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Thursday, 6 December, 2001, 14:48 GMT
'Take your pick': Good for patients?
By BBC News Online's Martin Hutchinson
The urgent need to dig deeply into waiting lists is to prompt unprecedented deals with the private sector - and other countries.
Patients waiting more than six months for some operations are to be called up and offered the choice - go private, to another hospital, or perhaps even go abroad for treatment.
The road to this point has certainly been Damascean - it took a European Court ruling to really open the door to Europe, and Labour's previous avowal of all things private in regard to the NHS has now been firmly pushed aside.
However, with patient expectation levels likely to skyrocket in the wake of this announcement, what can they expect in reality?
At present, there are 43,900 people in England waiting more than a year for hospital treatment, so there are likely to be many more if the six-month deadline is applied.
No instant change
In certain specialties, such as orthopaedics or ear, nose and throat, long delays are par for the course, and the south-east of England is particularly hard hit.
There is no chance that all these people will be able to troop into their GP surgeries next week and demand their operation.
Prioritised will be the most seriously-ill - those waiting for heart bypasses, for example.
It is impossible that vast numbers of patients can, at present, be absorbed by the private sector, or by other NHS hospitals.
This is because the nurses and doctors offering care in the private sector are the same ones doing that job in the NHS - there is a finite, and extremely limited supply of both.
Bupa cannot agree to do 100,000 more operations in a year - it does not have, and, like the NHS, cannot recruit the staff to carry them out.
The government is desperately trying to recruit and train more staff, but this could take several years, particularly in the case of specialists such as surgeons.
While there is some slack in the private sector, there is not a great deal.
And whatever deal has to be struck with French or German hospitals must include travel and accommodation costs for patients, and their relatives.
It could well be that surgeons abroad will be keen to keep patients in hospital for longer than their NHS equivalents, as the alternative is discharging them for a long journey home.
The overall price is unlikely to be cheaper than the costs of doing it at home.
Other doctors are less than enthused with the idea of patients having complex surgery many hundreds of miles from home.
He said: "An operation is not like having your hair done.
"You need care before and after - it's difficult to do that if the hospital is elsewhere in the country, or abroad."
Charles Collins, a surgeon from Taunton and Somerset Hospital, said: "Different hospitals use different techniques - perhaps different implants for example in hip operations.
"When the patient runs into trouble, who is going to look after them?"
This will not be a pure choice for the patient - for example, it's unlikely that a patient will be able to pick a hospital with a three-star rating from the government.
Patients will simply be offered somewhere which has spare capacity - take it or leave it.
Each local area will negotiate its own deals with private hospitals - so there will be a shortlist of options for patients rather than long one.
And the evidence is that many will leave it - Charles Collins, who has participated in a similar pilot project, found a very low uptake amongst patients.
"Most patients simply opted to wait," he said.
And that attitude, if reproduced, will do little to shorten Alan Milburn's waiting lists.
It is politically important for waiting times and lists to fall away sharply over the next few years - the government needs tangible evidence that it is making a difference in the NHS.
And many in the NHS see this as a short-term strategy to buy the NHS some time to improve.
He said: "I don't think it will work in the long-term. We have to invest in more doctors and nurses."
It is a ground-breaking announcement from the government - giving NHS patients, for the first time, a limited choice of where and when they receive their operations.
However, the government needs this initiative to be more than symbolic.
It will spend millions getting more patients into an operating theatre - any operating theatre.
They are relying on this to create breathing space for their other NHS reforms to flourish.
If these fail, choice, ultimately, will make little difference.
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