Private Medical Insurance – my views

There has never, in my opinion, been a more important time for considering Private Medical Insurance (PMI) to optimise you and your familys healthcare, particularly with regards to Ear, Nose and Throat Surgery – there was an excellent article on PMl in The Daily Telegraph this week.( )

If you are unsure about which of the myriad of policies suits you, try using a broker with special expertise in this field. I used Healthcare Partners (www.hcpl.co.uk) who found the best policy for me and carry out a yearly review to see if it remains the best and most competitive deal.

Why do I think the NHS can’t take the strain?

Many reasons, which I will outline here:-

The majority of my working week is spent working in the NHS, and I believe strongly in it, but in todays world a universal tax funded Healthcare system which is able to offer all the best and most up to date treatments to all is just financially impossible. This is by no means a problem confined to the UK – an ageing and growing population and ever more advanced medical and surgical treatments make it impossible for the NHS even to stand still, let alone pay for and develop new techniques while ensuring equal access for all. This is despite the last Government throwing money at the problem, with above inflation budgetary growth. The next 4 years will see NO growth in funding, and believe me that will feel like a heavy cut, despite what politicians of all Political Parties may say.

To give a simple example of this, I was talking to a retired GP the other day who told me when he first went into practice in the mid 50s he had just 3 medicines at his general disposal to treat all ailments. One of these was Paracetamol and the other 2 escape my memory, but this goes to show quite how times have changed!

My own feeling is that if you can afford to go Privately, you should regard the NHS as providing GP, trauma and emergency, cancer , maternity and paediatric care as well as for the treatment of more complex medical and surgical conditions and Intensive Care. These are the ‘core’ issues that the NHS does and should be able to concentrate on, but for the rest of your more ‘elective’ healthcare think of the NHS as a ‘default’ mechanism and look further afield. This is particularly the case in Ear, Nose and Throat Surgery – we perform a number of life saving procedures and treat many Head and Neck Cancers, but the majority of the surgery we do is for ‘life enhancing’ and non urgent, elective reasons. In times of financial austerity, these are inevitably seen as of secondary importance by NHS purchasing bodys (see my article on ‘Low Priority Procedures’ – http://www.nosesurgeon.co.uk/26.php )

There is never ending material to be read about new changes and directives in the NHS these days. Many of the current discussions about who holds the budgets for Health will not make a huge impact on how you will perceive your own Healthcare. Be very certain of one thing however, when your individual GP or GP Consortium is shortly directly responsible for the bill which they receive from a Hospital when they refer you there, they will have an incentive to treat you in house and not to incur specialist Hospital charges. Being treated nearer to home is a good thing I hear you say, and in some cases that’s true. I do 2 GP Practice based ENT clinics which work well and which I am told patients appreciate. In contrast to Continental Europe however, (where patients make an appointment directly with a ‘High Street’ office based ENT Specialist), GPs continue to see and treat the majority of patients with ENT problems. I am constantly amazed how GPs (my wife being one of them!) can be experts at quite so many different ever expanding topics. With the best will in the world from your GP, I’m not at all surprised that it may take several visits to them before they and you decide that a referral to the Hospital for a specialist opinion is in your best interests. This may cause prolonged issues with work or your personal life that you would like sorted as quickly and efficiently as possible.

In addition to this, many GPs have now admitted that they will be more likely to refer patients privately in the future to circumvent spiralling NHS Hospital costs – see .

These days I, along with many all my fellow Medical Professionals and Managers, are under constant pressure within our NHS timetables to keep within financial and waiting time ‘targets’. Although in theory the entirely arbitrary time targets (reducing the average time waited from ’18 months to 18weeks’ being a great political soundbyte by the last Government) may seem a good idea from a patient perspective at first glance, what it has done is to take away Clinician autonomy in where, when and by whom a patient is treated. The primary concern in the NHS is to get you treated within 18 weeks of referral and at the cheapest price, regardless of other issues which may be important to me as your Consultant or you as the patient. This means that I now see patients from Margate in my clinic in Ashford (a 70 mile round trip for them when there is a Hospital just up the road) and vice versa – this is to save time in the ’18 week pathway’ but makes for a mighty convoluted patient experience! Patients nominally under my care are often operated on by my junior middle grade colleagues and by colleagues with spare capacity on their lists in a largely ‘generic’ rather than specialist orientated system of patient treatment. New and innovative treatments I want to introduce to my NHS Practice are repeatedly knocked back and put to the bottom of the funding pile.

