Health service discovers private clinics are employing the same specialists patients have been waiting two years to see, only with considerably more convenient appointment times
LONDON – The National Health Service has encountered an unusual staffing difficulty after discovering that psychologists, psychiatrists and specialist nurses are leaving public healthcare to work for private clinics offering many of the same services.
The migration has become particularly worrying in ADHD and autism assessment services, where roughly 810,000 children and adults in England are waiting for assessment, The Guardian reports. One NHS trust has already had to restrict access to its neurodevelopmental service for the time being after losing a significant number of specialist staff.
The development presents ministers with an extraordinary question: why would trained professionals move to organisations offering different working conditions when they could stay in a system struggling to meet overwhelming demand?
NHS Waiting List for ADHD and Autism Assessment: Fastest Way to See a Specialist Is to Pay the Specialist
The British healthcare system has developed two increasingly distinct methods of getting an appointment. Under the first, a patient contacts the NHS, joins a waiting list and receives periodic reassurance that their place in the queue remains administratively important. Under the second, the patient contacts a private clinic and finds that medical professionals appear to go on existing during ordinary business hours.
The difference has surprised patients who assumed that the national shortage of appointments reflected an actual shortage of human beings able to conduct appointments. It turns out that the same expertise may be available through a different payment arrangement. It is a remarkable administrative achievement to create a healthcare system in which the doctor is unavailable on Monday but potentially available on Tuesday, provided the invoice is addressed to somebody else.
Private treatment is not necessarily inappropriate, and independent providers can offer valuable extra capacity. The trouble starts when the people providing that capacity have been recruited from an already overstretched public system. Moving an NHS specialist into a private clinic does not create another specialist. It only changes the location of the specialist’s desk. NHS England publishes waiting list data, and the numbers have so far shown no sign of being embarrassed by it.
Government Considers Regulating the Queue After Discovering the Queue Has Become Extremely Long
A government-commissioned review has highlighted growing demand for mental health, ADHD and autism services, along with concern about diagnostic quality and access to appropriate support. The Care Quality Commission is also widening its oversight of private assessment providers. The aim is to protect patients and ensure consistency, both essential duties in a healthcare market that deals with vulnerable people. The NICE guideline on ADHD already sets out how assessment and treatment are supposed to work, and the difficulty is generally in finding somebody to carry it out.
More regulation cannot, by itself, fix the basic arithmetic. If a country has 100 specialists and needs 200, an extra inspection form does not produce the missing 100 specialists. It produces another form. A healthcare manager might then hire someone to administer the form, reducing the budget available for hiring somebody qualified to treat patients, and the new administrator will understandably need a manager. Within a few months the organisation could have an impressive administrative structure surrounding a waiting room containing 810,000 people.
Patients Request Healthcare Rather Than Evidence That Healthcare Is Being Reviewed
The most troubling consequence is the inequality between families who can afford to bypass long waiting lists and those who cannot. For parents seeking help for a child, a timely assessment can affect schooling, wellbeing and access to support. A system that provides quick access mainly to people with enough disposable income is hard to square with the NHS principle that care should be available according to need.
The practical response would be to expand specialist training, improve retention, cut unnecessary administration and make sure public money buys genuinely additional capacity. The Royal College of Psychiatrists and the British Medical Association have both raised workforce pressures many times. Unfortunately these reforms lack the immediate photo opportunity of announcing another national review. Ministers can commission a report within weeks. Training an experienced clinical specialist takes years, and persuading that specialist to stay in an overstretched public service may need something more substantial than a motivational poster in the staff kitchen.
A trust manager, who asked not to be named because the trust is still advertising her colleague’s old post, said the vacancy had been open for fourteen months and had so far attracted one applicant, who was already working there.
Britain remains committed to healthcare that is free at the point of use. The question is whether patients can get to the point of use before the specialist has moved to another building.
Five Humorous Observations
- 810,000 people waiting for an assessment. That’s the population of Leeds in a waiting room. It’s the worst Leeds has ever been.
- The specialists leave for private clinics. Same doctor, different desk, different invoice. It’s like finding out your favourite pub is the same pub with a velvet rope.
- The government commissioned a review of the queue. A review doesn’t shorten a queue. It just gives the queue a PDF.
- More regulation means another form, and then someone to read the form, and then a manager for that person. Soon you’ve got fourteen people, none of whom can treat you, but they’ve all got lanyards.
- They say stay in the NHS and we’ll give you a motivational poster. Hang in there, with the kitten. If a poster of a kitten fixed burnout, I’d have retired at 26.
Satire: this is satirical news based on the reporting linked above. The trust manager, the vacancy and the reactions are invented, and the waiting list for this disclaimer is mercifully short. Anyone seeking help with ADHD or autism should start with their GP. Anyone seeking to know what prat means can find out without a referral.
