I think you’ve made a couple of major errors here.
1. You’ve referred to the 1999 Act, and even quoted the Heading: “Payment for hospital treatment of traffic casualties”. The whole Act is about hospital treatment.
But a Walk-In Centre isn’t a hospital. So the 1999 Act doesn’t apply to it.

2. You’ve not referenced the BMA Guidance that One Medicare is relying on. The whole thing can be found at http://bma.org.uk/practical-support-at-work/pay-fees-allowances/fees/road-accidents, but it certainly seems to back up One Medicare’s stance – even though it’s largely aimed at GPs, not privately-operated Walk-In Centres. Key extracts:

“Under the Road Traffic Act 1988, the first doctor providing emergency treatment to the victim of a road traffic accident is generally entitled to charge a fee. A fee may be levied in respect of each person treated (Section 158(2) of the Road Traffic Act 1988). Mileage is also payable in excess of two miles.

Since 1999 the ability to levy a fee under S158 of the Road Traffic Act has been limited to claims by doctors not working in NHS hospitals, as the cost of hospital treatment is recovered from insurers directly by the NHS. The fee can be levied even if the person driving the vehicle at the time of the accident is on the GP’s NHS list.

…

The BMA’s legal advice is that, while treatment provided at the scene of the accident will be most common, treatment provided at the GP’s surgery can be included in the definition of ‘emergency treatment’ and therefore attract a fee under the Road Traffic Act.

The person driving the vehicle at the time of the accident is responsible for meeting the doctor’s professional fee for themselves, their passengers or anyone injured by their vehicle. All UK motor insurance policies cover such fees and payment of such fees does not constitute any admission of liability.”

I have no idea how common it is for GPs to exercise their right to payment; however, I don’t think that applying BMA advice can in any way be deemed to be “rooting around in Parliamentary legislation for loopholes”. The Guidance seems to suggest that the allowable fee is £21.30, but it’s not been updated since 2006, so it may well be that the fee has since been increased.

I think you’ll find it’s quite normal for the victim of a road accident to be charged. My wife was when she suffered whiplash from a nurse driving into the back of her car on the way back from collecting the children from school. This was about 12 years ago mind.

She claimed it back on the insurance as that is what it’s designed for.

Thanks for the corrections, Rob.

I suppose what I’d take away from the incident is that there is a much bigger difference between a privately operated, NHS branded service and a pure NHS service than is commonly let on.

Obviously, BMA guidance isn’t statutory, but as a private business the One Medicare operated centre can do what it likes and isn’t directed by statute in the same way an NHS service would be.

There’s also less effort to keep money from changing hands as there would be in an NHS service with the certificate system.

Ah, growing interest in the minutiae of legal wording – I wonder if we will see more, or less of this as private providers get their snout stuck in the NHS trough?

A search on Google for “RTA GP fee” led me to this GPs’ surgery site, where they clearly show that they charge £21.30 for treatment following a road traffic accident. http://www.easygp.net/site9511/index.php?section=3093&page_id=15558 (I hasten to add I have no axe to grind against this surgery, it just happened to be the first to appear in my results page.) My own practice’s website merely states that for non-NHS services, a charge will be made – and the 1988 Act seems to make initial treatment following an RTA (the equivalent of) a non-NHS service – I seem to remember the debate at the time being about how unfair it was to expect taxpayers to fund this when there was an insured party at fault…

@Jon, @the a&e charge nurse
I’m not sure I know what a “pure NHS service” outside of a hospital setting is – GPs are “private businesses”, and have been since Nye got the Act through Parliament in the 40s. That doesn’t mean they’re not “directed by statute”, and I can’t see that One Medicare is doing anything novel.

Of all the things to worry about in the NHS, I’m really not sure that the application of a 24-year-old provision deserves people getting hot under the collar.

@1. Rob G: “The Guidance seems to suggest that the allowable fee is £21.30, but it’s not been updated since 2006, so it may well be that the fee has since been increased.”

That sounds about right. £12.30 plus 17.5% VAT (as it was in 2006) comes out at £25.02.

I’m not sure I know what a “pure NHS service” is – GPs have been private businesses ever since the NHS was set up in the 40s, and they’re “directed by statute” as I believe other non-NHS operators are.

