to do it at the NHS rate,' says Mr Wells.

There is no restriction on types of procedures that can be done under the scheme. The private hospitals will have NHS contracts which require them to carry out a certain number of ops every year.

Q: I have been waiting for hip replacement surgery on the NHS – can I ask to go private?

A: You have two chances to ask to go private. The first is in your initial consultation with a GP.

'Dialogue is key at this appointment, it's your main opportunity to make the switch,' says Mr Hare.

'Even though the expectation is that your GP will discuss all options with you, this is your chance to raise the issue.'

If you did not choose to go private initially and are on an NHS waiting list, you can't change your treatment plan until you have been waiting for at least 18 weeks.

There are more than three million people who fit that criteria, with the average waiting time doubling since 2019.

But Mr Wells says: 'It is still worth discussing options with your GP while on the NHS waiting list, as if it looks likely you will be waiting 18 weeks they may be able to help you to plan ahead.'

Q: Will the £1billion rescue plan change rights to the scheme?

A: The proposals would be in addition to patients' rights, so will not change your ability to access private care for referrals.

Currently, patients can opt to have a procedure done in a private hospital rather than on the NHS.

The new plan will involve private hospitals covering the cost of new diagnostic centres – where patients could be tested for conditions such as cancer – surgery units and intensive care facilities.

These services would be owned by the private firms but free of charge for NHS patients. It is estimated 2.5 million more NHS patients would be seen every year.

I only had to wait a month to get my hip replacement

'I really don't think enough people realise that they have a legal right to choose where to have their NHS treatment,' says Janet

When pain became too much, Janet Lovell paid £10,000 for her first hip replacement operation at a private hospital – but the NHS picked up the tab for her second one, also private, just a month later.

Former accountant Janet, 73, from the Isle of Wight, suffered severe osteoarthritis which left her in agony and in a wheelchair. She is also full-time carer for her husband Martin, 75, who has Alzheimer's.

She had been waiting two years to get her first hip op. It was only after she had it done privately that she was told the NHS bill could have covered the bill.

While recovering, Janet was told she would also need to have her other hip replaced – and that the wait could be as long as before, two years.

So she asked her GP if it could be done in a private hospital instead. Her request was approved and the procedure was carried out just a month later.

Janet says: 'I really don't think enough people realise that they have a legal right to choose where to have their NHS treatment – and that they can find shorter waits.'

Weird science

A man died last year after rinsing his sinuses with tap water – and contracting a brain-eating infection.

Officials from the Department of Health in Charlotte County, Florida reported that a resident had been infected with N. fowleri – an amoeba that usually lives in soil and warm freshwater environments. It's generally harmless when accidentally ingested through the mouth.

But when the infection enters the body through the nose, it can migrate to the brain, where it eats brain cells and causes massive inflammation.

The unlucky man reportedly rinsed his sinuses with unboiled tap water daily, which doctors believe led to him contracting the infection.

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