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Tuesday, 11 December, 2001, 10:49 GMT
Patient choice: Will it work?
The British government will pay patients for private medical treatment, and even treatment abroad, in an effort to cut waiting lists in the publicly-funded health service.

The choice will be given to people who have waited more than six months for an operation.

The government said it is trying to tackle decades of under investment in the National Health Service.

But the opposition Conservative party said the scheme is about political expediency rather than clinical priorities.

Patient groups said it will raise patients' expectations and the government must now fulfil those expectations.

Can this scheme work? Will it be a boost to the NHS, or does it mark the beginning of its end?

This debate is now closed. Read a selection of your comments below.


Your reaction


People know exactly what proportion of their salary deductions goes into what fund

JD, UK
The crux of the problem is centred on the way the NHS is funded. If we were to adopt a system similar to the one which operates in Germany we would not have to rely on politically motivated funding. In Germany people know exactly what proportion of their salary deductions goes into what fund, i.e. deductions are divided up into unemployment insurance, medical insurance, pension and income tax. Central government only determines the percentages of each deduction. The handling of each separate fund is carried out by insurance companies. This way Germany has no waiting lists and treatment on demand, better pensions and better unemployment benefits
JD, UK

It's another roundabout way of avoiding the real issue: funding the NHS to adequate levels. The Conservatives may believe that putting extra money into the NHS isn't the solution but I think everyone else knows that it is. Why don't we just fund the system properly instead of all this messing around?
David Hazel, UK

NHS treatment should be means tested so it is available for those who have no other option and who do not cause health problems by their choices (smoking etc). However, everyone else should have to pay health insurance if they want access to health services.
Bernard, UK


The latest initiative will probably be too late for my brother-in-law, who has three blocked arteries and has been told he is not an "emergency"

Avril, UK
This is not a long term solution. My brother-in-law, who has three blocked arteries and one ruptured artery, has just been told he will have to wait eleven months for surgery as he is not an "emergency". The latest initiative will probably be too late for him. Is this a strategy for reducing waiting lists?
Avril, UK

National Insurance contributions make up only a tiny proportion of the NHS budget. Those who pay tax don't use the NHS as much as those who don't. As an insider I can see the NHS crumbling under the pressure of demand, expectation political interference and increasingly defensive practice. Passing the easy work to the private sector has already diverted huge sums of money away from where it's needed most. Time to set up an independent Royal Commission to look at alternatives to the present service.
M, UK

Most of the gap between health spending here and in the rest of Europe is due to lower private spending, where we are bottom of the league. There are plenty of ways of delivering "free" (tax-funded) healthcare without having to rely on this megalithic, Stalinist, centralised disaster, aka - the NHS.
Ben Broadbent, England


Give us back our NI and we will spend it on the health services we want

Martin, UK
Labour has significantly increased taxation in the UK since they won government. This money (£billions and billions) should have gone immediately into the Health and Education system - instead it was used to sooth their own personal politics of income re-distribution. Give us back our NI and we will spend it on the health services we want.
Martin, UK

I think a mix of the NHS and private hospitals, as done in parts of Europe is the best solution. But the government must ensure that it's not the same surgeons chasing their own tales doing operations in both sectors, whilst trying to make a fast buck.
Barry, England

The government could save the NHS and the holiday industry at the same time. If the NHS team up with say Thomas Cook you could go to Florida to have your operation and then have a couple of weeks at Disney land at the same time. Brilliant.
Gareth, UK

This scheme will be no different from the parental choice for Schools. Of course hospitals do not have an infinite capacity, and so patients will find in practice that the 'people's choice' hospitals will become too busy, or over-subscribed and they will not get in anyway. This is really an abrogation by the Government of its duty to use our taxes efficiently for our benefit.
Paul, UK


The public will gain for a short time and the NHS will suffer

Isabel, UK
It would help if a fair tax system were in place. People forget that things have changed drastically since the establishment of the NHS. Costs have risen and operations are now being carried out that were not even considered in the past. I think the private health sector will undoubtedly gain. The public will gain for a short time and the NHS will suffer. The government should be doing something to help the moral of NHS staff, which has deteriorated, offering flexible working time to suit social circumstances as they are now. Perhaps there wouldn't be so much of a waiting list through staff shortages.
Isabel, UK

I don't want to be cynical but is it not the government's job to run the country. Evidently we will be unable to provide our own water companies, power generating companies, transport system, or health service. How long before we are shipping our kids off to school at some European destination. This stinks of a country that has exceeded its carrying capacity and its basic ability to provide for its people, which makes us vulnerable. Get a grip Blair and co, stop selling this country off, and stop making us the laughing stock of the world.
Clive, England

Of course it will work for those who have to wait for longer than six months. But finally it comes down to spending more money either on the NHS itself or on buying services from the private sector. In the long run it is more expensive to buy services from the private sector. So the government spends more money than it would have otherwise spent on the NHS. Anybody see the resemblance with Railtrack here?
Erling Nylund, Norway


Freedom of choice for one person results in a reduction of choice for others

Martin, UK
Freedom of choice for one person results in a reduction of choice for others. A much better idea is to ensure that the NHS consultants actually work 100% of the time in the NHS. How is it that 'overworked' consultants can suddenly see a patient when they go private and usually in the same hospital? What a disgrace!
Martin, UK

To Martin: First of all, the reason consultants can see patients straight away when seen privately is that this is done in their own time not that for which they are contracted to do for the NHS. Some consultants work 60 hours a week for the NHS. Secondly, one of the proposals was that a patient waiting longer than six months would be able to choose the hospital and time of his choice. I can see this causing big problems - imagine a patient at hospital A waiting more than six months deciding to have his operation at hospital B in another health authority's district right away. This would mean all the patients at hospital B would have their own appointments delayed. At its extreme it could mean patients at that hospital having to wait more than six months!
Stephen, England