A search on Google for “RTA GP fee” led me to the following GPs’ surgery website http://www.easygp.net/site9511/index.php?section=3093&page_id=15558 (I know nothing about them, and certainly have no axe to grind against them.) My own practice’s site merely says that they charge for non-NHS services without listing them, and the 1988 Act seems to make treatment after an RTA the equivalent of a non-NHS service. (I vaguely remember the discussion at the time that legislation was going through being about how unfair it was for the taxpayer to fund treatment that a “guilty” third party had insurance cover for…)

I really can’t see that the application of a legislative provision that’s little shy of a quarter century old is really something to lose any sleep over – in fact, I’d argue that it distracts from genuine concerns and can even discredit anyone warning about those.

Doh, £21.30 plus 17.5% VAT.

@4 – “I wonder if we will see more, or less of this as private providers get their snout stuck in the NHS trough?”

Oh I think we’ll be seeing much much more of this and sooner than you might think. Market-based healthcare providers do not respond to ordinary human need, regardless of the trauma, pain and suffering which that need might encompass – no, they respond to buying power, plain and simple. Those who have the buying power will have their pain assuaged, those without will find themselves with lowgrade care.

Sorry about the repetition – after I posted (5), it didn’t show in my browser

3 DECEMBER 1998
The Road Traffic (NHS Charges) Bill
Bill 3 1998-99

“The NHS currently has the power, under the Road Traffic Act 1988, to recoup the costs of treating the casualties of road traffic accidents. GPs or hospitals may levy an “emergency treatment fee” of £21.70 directly on the patients…”

“NHS hospitals will no longer be able to levy the emergency treatment fee of £21.70. However, GPs and charitable non-NHS hospitals (who will not benefit from the other changes in the Bill) will be allowed to continue charging it if they wish.”

[5] ‘Of all the things to worry about in the NHS, I’m really not sure that the application of a 24-year-old provision deserves people getting hot under the collar’.

It is not the charge per se but what it might signify in the wake of Andy’s mammoth turdburger
http://www.dh.gov.uk/health/2012/03/royalassent/

We’ve got to start clawing £20 billion in cut backs, sorry, I meant efficiency savings from somewhere – what better way than auctioning the NHS off to big business?

@12. the a&e charge nurse: “We’ve got to start clawing £20 billion in cut backs, sorry”

Yes, and the only way to achieve that it is to do different things.

Attention Jon!

http://begthequestion.info/

[14] you mean different as in creating the illusion of progress, or different as in improving clinical outcomes?

The former requires little more than the rhetoric the latter evidence.

We are already witnessing the cack hand of privately run services in the NHS and some of the results hardly inspire confidence
http://www.guardian.co.uk/society/2012/may/25/questions-outsource-nhs-care

One of the LC content checkers deleted previous comments that I made. I observed that £21.30 multiplied by VAT at 2006 rate (17.5%) equals £25.02.

We live in a strange world, do we not.

Apologies for the paranoia and false accusation. I was reading two threads on the same topic at once and jumped to incorrect conclusions.

A&E challenged me about my statement “Yes, and the only way to achieve that it is to do different things.”

I’ll defend those words on the basis that if you can’t do something (owing to lack of money, lack of time, lack of talent etc), you have to try something different.

I do not believe that changing delivery of health care from the NHS to a private care provider changes much; money changes hands but the only difference is who holds the knives or pills. That is not the same thing as doing really different things which are required to reduce health care costs.

If health care is delivered as it is today, it will become unaffordable, even for those on private plans. The options are to ignore the problem or something else.

To repeat myself, I do not believe that private providers, uninformed choice or markets are answers. Affordable health care requires a lot of smart changes.

charlieman

There is one rather big change in a shift from private to public provision of NHS services.

That change is that while one rarely has great insentive to take more money from one’s self – one often has great insentive to take more money from some one else.

Public provision is cheap compared to private provision when it comes to healthcare because, to put it bluntly, the lobbying aspect of such a publicly political activity is vast and expensive.

This can be a good thing. If one thinks that new railways are good – then privatising the rail system is a good idea – since it creates demand for, and thus creates an industry worth hundreds of millions a year dedicated to nothing but getting government to spend money on railways.

The same is true with healthcare. The UK gets more healthcare for the money it spends on healthcare than countries with higher levels of private provision – especially in regards to equality of care (the OECD ranks the UK best in the world for healthcare equality between the richest and poorest 50%s)

Creating multi-billion pound healthcare industry within that creates demand, and so creates, a lobbying industry worth hundreds of millions if not billions – studying laws for possible loopholes, challenging various regulations and conventions in court, and of course – driving up the cost of healthcare by effectively selling to politicians, nice shiny things that cost lots and lots. (The private sector hates NICE, for example, as it evaluates their products on the basis of value rather than on who can best convince the papers and the public and the politicians to spend more)

The article is a tiny illustration of the sorts of rules the UK will have to change in time consuming legislation and test cases as we shift to a privatised model of healthcare. Because if charging patients up front for becomes anything like a regular practice – the public (mainly via the labour party in this particular examjple – since it is about charging for healthcare) will demand the rules are changes to stop it happening.

