Is eczema an election issue? NHS privatisation and the British dermatology crisis

A week before the country goes to the polls, dermatology provision in the UK is teetering on the brink of a major crisis. A report issued this week from an independent health think tank reveals the desperate lack of training for GPs in skin conditions and their treatment. But the most alarming news comes in the shape of the dismantling of existing dermatological services and the resulting ‘mass exodus’ of NHS dermatology consultants in its wake, leaving eczema patients with nowhere to go.

If you suffer from eczema or other skin conditions you will already know how woeful and under resourced the level dermatology care that your local GP is able to provide. Which is desperately ironic as skin issues make up a massive percentage of visits to GPs, in fact 24% of the population will make a visit to their GP each year with a skin complaint.

24% of the population will visit their GP each year with a skin condition yet GPs receive just six days dermatology training
A report on the state of the country’s dermatology provision from health think tank, the Kings Fund this week lays the facts bare. “GP dermatology teaching averages approximately only six days and most GP training schemes have no dermatology attachment,” says the report. “Dermatology undergraduate training averages a couple of weeks at most, is variable in terms of quality as well as syllabus, and it is not compulsory.”

And for the 13 million GP consultations for skin conditions each year there are just 650 skin specialists across the whole of the country to advise GPs and provide specialist care.

The psychological affects of skin conditions have been highlighted again and again, from cross-party reports from MPs to actions groups such as Changing Faces, yet these needs remain tragically unmet by GPs who are poorly equipped to meet the needs of their patients due to the low priority of skin disease and its impact on quality of life in medical training.

But most worrying of all, as people with skin issues are predominantly treated as outpatients, dermatology provision – even in its specialist capacity – has been extremely vulnerable to quiet and swift privatisation. Dr. David Eedy, President of the British Association of Dermatologists (BAD) believes that dermatology has been seen as an easy service for NHS commissioners to shift ‘into the community’ due to a widely held but mistaken view that skin diseases are minor ailments and can be easily identified and treated locally, reducing the burden on hospitals.

“The drive to shift treatment into the community leads to decommissioning of Dermatology hospital services,” says Dr Eedy. “Another concern is the practice of ‘cherry-picking’ by private healthcare providers who are more likely to take on relatively easy, high volume, lucrative work in the interests of profit. The upshot of this is that the local NHS hospital department is left to pick up the more difficult and expensive work while saddled with increased financial pressures.”

Dr Eedy goes on to explain that there have even been cases of independent providers tendering for dermatology services without even having dermatologists or other appropriately trained staff in post. This could be explained by the commercial confidentiality clauses that can, according to Dr Eedy, “stifle transparency,” when private companies are involved in bidding to provide healthcare services. “This makes it hard for external bodies to scrutinize whether the new service is compliant with national guidelines,” he says.

One particular case very close to my heart is the closure of the acute dermatological services at Nottingham University Hospital (NUH) Trust earlier this year. Long upheld as a centre of excellence in dermatology – and in fact my first ever visit to a sympathetic specialist dermatologist when I was in my teens. The reason for the closure? Six of its eight consultants walked out after refusing to work for a private subcontractor, which had been awarded the contract to provide the majority of local dermatology services in the area.

Nottingham University Hospital, which closed its acute adult dermatology service earlier this year
But the news gets worse. The subcontractor awarded the contract was Circle, you may remember the private health care company from the news earlier this year. Circle became the first private company to run an NHS hospital when it took operational control of Hinchingbrooke Health Care NHS Trust in February 2012.

In January 2015, Circle announced its intension to withdraw from the contract, just three years into the 10-year agreement, following a damning review of its services from a health care quality watchdog, leaving the taxpayer to pick up a massive bill for its lack of understanding of the actual costs of running a hospital.

“We expressed concerns that Circle’s bid to run Hinchingbrooke had not been properly risk assessed and was based on overly optimistic and unachievable savings projections,” said Margaret Hodge speaking at a parliamentary committee reporting on Circle’s failure to deliver.

Private health care provider, Circle - famous for its failure to run Hinchingbrooke Hospital, has taken over dermatology service in Nottingham.
Private health care provider, Circle – famous for its failure to run Hinchingbrooke Hospital, has taken over dermatology service in Nottingham.
It has been reported that the senior dermatology consultants at Nottingham refused to join the private contractor largely due to lack of opportunities for proper academic research and training under Circle’s management.

“Nobody has thought through the implications for teaching, training and research – the whole future of British dermatology,” said Dr Eedy commenting on the closure of NUH’s dermatology services. “Nottingham is just one example of the many fires we are fighting across the UK to try to keep dermatology services open in the face of poorly thought-out commissioning decisions and the Government’s lack of understanding of the implications of pushing NHS services into unsustainable models provided by commercially driven private providers or enterprises.”

Labour’s shadow Health Secretary, Andy Burnham believes that the Nottingham dermatology crisis has revealed that the true ‘ideological intent’ of the Government’s NHS plans is becoming clearer by the day. “They ploughed on with this privatisation even though doctors said they would leave,” he said. “It shows competition lawyers, not consultants, calling the shots in the Coalition NHS. Labour will scrap the competition culture and put the right values at the heart of the NHS.”

While NHS dermatology provision is far from adequate, if academic research and training provision is at greater risk under private management and rare centres of excellence are closing their doors – privatisation of dermatology, its lack of accountability and questionable track record in proper financial management could be the final nail in the coffin for the kind of improvements that are desperately required for patients with skin conditions in urgent need of better specialist care.

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