Last month, a widely-shared blog post claimed to show a price list for certain medical treatments, published by an NHS hospital trust in England, and lots of our readers asked us to look into it. The list was also reported on by a number of media outlets.
The blog post claimed this was “the very first price lists since the formation of the NHS”, and represented the NHS “stealthily introducing actual charges to NHS patients at point of need.”
Although the price list is genuine, the blog is missing a lot of context. It is not the first-ever price list published by the NHS, and it has been common for the NHS to charge for a select group of treatments—if patients don’t meet the criteria for getting the treatment on the NHS—for some years now.
The hospital trust at the centre of the coverage has since suspended its scheme, as was also reported by the blog.
Honesty in public debate matters
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Who decides what the NHS pays for?
In England most decisions about what treatments are available on the NHS are made by your local Clinical Commissioning Group (CCG). They are groups of GPs, nurses and other clinicians who plan and buy local health services, including most hospital care. They decide what the NHS in that area should pay for using guidance from other organisations such as the National Institute for Health and Care Excellence (NICE).
Some treatments will only be paid for by the CCG if the patient meets certain criteria, or has an exceptional need; these are now called Criteria Based Clinical Treatments (CBCT). If a patient doesn’t meet the criteria then they can’t usually be treated through the NHS. In the Midlands and Lancashire, for example, treatments that fall under a CBCT policy include tonsillectomies, haemorrhoid surgery and laser tattoo removal.
Why is there a price list?
Some NHS trusts offer patients who don’t meet the criteria the option of paying for their own treatment based on the estimated cost to the NHS, which some trusts claim is “potentially more affordable than the private sector”.
In 2013, the British Medical Journal found that 89% of acute hospital trusts in England offered private or “self funded” services and 13% allowed “patients to pay for one or more services at notional NHS rates, under the self funding scheme”, based on 134 trusts it received data from.
The price list shared by the blog was for such a “self funded” service, provided by Warrington and Halton Hospitals NHS Foundation Trust. The trust introduced self-funding for varicose vein surgery in 2013 and relaunched the scheme in September 2018, though the trust has also said no one has been treated through the scheme yet. On 20 June 2019 it announced that the scheme was being paused and reviewed.