Call for investigation into 8,500 private patients treated on NHS Scotland

• Analysis: Risk of rationing if private patients become an NHS cash cow

His comments were echoed by former Scottish Health Secretary Alex Neil who demanded an investigation into what effect paid procedures may be having on normal service – as both raised fears over any risk of a two-tier service for the rich and those who are unable to buy their treatment.

It follows an investigation by The Herald that reveals today how NHS Scotland has earned more than £13.2 million since 2012 carrying out tests and procedures on at least 8,500 private patients in NHS hospitals. 

It ranges from ultrasounds and biopsies to hip replacements, heart surgery and CT scans.

• READ MORE: NHS Ayrshire earning £100,000 a year from private cataracts patients - amid NHS referrals row 

There is also huge variation in activity between health boards, with NHS Fife and Lanarkshire shunning private work altogether while NHS Lothian has accounted for the vast majority of private turnover in the past six years.

Data obtained under freedom of information shows that it earned £6.7m from 3,128 private patients, with radiology scans for cancer patients and heart surgery among the most common procedures carried out for a fee.

Mr Neil, said it was time the issue was scrutinised.

He said: "I think the irony is that one of the health boards that is under the most pressure is NHS Lothian because of the huge increase in demand coming from the population in the Lothians area and it would also appear to be the health board with the highest number of private patients being treated in NHS facilities.

"I think probably it is time for Healthcare Improvement Scotland to carry out a review of the whole issue, because clearly people who are paying into national insurance and taxes wouldn't be too happy if they are left at the end of the queue because they don't have the money to go private."

There is nothing to prevent health boards providing treatments such as surgery, scans or routine day case procedures within NHS hospitals to private patients.

• READ MORE: Some hospitals in NHS England making multi-million pound losses treating private patients

Usually, this will be provided by consultants who do private practice alongside NHS work, with the hospital reimbursed for costs such as the use of a bed, operating theatre, or scanner while the medic is paid separately for labour.

Health boards are expected to ensure that there is no adverse impact on NHS patients, such as private patients 'skipping the queue' on waiting lists or exacerbating bed shortages, but there is currently no independent scrutiny of the practice nationally.

The figures for Lothian show that annual income from private activity peaked at £1,345,401 in 2017/18 when its opened its doors to 502 private patients. This fell back to £457,305 and 147 patients in the first six months of the current financial year.

Neil Findlay, Labour MSP for Lothian and a former convener of the Health and Sport Committee, said he would be writing to NHS Lothian.

He said: "These figures are extraordinary. At a time when we see waiting lists increasing, including for diagnostic tests and a whole host of procedures, NHS Lothian appear to be seeking to supplement their income by allowing private sector patients to leapfrog NHS patients who have often been waiting very long periods for treatment.

"We are currently seeing NHS patients wait up to 60 weeks for some procedures. This cannot be right, the Government must intervene the parliament health and sport committee should also conduct an immediate investigation."

• READ MORE: Scottish Government waiting times plan pledges to hit cancer treatment target by 2021 

A spokesman for the Royal College of Physicians of Edinburgh said full transparency was needed.

He said: “The College asupports the idea that NHS treatment must remain free at the point of access.

"Any suggestion of private referrals should be examined, particularly if this practice may have resulted in fewer beds and longer waiting times for NHS patients.

"It would be helpful to have clarity from health boards regarding these figures, and to know whether any private treatment is during routine hours.”

Jacquie Campbell, chief officer of Acute Services at NHS Lothian, said: “NHS Lothian is fully committed to providing access to diagnostic test and treatment as rapidly as possible to our patients.

“Although continuing to accept referrals from independent healthcare providers we have significantly reduced the numbers seen/treated as demonstrated in the 18/19 figures and will continue to review access to a small number of specialties on a case by case basis.

"The procedures requested are usually specialist scans or tests that cannot be carried out elsewhere, or require a specific level of complexity and support.”

NHS Highland and NHS Ayrshire and Arran had the highest volume of private activity last year, after NHS Lothian.

NHS Highland earned £398,000 from 1,234 outpatient consultations and 96 orthopaedic treatments, while NHS Ayrshire and Arran - which has come under fire for restricting NHS cataracts referrals - made £168,000 from 241 private patients, many of them cataracts patients.

Scotland's largest health board, NHS Greater Glasgow and Clyde, provided data since 2014, showing it had administered specialist scans and ultrasounds to 1,182 private patients, including children, earning it £260,000.

Three health boards - NHS Grampian, Borders and Forth Valley - have drastically reduced their private activity in the past six years.

NHS Grampian, which recorded tonsillectomies, prostate biopsies, and coronary artery examinations among its most common private procedures, has gone from treating 968 private patients between 2012 and 2017 to fewer than 20 in the past 18 months.

It said it had done so to prioritise NHS patients at a time when it has been struggling with a shortage of theatre staff.

A Scottish Government spokesman said: “We are absolutely committed to a publicly owned and operated NHS, and for the people of Scotland to continue to have free timely access to health services.

“Health boards are able to provide treatment and care to private patients, but only where they have additional capacity and if doing so will not negatively impact on NHS patients.”