Examination of Witnesses (Question Numbers
260-279)
MR DAVID
MOBBS, MS
RUTH JARRATT
AND MR
STEPHEN LLOYD
8 JULY 2008
Q260 Paul Flynn: What is the obesity
proportion?
Mr Mobbs: I think we did 500 obesity
cases last year. Some parts of the NHS offer obesity surgery,
some parts do not, which is why we offer it. When you look at
the issue of cosmetic surgery, it is a very small proportion of
what we do, and when you look at the range of motivations for
cosmetic surgery, yes, at one extreme you do have people that
want to do it for vanity reasons, at the other extreme you have
people that do it for profound psychological reasons, and in the
middle you have a whole bunch of people that do it for esteem
and wellbeing issues, and to try and disentangle one from the
other is almost impossible. It is such a small proportion of our
work.
Q261 Paul Flynn: Do you have surgeons
that work both for you and for the Health Service?
Mr Mobbs: The majority.
Q262 Paul Flynn: One of your surgeons
earned three-quarters of a million last year. Could you compare
the income that he or she gets and the work he or she does in
the Health Service and the work he does for you? I am going to
give you an example. I know a surgeon that does three operations
a week for the Health Service and ten operations a week in his
private practice and earns a great deal, more than three-quarters
of a million. If they are working for both you and the Health
Service do they have a vested interest in keeping up a high waiting
list rate in order to act as a recruiting sergeant for private
medicine?
Mr Mobbs: No, I do not believe
they do.
Q263 Paul Flynn: Can you give me
an example? Say a theoretical one is earning three-quarters of
a million. How much would he earn for you and how much would he
earn for the Health Service?
Mr Mobbs: I do not know what his
NHS salary would be. I suspect an NHS salary would be between
£100,000 and £150,000. It might be more if there are
special awards for merit.
Q264 Paul Flynn: So he would be earning
about £600,000 from you?
Mr Mobbs: It really depends on
what speciality he is in but yes, he can actually earn considerably
more in private practice than he can in the NHS.
Q265 Paul Flynn: So where does he
put his best skills and his best effort, do you think?
Mr Mobbs: I think he puts his
best skills and his best effort in both sectors because if he
does not have a thriving NHS—
Q266 Paul Flynn: Because he is a
saintly person, would you say? He is not in it for the money at
all?
Mr Mobbs: If I might just describe
the situation. If he does not perform high quality surgery in
the NHS, then he will not have the reputation to be able to receive
patients on an independent basis.
Q267 Paul Flynn: If he is providing
that service do you think it is fair, reasonable and equitable,
that he does three operations for the NHS and a dozen in your
field?
Mr Mobbs: I think that is more
of a political question in terms of the design of the overall
health system we have in the UK. I do not think that is just a
charity issue.
Q268 Paul Flynn: The work you get
from the NHS is about 10%, is it, 20%?
Mr Mobbs: Last year we did 10%.
The year before that we did about 20%.
Q269 Paul Flynn: And that is because
of falling waiting lists?
Mr Mobbs: No. We are making a
contribution to modernising the NHS. That is how we see it.
Q270 Paul Flynn: It coincided with
falling waiting lists.
Mr Mobbs: We have helped to reduce
the waiting lists by the work we have done, yes, you are right.
Q271 Paul Flynn: I am sure you have.
If it fell to nothing, would you still have a claim for charitable
status?
Mr Mobbs: I think, our charitable
status is not actually tied to the length of the waiting lists.
Q272 Paul Flynn: No, the number of
NHS patients. If all your National Health Service patients disappeared,
waiting lists gone down to zero, then no-one would want to jump
the queue.
Mr Mobbs: Oh, I see what you mean.
If we did no NHS work whatsoever, would we still be a charity?
Yes, we would because we are established for the public benefit.
The issue for us then, we would have to examine, is how accessible
is our public benefit. So, we stay being a charity then the issue
is how is that charity operating. On the basis that we offer services
from a few pounds to a few thousand pounds, we believe we offer
access across a whole range of services for a whole range of incomes,
so I do not believe that we would have a problem with that.
Q273 Paul Flynn: How are your NHS
patients selected?
Mr Mobbs: Broadly they select
themselves either through patient choice or the NHS trust selects
them if they sub-contract.
Q274 Paul Flynn: If you have a cross-section
of NHS patients coming in, the rest of your patients are from
which category of society? I mean are they all people in the top
income bracket or the medium to top income bracket?
Mr Mobbs: No. We track our admissions
by postal code, so, for example, about 11% of our admissions come
from either hard-pressed or only moderately off postcodes.
Q275 Paul Flynn: How do they get
into your hospital, apart from the NHS patients? We are dealing
with the ones that come in. How do people come in?
Mr Mobbs: If you do not come in
free at the point of delivery by the NHS Choice or an NHS contract,
you can come in either by an insurance scheme that you pay for
yourself—
Q276 Paul Flynn: How many people
in that category, in the lowest income levels, let us say the
bottom decile of income, can afford a health insurance scheme,
and why on earth should they pay?
Mr Mobbs: I think the issue is
that insurance schemes are only one route to come in, and again
I think what we are doing—
Q277 Paul Flynn: We can talk a bit
but I do not want to take up too much of the time of the Committee.
Have you got some accurate picture of the income of your patients
who are non-NHS patients?
Mr Mobbs: No, we don't actually
take data on our patients in relation to their income. But what
we do is track where the admissions come from and, as I have just
said, about 11% of our admissions come from hard-pressed or moderately
off postal codes.
Q278 Paul Flynn: How do you know
that?
Mr Mobbs: Because we track that.
Q279 Paul Flynn: How do they get
there? I am sorry, but it is an implausible reply. I find it very
difficult to believe that someone who is hard-pressed—
Mr Mobbs: They pay for the service
themselves. The most common procedure that we undertake is less
than £100. People pay for themselves.
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