All very expensive and wasteful – but this will become a normal part of NHS management.

@18. margin4error: “Public provision is cheap compared to private provision when it comes to healthcare because, to put it bluntly, the lobbying aspect of such a publicly political activity is vast and expensive.”

As margin4error wisely pointed out a few paragraphs later, UK health uses NICE to determine whether health care methodology is effective. I think we’d both agree that it is stupid for lobbyists to challenge decisions outside of NICE and conduct (potentially) sly practice to push treatment that NICE does not accept. I wrote “(potentially)” on the basis that NICE may be out of date at times, because opinions and professional values change.

Super-repetition of my words: “To repeat myself, I do not believe that private providers, uninformed choice or markets are answers. Affordable health care requires a lot of smart changes.”

My clarification of “smart changes” is tricky to define. It means that when faced with an overall 10% budget cut, you don’t cut all budgets by 10% or another budget by 30%. It means that you transform everything that you do. In that transformation, you have to assume that there is a better way to do everything.

I trust that after this blow off, margin4error and I can have further civilised conversations. margin4error: “Creating multi-billion pound healthcare industry within that creates demand, and so creates, a lobbying industry worth hundreds of millions if not billions – studying laws for possible loopholes, challenging various regulations and conventions in court, and of course – driving up the cost of healthcare by effectively selling to politicians, nice shiny things that cost lots and lots.”

But NICE changes that, by delivering standards. My guess is that NICE must be defended from bullies, but it has to respect its own limits.

@Charlieman #19:

My clarification of “smart changes” is tricky to define. It means that when faced with an overall 10% budget cut, you don’t cut all budgets by 10% or another budget by 30%. It means that you transform everything that you do. In that transformation, you have to assume that there is a better way to do everything.

And if there isn’t a better way? Services collapse.

You have to spend to save. Finding and changing to the better way, if there is one, costs time and therefore money; if you want to re-engineer processes, you have to budget for an increase in spending for the period over which they will be introduced. This perhaps explains why simply cutting budgets year-on-year by c3%, which has happened annually for a period of at least 30 years (when was the last Budget you heard that didn’t rely upon “efficiency savings”?), has not produced superbly efficient public services.

Thanks for taking the argument seriously, Robin. To me it seems that there is almost universal denial about the affordability of health care in the future — and by health care, I mean more than the NHS — so we have to change the ways that we deliver it.

You state how bad it would be if there is no “better way”. But that is the same consequence as doing nothing (bad outcome guaranteed) which lacks the opportunity for a positive result. Another difference is that by acting proactively, government and health care providers have greater control over how change happens.

I entirely follow the argument that change costs money. Genuinely radical reform of health care will require employment of different people or retraining as an obvious example of cost. And you are entirely correct that “efficiency savings” over recent years are often falsehoods; I’ve worked on enough purchasing contracts to understand that when you cut the supplier’s margins you spend an awful lot of time (opportunity cost) ensuring that the contract is delivered.

Charlieman

I should stress that I only responded to you directly as you had said you don’t believe changing towards private provision changes much. In reality I largely agree with you – but it does only hold true where the phenomenon I outlined is properly managed and mitigated.

NICE is a good institution – but it is flawed. There have already been cases where it has faced such widespread attacks over its refusal to back certain drugs that it has in fact then chosen to do so, or NHS providers have ignored NICE and provided them anyway. It is worth noting in this regard that NICE effectively sets out what NHS providers must provide – and does not ban them from providing other stuff besides. (That is a matter of licensing drugs and treatments as safe, which is not the NICE’s role)

NICE is one useful tool in mitigating the problem outlined – but it does not evaluate most NHS activity nor does it drive the principle of free provision of healthcare. New and clear legislation will be needed to secure those things and remove the thousands of anomalies that have been of little concern in a system of public provision.

A potentially very political example will be abortion.

