Am I just being naïve in saying that every penny given to shareholders is a penny less spent on healthcare?

A while ago I made this comment in reply to a posting on Dr Crippin’s blog I don’t think I made myself clear at the time and I’d like to take this opportunity to do so. Firstly I was referring to NHS money going to shareholders not payments from insurance companies or self-paying patients. I have nothing against private patients, in many cases I can see why they do it. I do object however to private patients expecting to jump queues in NHS hospitals [1], but that is a different story.
A few years ago the Government supplied quite a number of DGHs with MRI scanners. Many scanners don’t run to capacity. Those that do mainly do so during normal working hours – nine to five, Monday to Friday. This is predominantly due to staffing levels, either radiographers to run the scanners or radiologists to supervise and report the scans. MRI is only one example. Other modalities such as nuclear medicine and CT scanning are in a similar position. These are not insignificant pieces of kit. Any one of these cost between quarter and half a million quid to buy and install, maybe even more if it’s particularly flash. Furthermore they have an accepted life cycle of seven to ten years (Royal College of Radiologists’ figures). After this the technology is superceded, spares are difficult to obtain; they become obsolete.
With all this cyclic capital investment it makes sense to invest in staff numbers to maximise the use of this equipment. It would not be unreasonable to run a scanner 8am to 10pm Monday to Saturday and at least some time on Sundays. Wasn’t it Ian McGreggor who said he paid interest on the loan used to buy the equipment 7 days a week 24 hours a day and should use it by the same principle?
Do we do that?
No! We agree to give 20% of our scans to the independent sector. We pay the likes of Alliance medical [2] more than we would pay an NHS hospital to perform scans for us. We allow them to cherry-pick the easy case leaving the NHS the difficult & costly to perform scans (this means a 25% reduction in the number of patients waiting realistically means only 10% in the time patients can wait). We have a financial crisis. We panic. We freeze posts. We lay off qualified staff further reducing our capacity to perform scans or to react to an increase in demand (if a post is subsequently ‘unfrozen’ you are looking at six months before it is filled[3])

It is this money I begrudge going into the pockets of shareholders.

One hospital with problems… is treating patients with a mobile scanner while its own machine is often switched off. It should run for 10 sessions a week but the trust can only afford six.

(BBC)

[1] I have lost count of the times I have been asked “Can I have it done quicker if I go private?”. The answer is ‘No’. It will always be ‘No’. I do not have the luxury of keeping empty slots for a PP just in case one comes along. I book cases by clinical urgency. Most scans have a 2 week wait anyway.
[2] You will note I refer to Alliance as an example. There are, of course, other companies such as Lodestone, fulfilling similar roles or aiming to do so in future contracts. I am however particularly worried about Alliance. That’s another story. Please refer to the posting entitled ‘Unholy alliance‘ for further details.
[3] Including advertising. shortlisting and interviews. CRB checks are currently taking two months or so and no one in their right mind would give notice until all checks are through. AfC requires 2 months notice.