Section 1 of the National Health Service Act 2006 (which is essentially the same as section 1 of the original NHS Act of 1946) says that national health service services:
“...must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”
This prevents NHS bodies from accepting payments for NHS services, unless this is provided for in legislation. It also prevents an NHS body from providing an incomplete package of care which patients then ‘top up’.
Patients can of course obtain additional treatment by becoming a private patient for a separate episode of care.
(2) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, and with reference to paragraph 23 of the 1986 guidance entitled “The Management of Private Practice in National Health Service hospitals in England and Wales”, when private inpatients are permitted to change their status to NHS inpatients during the course of a single visit to an NHS hospital;
(3) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, and with reference to paragraph 23 of the 1986 guidance entitled “The Management of Private Practice in National Health Service Hospitals in England and Wales”, whether private inpatients are only permitted to change their status during a course of a stay in hospital at the conclusion of an episode of care;
(4) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, what the (a) maximum, (b) minimum and (c) mean length of an episode of care delivered in the NHS was in the most recent year for which figures are available;
(5) pursuant to the answer of 29 February 2008, Official Report, column 1977W, on the NHS: private sector, how many different types of episode of care exist; and for each whether other episodes of care are allowed to run concurrently with it;
(6) when his Department first collected information on episodes of care.
As outlined in the 1986 guidance, “The Management of Private Practice in NHS Hospitals in England and Wales”, the precise definition of an “episode of care” in this context is a judgment that must be made locally by clinicians and the local national health service, not by the Government, and so there is no reason to specify different types of episode of care. Clinicians may judge that treatments that run concurrently should be regarded as separate episodes.
With reference to paragraph 23, there are no restrictions on when a private inpatient may choose to become an NHS patient. However, the guidance says that private patients who change their status should have their clinical priority for treatment assessed, and should not gain any advantage over other NHS patients. This was reiterated in the 2004 guidance “A Code of Conduct for Private Practice—Recommended Standards of Practice for NHS Consultants”, which said that:
“a patient cannot be both a private and a NHS patient for the treatment of one condition during a single visit to a NHS organisation”; and
“should a patient be admitted to an NHS hospital as a private inpatient, but subsequently decide to change to NHS status before having received treatment, there should be an assessment to determine the patient's priority for NHS care”.
Copies of both documents are available in the Library.
Information on the number or lengths of these episodes of care is not collected centrally.