The NHS Bill effectively privatises NHS budgets to the tune of around £80billion. This sees management companies holding the purse strings for GPs. That should have little impact on abortions in and of itself. Indeed even if the private management firm involved has strong pro-life affiliations, there is a legal requirement to provide abortion where pregnancy presents a health risk to the mother. (We have to hope the law will enforce this law). But here is another anomaly that will thus cost the NHS a lot of money.

Abortion in the UK is a largely private sector service. People pay for their abortions. Officially only where there is a medical imperative does the NHS pay the fee. But in reality hundreds of thousands of non-medical-reason abortions are paid for by the NHS because GPs rightly recognise that a great many women (especially young women) can’t afford very easilly to pay for the abortion, or by paying for it risk exposure to those they don’t want finding out about the abortion (parents, husbands, etc).

Under public provision GPs have been free to sign that off as medical. It isn’t medial. In no way does it qualify as medical. But as a society we let that slide, and the NHS has no imperative to change that. A private provider however, will be under pressure to stop that happening – and indeed will have a contractual duty to stop that happening, since it will be contractually obliged to ensure money is used according to NHS rules only. (Contract law is, in some ways, a bigger concern in a privatised model than the profit motive).

That means we will have to change the law to make abortion available through the NHS for non-medical reasons. (Assuming the UK doesn’t suddenly become very anti-abortion compared to its current position)

That in turn will mean women who have been comfortable, in their hundreds of thousands, with paying for abortions – will no longer do so. And that is a cost burden ahead for the NHS.

I appreciate this hyper-political example is just one long term example – but thousands of similar anomalies work out fine under public provision, that would become legally very complicated under private provision.

This was why I reference teams of lawyers in my post.

Oh – and in terms of the “blow off” – I didn’t take this to be any sort of row.

This is much more a civilised discussion of a complicated issue that the UK (like other countries) is not well prepared to resolve any time soon.

@23. margin4error: “Oh – and in terms of the “blow off” – I didn’t take this to be any sort of row.”

It’s a row if I say it is I merely intended to say that when my arguments are abrupt, I’m just releasing steam.

The abortion argument that you raise is a significant one. Provision/funding of abortion by the the NHS may not be necessary on a purely medical basis but, as you argue, it may be a valid health/social consideration in some circumstances.

In less politically controversial scenarios, there is an overlap between social care for elderly people and NHS care. Money for care comes from the government via agencies, or from the person who requires care (there is something in Parliament about this…) It is a clear area for reform and I partially welcome some proposals.

But I am unsure. NHS and local authority social services care for the elderly must change in more fundamental ways; tossing responsibility between the two is repulsive if you consider the consequences for the “customer”. Any reform of health care has to acknowledge that the NHS is not the sole provider.

A couple of notes:
* The people who try to negotiate between potential carers and funders may not be youngsters.

* My mum’s flat will be sold in twelve hour’s time (I am not bullshitting to make a point; it is what the solicitors intend) in order to pay for her social care — future posts here will be delivered from a Lloyd loom chair. I love the chair and I acknowledge that I’ll get nothing more than it as an inheritance. I love my mum more than any chair in the world.

Just got this from Alex at KONHS, re:t he Broad Lane NHS Walk In centre, Sheffield charging £25 for whiplash injuries.

“Thanks for sending this – we were aware of it. Apparently it has been legal
to charge for whiplash from RTAs since 1999, because it’s all bound up with
insurance companies. It’s not a good precedent.”

Alex Nunns
Information Officer
Keep Our NHS Public

Charlieman

I wasn’t even going to get into the issues surrounding care services – as they are so complex and now so entrenched that they only serve to demonstrate the problems that exist when a fairly informal structural outlook (as is possible with public provision) is maintained when dealing with private provision.

I’m sorry to hear about your mum – or at least about her having to sell her home to pay for her care. I hope she recieves the care she deserves. Many do despite some of the terrible situations that rightly make the front page from time to time.

And yes – any reform of healthcare does have to recognise that the public sector is not the sole provider. But that will mean recognising a very expensive change process in how rules and legislation are framed surrounding a great many areas of provision.

Our difficulties in achieving that with care homes don’t bode well – but that is not to say that lessons can’t be learned and better things achieved if it is done right. I just fear that the debate right now, and the people undertaking change through the NHS are not discussing those issues.

The really sad thing with care for the elderly is of course that if they are basically well, they have to pay for their care by selling their home. Ig they are medically ill in some way – the NHS is legally required to fund their care. That’s a nice big grey line that should have been resolved long ago.

Thanks David

Nice to know people are campaigning on this stuff.