Howard Croft column: Transparency in NHS needs to be universal

Jeremy Hunt is about to negotiate new contracts with hospital consultants.
Jeremy Hunt is about to negotiate new contracts with hospital consultants.

The proposal that hospital consultants should be compelled to reveal their earnings from treating private patients “as it will prove transparency” is very odd. It will not, of course, prove any such thing, but it may reveal vindictiveness. There are those who regard private medical practice as a repugnant wart on the pristine body of the NHS and morally questionable, but this will not satisfy them.

The situation, as I understand it, is that consultants’ contracts specify that they must work a minimum of seven elevenths of their time in the NHS – for which they are paid seven elevenths of their normal salary. An agreed number of elevenths not exceeding four may be worked in the private sector. An eleventh is half a day, and the basic week is five and a half days.

I do not have strong views about private practice – I am, if you like, an agnostic with doubts – although I do have concerns about queue-jumping. I have to admit that when in the sixties my mother had to wait in pain for over three years to have her varicose veins surgically treated I would happily have forked out to go private. Sadly, I had no money. The fact remains that treating patients privately is not illegal and the NHS is not perfect, otherwise there would be no private practice.

Given the NHS’s penchant for secrecy – gagging contracts, dishonest personnel records, refusal to share with other NHS bodies details of prices paid for consumables on data protection grounds, that old chestnut – this sanctimonious yearning for transparency is a bit much. How I wish, by the way, that I were a supplier of latex gloves to the NHS.

I do agree, however, that transparency is a good thing and universal transparency is even better. Hospital managers, for example, should be obliged to reveal their income from moonlighting – consultancies to pharmaceutical companies and others who supply goods and services to the NHS, for example. In the private business sector, beneficial relationships with suppliers would be viewed as gross misconduct leading to dismissal.

What people do in their spare time is hardly something to be regulated unless corruption is involved. Some teachers, for example, do private coaching, or mark A level exam papers (a nice little earner in my day) but do I need to know how much they are trousering? Some firemen earn a bit on the side doing ladder work – cleaning windows, say – and why not? I don’t need to know his hourly rate. Nearer to home, if the Editor of this publication were to do a paper-round before he makes his way to the office, do you need to know how much he is raking in?

In the old days, of course, when things were simpler, many teaching hospitals had private wings which generated income for the hospital as well as putting a few bob in the pockets of doctors. And it was gentlemanly. Doctors would not charge private patients who were colleagues or family members of colleagues, nor would they charge clergymen and their wives or members of the royal family, indeed, members of any royal family. I don’t remember anyone complaining or getting indignant about it.

I think what is really going on here, bearing in mind that Mr Hunt is about to negotiate new contracts with consultants, is an attempt to undermine the high regard in which they are held in anticipation of a row. I doubt if it will succeed. I also doubt if consultants will go on strike. Most of them are old enough to remember when doctors in Israel struck for a lengthy period. Post strike analysis revealed that during the widespread absence of doctors the death rate fell significantly. Doctors thereafter were perceived as killers.

Let me tell you a story. An old friend of mine, a distinguished neurologist, attended a medical conference in New York during which a local specialist asked him to examine and give a second opinion on a patient. This he did. After the examination, the patient asked for the amount of the fee. This British neurologist was not permitted to undertake private practice because he held an academic appointment (he was a professor of medicine) and this he explained. The patient urged him, saying that he was in America now and in any case he would pay cash in hand. My friend refused.

Can you imagine a politician behaving with such integrity? Many years after this episode the patient died and left his British doctor twenty-five thousand dollars in his will. As my friend remarked at the time: you do the right thing and often it pays off. He put the money into his research fund.