Friday, 8 June 2007

Private MRI scanning. Best year ever.

Now that we are coming to the end of Patsy Hewitt's "best year ever" for the NHS it is interesting to ask why, in my region of the W.Midlands and Wales, record numbers of patients are paying for their own CT and MRI scans and other radiology at UK-radiology and at our local Nuffield private hospital.

Many private patients are covered by medical insurance provided by their employers and I am sure in areas such as London, where the economy is booming, many people will "go private" because of this but in my area, which has missed out on the economic boom, patients are mostly paying out of their own pockets and doing so in increasing numbers.

We are also seeing a number of private companies risking their own money setting up private scanning services, even though Nulabour has already negotiated and paid for a vast increase in scanning provision from their friends in the independent sector.

To me, this doesn't indicate improving satisfaction with the NHS. Why is this?

I haven't done a scientific survey or brought in management consultants to look into this but I can think of a number of reasons.

The "improvements" in the NHS have been targeted at the sexier aspects of healthcare and for someone with, say, M.S., sciatica or dementia, access to scanning has not really improved. In fact, because of the pressure to do cancer patients urgently, these patients often wait longer now. Waiting times figures for facet injections, which I do for back pain, are not even collected by the DOH and these patients can still wait indefinitely without breaching any target.

I don't think the process of "NHS dumbing down" is driving radiology patients to the private sector yet. Most patients don't even realise that a Radiologist is a medical consultant and have been blissfully unaware that their ultrasound scans or barium enemas have been done by advanced practitioners for the last few years (if a nurse practitioner is called a "Numpy" should I call a radiology practitioner a "Rumpy"?). Now scans are being reported abroad and the UK medical establishment has lost control over standards but the general public is still unaware of this.

I think the real reason is unmet rising public expectations. When my medical colleagues or their families suffer say, back or neck pain, we tend to give them priority and scan them within a few days. However, like other departments, we also issue "evidence based" recommendations to our GPs regarding who should and shouldn't be scanned and therefore ration access to scanning for the general public. Wanting the reassurance of a normal scan is not considered adequate reason for a scan but it is the reason my doctor friends and, indeed myself, would want a scan. I suppose the distinction is between need and want and, as Dr Crippen points out on his blog, the government has quietly been changing the provision of NHS care from "free and the point of use" to "free at the point of need". So far they haven't specified who will define "need" but I predict this will be a moveable hurdle imposed by a system of incentives like the GP QoF points system.

Nulabour wanted to abolish private practice and private schools and, after 10 years, they are both flourishing. "Vote Nulabour - things can only get better"


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