A conflict of interests? NHS campaigner questions health chiefs over contract

NHS campaigners are concerned that senior doctors are encouraging patients to have surgery at private clinics where they have a financial interest.

Sussex Defend the NHS campaigner Linda Miller said that the pattern of referrals had given rise to concerns about conflicts of interest.

But David Supple, the clinical chair of the Brighton and Hove Clinical Commissioning Group (CCG), defended the way that colleagues made referrals.

Dr Supple said that “to be fair to the health professionals” they would be trying to achieve the best outcome for patients above any other consideration.

Mrs Miller asked health chiefs a series of questions at the CCG’s governing body meeting at the Amex Community Stadium in Falmer this week.

They focused on the growing percentage of local hip and knee replacement operations being carried out in private hospitals rather than in an NHS hospital.

Dr Supple said that even though the contract holder for musculoskeletal (MSK) services, the Sussex MSK Partnership, referred some patients to private consultants, it gave plenty of work to the NHS too.

But Mrs Miller said that the CCG had previously accepted that the contract was having a damaging impact on the local NHS hospital trust – Brighton and Sussex University Hospitals (BSUH) – which runs the Royal Sussex County Hospital.

She quoted the CCG saying: “Over the three years of the Sussex MSK Partnership contract there had been a shift of elective orthopaedic activity from BSUH to the independent sector.

“The impact of this is loss of income to BSUH (has) impacted on their ability to train junior staff and also potentially … could affect the sustainability of the service (and the trust’s) major trauma centre status.”

And she asked how the contract was monitored, citing a report published in June by the Centre for Health and the Public Interest which said that many senior NHS doctors own shares or equipment or both in the private hospitals to which they refer patients.

Dr Supple said that there was extensive monitoring and added that patients often ask for a private referral to beat waiting lists because of the level of their pain.

He said: “Most patients – over 80 per cent – make a decision about the provider of surgery before they see a consultant orthopaedic surgeon.

“They consult either with an MSK practitioner or a patient care adviser if they do not require assessment.

“Sussex MSK has confirmed these professionals are employed by Here or Sussex Community NHS Foundation Trust and have no pecuniary interest in any hospital sub-contractor.”

The new-look Royal Sussex County Hospital in Brighton

Those who see a surgeon before an operation tend to be unusual. Most do not see a surgeon first, Dr Supple said.

And an audit found that orthopaedic surgeons were no more likely to refer people to private hospitals – but they were more likely to make out-of-area referrals to NHS providers.

Dr Supple agreed that there ought to be a discussion about the way the contract was affecting the NHS hospital trust.

He told Mrs Miller, who works with the campaign group Sussex Defend the NHS, said that the Sussex MSK contract runs until September 2021.

She said that the more people were referred to private hospitals, the more the local NHS trust’s orthopaedic department would lose funding, and its waiting lists would grow longer.

She added: “We are only three years into the contract and there has been a shift in elective orthopaedic activity from Brighton and Sussex Universities Hospital Trust to the independent sector.

“The impact of this is loss of income to BSUH has impacted on their ability to train junior staff and could affect the sustainability of the service.”

David Supple

From anecdotal evidence, Mrs Miller said that it seemed as though people were given the option of a private provider without any thought about the effect on the NHS.

She said: “The orthopaedic department will be weakened. Ultimately it’s going to lead to the hospital becoming unsustainable.”

The number of NHS patients from Brighton and Hove opting for private knee and hip operations has more than doubled from 179 to 395 a year in the five years to 2017-18.

The increase of 216 was matched by a similar fall – of 219 – in the number of local patients having knee and hip operations carried out by the NHS. The number went down from 527 to 308.

  1. Valerie Reply

    MSK are a major problem – I was diverted to them by my GP repeatedly and inappropriately sent by them to the private Montefiore Hospital. That place has a list of many dozens of opportunist Consultant surgeons who cannot posdibly be remotely locally based.

    The person I saw did not address my situation responsibly & I peesonally believe both MsK & the Montefiore need to be dumped.

    And GP’s probably refer for personal financial reasons just as much as MSK !

    I no longer feel safe to get honest help for my serious orthopaedic problem.

  2. Rob Reply

    It’s easy to say of Dr Supple’s protestations, ‘he would say that wouldn’t he!’ However, I suspect the basic truths that doctors try to achieve the best outcomes for their patients. They may heed to policy diktats and medical fads and even to the contacts they have, of course. Who isn’t guilty of cognitive bias? Who lacks limitations? But I find it hard to believe in widescale corruption among our medics. Yes, there may be isolated cases and I hope it’s called out where it occurs. If it exists though, these campaigners should present their evidence rather than hint at a problem that probably doesn’t exist.

  3. Jean Reply

    The balance of private vs NHS is hardly unimportant and the trouble with the market health reforms we’ve seen under Labour and Tory Governments is too much focus goes on individual contracts and not enough on the effect of any changes on the system as a whole. The NHS is far from perfect but contracts like the one for MSK could be better designed to protect good value public provision otherwise we’ll be left with a private monopoly and all the problems that will bring.

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