When Madeleine Dickens went to her doctor in Brighton about an increasingly troublesome bunion, she was surprised and pleased to get a quick appointment with a consultant, but what she hadn’t reckoned on was finding her NHS care being delivered in the private sector.

Persistent foot pain in her right foot had first driven Madeleine to her GP, who was happy to refer her to a specialist. They didn’t discuss who this would be, so on the day of her outpatient trip she was not expecting to walk through the doors of a plush private health clinic in Burgess Hill.

“I was surprised on both counts [an appointment with a consultant rather than say a nurse practitioner and in a private clinic], but in particular to not be going to the podiatry clinic at the Brighton General.”

Madeleine is a member of a local NHS campaign group, so is more aware than most about the use of private companies in the NHS and because of her objections would certainly have opted to stay within the NHS if she had been given a choice.

After a short examination of her foot, the consultant proposed an operation, another surprise as Madeleine thought that under NHS guidelines a patient has to be almost immobilised to qualify for an operation and she certainly was not.

Further puzzlement followed when the confirmation letter arrived.

“Much to my astonishment the only hospital proposed was the Gatwick Spire which I knew was a private hospital.”

Madeleine immediately phoned the contact on the letter to say she didn’t want to travel to Gatwick and that she wanted to be treated by the NHS. The contact said all they could do was to transfer her back into the NHS.

This seemed odd as at no time previously had she opted ‘out’ of the NHS, so why was she having to transfer ‘back into’ the NHS.

Back of the queue

The transfer ‘back into’ the NHS turned out not to be as easy as suggested, as when she phoned the NHS trauma and orthopaedic department a few weeks later they had no record of her, nor had they any record of the consultant Madeleine saw in the private clinic.

So as a result of not wanting to be treated in the private sector, she had effectively been shifted right to the back of the queue.  

Madeleine’s experience throws up numerous questions –  at what point did Madeleine ‘leave’ the NHS? Why was she never given a choice of where her operation would take place? Why had she been offered an operation that appeared to go against guidelines? Why had the NHS departmental secretary not heard of the consultant?

Madeleine has now heard of others with similar experiences.

Madeleine has also taken her case up with the local CCG and has now been put back into the system and as a result she has now seen an advanced nurse practitioner and has an appointment to see an NHS consultant. 

In Brighton and Hove, foot conditions (and other musculoskeletal conditions, hip, knees etc.) are dealt with through the Sussex MSK Partnership, which has admitted that things had gone wrong in Madeleine’s particular case.  The Sussex MSK Partnership is made up of Here (also known as Care Unbound, an employee-owned limited company), Horder Healthcare (a charity), Sussex Community NHS Foundation Trust (SCFT) and Sussex Partnership NHS Foundation Trust (SPFT). 

The partnership operates as a not-for-profit organisation under contract to Sussex CCGs, including Brighton and Hove CCG. The contract covers taking patients from first referral from a GP or self-referral through the treatment process. 

Community clinic

According to the partnership’s website, referrals are assessed by clinicians, with the most likely next step an appointment at a local community clinic with one of several different types of clinicians, such as a consultant, nurse specialist, physiotherapist or podiatrist.

If an operation is considered to be the best option, then the operation could be carried out by NHS hospitals in SCFT or SPFT or private hospitals, including those owned by Spire and BMI. 

The use of the private sector for operations within the MSK pathway has grown steadily since 2014, coincidentally the year the Sussex MSK Partnership was set up. 

As a result of a freedom of information request by a group of retired GPs in Brighton & Hove it is known that from 2013/14 to 2017/18 the proportion of NHS-funded hip operations conducted in private hospitals increased from 24.5% to 54.5% each year and for knee operations the figure was 26.2% (2013/14) to 57.8% (2017/18).

In addition, the FOI found that the private hospitals were paid per operation and used their own selection criteria to choose patients. 

These figures show that over just a few years use of the private sector has sky-rocketed and it has become normalised in the NHS. In Madeleine’s case (and perhaps many others) patients are no longer being given a choice of NHS or private, but just shunted through the pathway.  Many people wouldn’t have noticed that they were going to a private clinic for an appointment, and even if they did are unlikely to complain in the same way as Madeleine. We have to hope that if they do, they don’t also wind up at the back of the queue.


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