The Secret Waiting List Scandal

The NHS is hooked on waiting lists. Neither consultants nor administrators can give them up. Whatever the Prime Minister, or the current health minister, might say, waiting lists aren't going to go away until one simple change is made to the way the NHS is run. The change that is needed is so simple that it could be implemented nationwide within minutes. But waiting lists would then entirely disappear. Patients (and voters) would welcome the change that is necessary.


The idea of patients having to wait for essential, and possibly life saving treatment, is something we've got used to. But Britain is the only country in the world where patients routinely have to wait for weeks, months or even years for essential treatment. Patients and doctors in other countries don't even understand the concept of a waiting list.

Waiting lists were originally an invention of part-time NHS consultants who wanted to boost their earnings from private patients. They kept their NHS lists long to encourage patients to pay for treatment. I first revealed this scandal in 1986. I was attacked rather viciously by many doctors at the time. But no one has bothered to deny the truth of this for a long time.

But today things are infinitely worse.

NHS hospitals have themselves become dependent on the extra income they receive from private patients. They need the cash desperate patients pay for investigations and treatment, in order to pay the hugely inflated salary bill for administrators and managers. (Astonishingly, there are more administrators than nurses or beds in the NHS today.)

The need to make money this way is made possible because even full-time salaried NHS hospital consultants (the ones who have signed contracts promising to work full-time for the NHS rather than to share their working lives between NHS and private patients) are allowed to charge patients for private treatment - and to pocket the money they make.

Since they don't have private consulting rooms or private hospital facilities available they are, of course, allowed to use NHS facilities, NHS equipment and NHS staff. They are even allowed to use NHS secretaries, NHS stationery and NHS stamps to deal with the paperwork (such as sending out appointments and bills).

The way this works in practice is alarmingly simple.

A patient who needs to have a scan to find out whether their pain is caused by a developing cancer may be told by his or her GP that there is, say, a one year waiting list. But if the patient is prepared to pay for the scan then it can be done within a week. The staff, the equipment and the venue remain the same. There is no welcoming cup of tea for relatives and friends. No obsequious consultant in a pinstriped suit. No explanations, no welcome and none of the perks that patients have traditionally paid for when buying private treatment. 'Private patients' sit alongside the standard (second class) NHS patients and on hard chairs and wait to be called. The only difference is that the patient gets a diagnosis before it's too late and pays the hospital around 500 for the scan and the radiologist between 150 and 200 to send a letter reporting the results. Hospitals and consultants are unashamedly flogging off places higher up the waiting list. If there wasn't a waiting list they wouldn't have anything to sell.

If all this sounds too bad to be true you can check it out for yourself in minutes. Pick a speciality (any speciality). Ring your nearest large NHS hospital and ask to speak to a secretary working for a consultant in that speciality. Name an operation or an investigation and ask how long the waiting list is. Then ask how long you'd have to wait if you paid for private care. Hospital managers don't try to hide what is happening. They brazenly admit that they're flogging places on the waiting list.

If waiting lists were to disappear, NHS hospitals (and NHS consultants) would lose this nice little earner. Many NHS hospitals would go bust and a lot of NHS consultants would have to sell the second BMW and the chalet in Switzerland.

The current system means that the NHS is appallingly unfair.

There have always been inequalities. Some areas have better hospitals than others. It's called a 'National' Health Service but if you have a rare disease then your chances of surviving have always depended on where you live.

But the way the NHS is now run is clearly divisive and grossly unequal. The NHS was founded to ensure that everyone got equal care - regardless of wealth.

The modern NHS is flourishing by taking advantage of the fact that some patients can afford to pay (or will find the money by selling the car or remortgaging the house).

In today's NHS this new way of doing things means that if you're poor and cannot afford to 'buy' a higher place on the waiting list, your chances of surviving your illness are dramatically reduced.

Neither NHS administrators nor NHS consultants want to get rid of waiting lists. Indeed, they have a vested interest in maintaining them and keeping them as long as possible. Bureaucrats are making huge salaries out of the modern, two-tier NHS. And consultants are making a fortune.

