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
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
But today things are infinitely
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
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
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
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
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
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
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.
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
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.)
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
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
Yet, this horrifying scandal could be stopped within
Waiting lists could be permanently eradicated. And countless
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
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
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
Surely even a politician can work out where to make the
The revised (2003) edition of Vernon Coleman's book
`How To Stop Your Doctor Killing You' is available from the shop on this
Copyright Vernon Coleman