Often, these are offered at cheaper rates than in the private sector but are increasingly seen as a new revenue stream to boost hospital incomes at a time that the NHS is making stringent savings.
The data was obtained by the British Medical Association’s BMJ journal from 134 acute hospital trusts in England. It found that 119 trusts (89%) now offer traditional private care or self-funded services, with 21 (16%) having added new self-funding or private treatment options for 2013-14. Also, among those surveyed there are also 17 hospitals (13%) that now allow patients to pay for one or more services at notional NHS rates, under the self-funding scheme. However, this shift has triggered a debate within the NHS.
Providers claim that self-funding schemes ‘allowed patients to access restricted treatments at a cheaper rate than in the private sector, making care more accessible, and are fair because patients are treated exactly the same as NHS patients and any income is reinvested into the service.
Critics argue that the growth of self-funding clouds the waters between private care and the NHS by creating a two tier system and could also disadvantage NHS patients because, unlike more traditional private patients, self-funding patients are often treated in the same premises as NHS patients.
NHS Trusts that have introduced new options for patients in the past year include Warrington and Halton Hospitals (varicose vein surgery), Epsom and St Helier University Hospitals (liver scans and age-related macular degeneration) and Princess Alexandra Hospital in Essex (imaging services and chemotherapy), while Mid-Cheshire Hospitals NHS Foundation Trust also recently began to offer self-funded treatment cycles of IVF treatment for patients who used up their NHS funded cycles.
The Foundation Trust Network (FTN), which represents NHS foundation hospital trusts in England, said such self-funding schemes would not impact significantly on NHS care because most hospital trusts ran selffunded care alongside NHS care and had systems in place to ensure selffunded patients did not queue-jump if treated in the same facility.
Frances Blunden, the FTN’s commercial and regulatory advisor, said: ‘It is clear that the NHS is under pressure and commissioners are doing more to scrutinise referrals and are being much tighter about the treatments they fund. ‘What self-funding means is that patients can get treatment that they will not otherwise receive unless they cover the cost.’ She believes such schemes are not disadvantaging general NHS patients and there is a patient demand for the self-funding option. ‘At a time of serious financial difficulties, this brings additional income, which helps to cover fixed costs’ – and thus ‘a benefit to the wider NHS organisation’. However, the King’s Fund (healthcare think tank) said that regardless of price, care is still funded from patients’ own pockets and driven by cost restrictions. King’s Fund chief economist John Appleby believes it’s ‘a private scheme’, essentially paying privately for NHS care. As selfpay schemes expand, he adds, they must be strictly governed and separated from NHS care to ensure those patients are not adversely affected.
David Hunter, Professor of health policy and management at Durham University, warns that self-funding schemes could herald ‘a two-tier or multi-tier system that’s complicated and inequitable,’ and lead to commissioners and providers focusing energies on more lucrative procedures to raise additional funds.
The Foundation Trust Network (FTN) is the membership organisation for NHS public provider trusts and represents more than 200 large acute and specialist hospitals through to community, ambulance and mental health trusts. Previously a senior policy manager at the NHS Confederation, a membership body for organisations that commission and provide NHS services, Frances Blunden, the FTN’s commercial and regulatory advisor, plays a leading role in the networks’ efforts at a time when the NHS regulatory framework is undergoing constant change.