NHS hospitals charge the same fees as private hospitals, though they provide a much more basic service. (The precise fees vary from doctor to doctor and hospital to hospital. They know that patients are usually too frightened to shop around to find the 'best buy'.)

Patients are still trusting. And they are a captive market. Consultants working in NHS hospitals invariably charge the same massive fees as genuinely private consultants - but they don't bother with the smiles, the handshakes, the comforting words or the expensive suits. They know that they're not selling 'special care'. They're flogging a chance to be seen this week instead of next year. They're selling a chance to be treated before it's too late. They're flogging a chance to stay alive. You don't have to tart things up when you're selling life itself.

They don't bother with expensive magazines, cups of tea and smiling receptionists. Neither doctors nor hospitals pretend to be offering anything more than a chance to be seen more speedily. Greedy consultants are getting rich, preying on patients who are struggling to stay alive in the wreckage of the NHS.

One reader of mine paid 90 to a consultant for a standard five minute consultation. She had to pay the hospital another 60 for the use of their grubby facilities.

Another reader had to pay 180 to a consultant who reported on a scan. The consultant hadn't even been there when the scan was done. Most patients don't even ask how much the bill is going to be.

`If patients don't ask I don't tell them,' boasted one consultant. `If they want to know how much the bill will be it's up to them to ask.'

The modern NHS consultant has the best of both worlds. He combines a stable income with an excellent pension, sick pay cover and all the other perks of government employment, with the ability to earn a vast amount through `private patients'.

He doesn't even have to go out and find the private patients. The NHS finds them for him.

Doctors have become as greedy and grasping as a bunch of Arthur Daleys. They snatch every penny they can from frightened and desperate patients and their frightened and desperate relatives. And for doctors and hospitals there is a bonus: NHS patients who are seen as 'private' patients cannot use the NHS complaints machinery. The patient may have been seen in an NHS building by a salaried NHS doctor using NHS equipment and dictating his report to an NHS secretary using NHS notepaper but if the patient has agreed to hand over money to jump the queue the hospital won't accept any complaint about itself or a doctor. Patients who pay to jump the queue lose all their rights and safeguards.

When the money runs out, the patients simply go back into the NHS system and waits for the next instalment of their treatment. The NHS has confirmed, however, that patients can jump the queue by doing this.

(And don't think you can use the system and refuse to pay. The modern NHS consultant is quite likely to have an account with a local debt collector. If you haven't handed over your `bribe' money quickly enough you could have the doctor's hired thugs banging on your door.)

The bottom line is that the people in power in the NHS don't want to change things. The politicians know what goes on but they close their eyes and hope no one will notice.

Last year, 300,000 people paid privately so that they could jump the NHS waiting list. Heaven knows how many paid privately for X-rays and scans. It's impossible to say how much we are talking about but this is undoubtedly a multi-billion pound a year scam. If this was happening somewhere hot, dusty and far away indignant MPs would be standing up wagging fingers and there would be programmes on our televisions about it.

The NHS offers a two tier service. Money doesn't buy better care. But it buys faster care. And that's crucial.

Yet, this horrifying scandal could be stopped within minutes.

Waiting lists could be permanently eradicated. And countless lives saved.

The Government simply has to tell NHS managers to stop charging patients. And all hospital consultants must be told to choose between the NHS and private practice. At present, hospital consultants have the security of a huge NHS salary - and the added bonus of fat private fees.

Politicians are frightened that if they confront hospital consultants they will leave the NHS. This is simply a sign that politicians don't understand doctors.

Hospital consultants may grumble but they won't quit. If the NHS becomes one-tier again then there will be no need for waiting lists. And without waiting lists the demand for private care will collapse. There will still be patients who want two TV sets, a fax machine and a private phone. They'll use private hospitals. But there won't be enough private work for NHS doctors to quit.

Of course, NHS hospitals may be short of cash for a while.

I would remind the Government of one simple fact: there are more managers (many of them very highly paid) than there are nurses or beds in today's NHS.

Surely even a politician can work out where to make the necessary cuts.

The revised (2003) edition of Vernon Coleman's book `How To Stop Your Doctor Killing You' is available from the shop on this website.

Copyright Vernon Coleman 2003