Why is the government set on closing hospitals and offering patients treatment abroad? Why not invest in hospitals and safeguard local communities rather than spend our money overseas?
Andy Presnail, UK


What happens if they cannot go to the hospital of their choice? They will consider they have been given no choice

Judie Read, UK
The Government is in the middle of a huge reform of the NHS - only problem is that it seems to be creating even more bureaucracy, not less. There is too much paperwork and pen pushing in the NHS. It is a good service. It has faults - what doesn't? But it needs efficiency. Sending patients abroad will not help; many will not want to go. Sending them to a hospital of their choice will cause even more trouble. What happens if they cannot go to the hospital of their choice? They will consider they have been given no choice. Money alone will not solve the NHS problem, but efficient working practices will. Trouble is, the goalposts are continually moving.
Judie Read, UK


As a medical student, I agree with this scheme for the benefit of patients

Lin Meng-chin, Taiwan
As a medical student, I agree with this scheme for the benefit of patients. What we care is life rather than political expediency. The patients should receive proper medical treatment in proper time.
Lin Meng-chin, Taiwan

Does it really matter whether it's clinical priorities or political expediency? For those who have waited ages for these operations it's really good news. Over the years the NHS (once the shining star of the welfare state) has been run down by successive governments, be it Labour or Conservative. This is a short-term solution and now the government should ensure that proper funding is available for the NHS to provide the services required of them and meet the expectations of an ageing population.
Arif Sayed, Dubai, UAE

The whole scheme is another government scam. Six months on a waiting list, does that include the wait to see the consultant and the wait for tests? Having waited three years for a bypass I do not believe a word of it. You will only get this treatment if your local health authority can afford it and when they say no the government will have someone to blame. It is just spin to make the majority less concerned about the pathetic resources we have.
Andy, England


I'd question whether this initiative really achieves longer-term objectives of developing the NHS into a world-class health system

Charlie Keeney, England
While patient choice is a right, I'd question whether this initiative really achieves longer-term objectives of developing the NHS into a world-class health system. This scheme will only succeed in diverting new resources away from the NHS. Instead of investing in existing facilities, money will be used to pay for delayed operations to be carried out in other EU countries. It will be like taking food out of the mouths of NHS organisations.
Charlie Keeney, England

In my opinion the NHS is a national disgrace. It should be wound down and finally abolished forever and then people can take out private cover to suite their needs.
Geoff, UK


What people want when they are ill is fast local care by people they trust

John, UK
No, it won't work. What most people want when they are ill is fast local care by people they trust. We trust the quality of our NHS, do we trust this quality outside the UK? I think not.
John, UK

Just before boarding the ferry, my wife became so ill that I rushed her to the local hospital. Dunkirk public hospital was fantastic. Patients were kept in twin bedrooms with TV and telephone, the food very good, and batteries of doctors examined her to see what was wrong. In the end, they decided on keyhole surgery that revealed an atypical appendicitis. Yes, an appendix removed by keyhole! If France is able to achieve this, why not Britain? As far as sending patients abroad, it is to be noted that many Eastern European countries have very good health facilities and thanks to their weak currencies, treatments and operations are very good value for money even after taking into account travel costs. Maybe an idea for the NHS to explore.
Pascal Jacquemain, UK (French)

What we are seeing this week is a government beginning to panic; be it health, education, transport, law and order or political sleaze.
Mac, Scotland


I think that this really is the best idea that's come out of this Government

Anthony, England
No recent Government has managed to get on top of the waiting list problems that beset the NHS. The scheme may well lead to private suppliers building more hospitals to cater for NHS demands. It may also have the effect of driving nurses' wages up as they find both the NHS and private hospitals trying to attract them. I think that this really is the best idea that's come out of this Government. It's not an idea prejudiced by private/public arguments but one that's trying to put the patient first.
Anthony, England

Anything that marks the beginning of the end of the shambles that is the present NHS is to be welcomed. The public are getting tired of the unions placing their members' interests above those of the patients.
Guy Hammond, England

The only way we will find out if it works is to try it! People are too quick to criticise instead of encourage - perhaps the phase "whinging Poms" is right!
Stef, England


Why is the Government not looking at Europe for new ideas and a better health system?

Ank, Edinburgh, Scotland
I think it's a good idea to help the people in need and to stop their suffering. However I really side with the NHS here. Why is the Government not looking at Europe for new ideas and a better health system? I have been working and living in the UK for six years now but I'd be seriously concerned if I was ill. I'll make sure I am treated in my native Holland.
Ank, Edinburgh, Scotland

The public want results, so what other choice is there? The Government cannot provide the extra nurses and doctors required overnight (short of abolishing the private sector and conscripting the displaced staff), so patients will have to go where there is spare capacity. But it should NOT be a substitute for increasing the efficiency and capacity of the NHS itself.
Steve, UK

The Government have quite obviously not thought this through. I can honestly say this has to be the worst waste of public funds I have heard of since the Millennium Dome. If they have the money to send people from the NHS to the private sector then they should spend it on more hospitals, beds, surgeons and doctors within the NHS, not putting it in another company's pocket. It's basic maths - something the Labour Party haven't got a grasp of yet. Short term it may reduce the waiting list. Long term the problem will still be there but with a larger population meaning more waiting lists
Pete, UK

See also:

06 Dec 01 | Health
Patients 'to pick' their hospital
06 Dec 01 | Health
How patient choice works abroad


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