The reason a sizeable proportion of patients just about keep within these pathways thus far is by these methods and by Hospitals working flat out. In a number of surgical disciplines such as Orthopaedic Surgery this means working both days at the weekends every weekend in ‘Waiting List Initiative’ (WLI) operating lists. This inevitably costs money to pay the theatre staff and surgeon and is optional work (I choose not to do it, preferring to spend time with my family at weekends), and is another example of why ‘chucking money at the problem’ (which the last government did to paper over the cracks) just so they can say that the 18 week pathway is working is so wrong. When Ed Miliband asked David Cameron in PM Questions the other day whether he could assure everyone that waiting times in the NHS won’t go up it was a clever bit of politics but an unbelievably deceitful thing to say as he (and everyone working in the NHS) knows that the last government has spent all the cash on these short term solutions and inevitably these extra sessions are now no longer affordable. If you want an idea of how much money has being spent, see the furore over the extra earnings of some Consultants in these extra WLI lists ( ) – you can’t blame these surgeons or theatre staff as the work they are doing is done in their own personal time and is significantly helping their Hospitals keep within the Holy Grail of the ’18 week target’ and avoid being fined. The vast majority of staff will earn nowhere near that amount for these extra, arduous periods of work at the end of an arduous and stressful day or week.

The MOST important thing in my view is that unlike insured or self pay Private Patients, the NHS can’t provide the ability to research and pick your surgeon. Virtually all surgeons these days have special areas of interest and expertise within their own branch of Surgery or Medicine. As you will see from this website, mine is Rhinology and Nasal Plastic Surgery. I put it to you that ideally you would want your nasal surgery done by someone who spends 90% of his time treating and operating on nasal problems, in the same way that you would want your knee surgery done by a knee and not a hand expert !? To be fair, this is something the NHS has never claimed to be able to do, as when you sign your NHS consent form it is clearly written that no guarantees have been given as to who will perform the surgery. This is not the case for the Private Patient, who chooses their Surgeon and is guaranteed that they will perform the operation.

I have recently had a surgical procedure and was absolutely sure of the surgeon with the specific skills that I wanted to perform it. I asked my GP to refer me to this colleague and with my PMI I was able to see him in outpatients the same week and choose a mutually convenient time in the Hospital I treat the majority of my own patients (The BMI Chaucer) for the procedure. It was interesting to experience the whole deal for myself and compare my own treatment with what I offer my Private Patients – I have to say I was very impressed, but also pleased that I could rest assured that I don’t think my own patients would have experienced anything different!

I think this ability to choose your surgeon based upon GP, friend or colleague recommendation is going to become ever more important as time goes by – please see my article on training in the modern NHS for further explanation – http://www.nosesurgeon.co.uk/22.php !

I will say one other thing on the subject of PMI – if you have it and have a problem with your health, USE IT! The care you will receive in the private Sector will almost inevitably (as I have just experienced myself) be top class. If you would like to see a specialist, ask your GP to refer you ! This is a ‘win win’ situation for everyone – you get the specialist opinion you want (at no cost to your GP or the NHS) and your GPs time can be spent dealing with other patients who may not be able to afford this option. There is nothing I find more frustrating than when a patient who has negotiated the NHS system (and may have waited an extra long time for a second opinion from me, as many of my patients do) then announces at the time that an operation is suggested that they have PMI ! Your time and NHS money wasted when things could have been so much simpler and quicker……

In summary, despite a huge number of people working extremely hard and enormous amounts of extra cash the NHS continues to really struggle – it’s only going to get worse as expensive new medications, cancer treatments and clever surgical gadgets come into the picture. There’s no new NHS money for these in the pipeline.

If you want autonomy and excellence in your healthcare , with optimal comfort and Hotel facilities for you and your family then you know what my advice is.

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