Tens of thousands of Scottish NHS patients are being sent to hospitals far from their homes at a cost of more than £200 million a year to the health budget, to reduce local waiting lists and plug gaps in specialisms.

The travel and accommodation expenses of friends or relatives accompanying patients judged vulnerable are also being covered.

The practice of sending patients to other hospitals, often many miles away and sometimes in England and even at private hospitals, has been justified by a Scottish Government spokesperson, who argued that “specialist treatments on a regional or national basis often leads to better outcomes for patients”.

The Sunday Herald, using freedom of information legislation, asked all 14 Scottish health boards how many patients were sent to hospitals outside their areas, where they went to and what the cost was to the local board. So far 10 have provided information, although not all have responded fully to our inquiries.

We also asked the Golden Jubilee Hospital at Clydebank (formerly the private HCI) the same questions. The Golden Jubilee specialises in heart and lung treatments but is also NHS Scotland’s National Waiting Times Centre, the flagship hospital where patients are sent to cut waiting lists.

In the year 2016/17, the latest figures available, the hospital treated 40,929 patients referred from health boards across Scotland (a spokesman said the 2017/18 figures were likely to show an increase) at a cost of £50,484,00, which was almost all of the hospital’s income.

Professor Cam Donaldson, an eminent health economist at Glasgow Caledonian University, said, “This is done to help with waiting list figures. It’s quite reasonable for one part of the system to accommodate another.”

There is no pressure on patients to accept having their operations carried out in a hospital they may never have visited, but faced with lengthy waiting lists in their own area – or with the promise of specialist care – many agree. “In this way it’s treating Scotland as one complete system,” Donaldson said.

Health boards negotiate deals between each other and with private hospitals for the best possible prices, so-called service agreements, although the contracts are not publicly available and the Scottish Government did not respond to questions about how treatment costs are worked out.

However, the amount of money spent and the numbers of patients involved is staggering.

Last year NHS Lanarkshire spent £167,341,000 on service agreements, sending more than 220,000 patients outside the board’s area, although a spokesperson stressed that the actual number could be less than this because the total includes some repeat visits.

Almost 4000 of these patients were sent to the Golden Jubilee, at a cost of £3.69m. Around 2000 were sent to private hospitals, such as Ross Hall and Nuffield in Glasgow, at a cost of more than £3m. “In order to meet treatment time guarantees Lanarkshire acute patients can be referred to private healthcare facilities for operations,” the spokesperson said.

Lanarkshire also sent patients to England for treatments, to Priory clinics (as well as in Scotland), for drug and alcohol problems, and to the Retreat, in York, for eating disorders.

“Where possible all patients are treated within NHS Lanarkshire,” the spokesperson added. “There can be circumstances, however, where this is not feasible where, for example, the specialty is not available within NHS Lanarkshire or demand is higher than can be provided. Private providers are only used when necessary.”

NHS Forth Valley “paid approximately £45m to other Scottish NHS boards for acute services in 2017/18”, a spokesperson responded without supplying patient numbers sent out or detailing where they went.

NHS Grampian spent £16.239m in 2016/17 on sending patients hospitals outside its area. A spokesman confirmed that Grampian also paid for travel and accommodation costs for adults accompanying patients where necessary. He said: “We are committed to ensuring patients are seen as quickly as possible which means occasionally people are offered the opportunity of surgery elsewhere during peaks in demand.”

Ayrshire and Arran did not provide details other than that: “The Golden Jubilee National Hospital (GJNH) has carried out 578 orthopaedic procedures,” a spokesperson said, “at a cost of £1.25million".

NHS Fife has not responded to our FOI request. NHS Lothian had not provided the information as we went to press last night. Nor had Tayside or Dumfries and Galloway

The Western Isles board, which covers a large geographic area, spent £8.9m sending 2,203 patients to other hospitals, including 185 procedures carried out at the Golden Jubilee.

NHS Highland said that 1,345 procedures were carried out on its patients by the Golden Jubilee but did not provide cost to the board or total numbers of patients treated in other hospitals. “Due to the number of individual service level agreements with the Golden Jubilee National Hospital and the individual complexities,” a spokesperson said, “it is not possible to give a breakdown of costs incurred to NHS Highland for these treatments as it would exceed the cost of compliance.”

NHS Orkney responded that in the year to March 31 this year there were 35 admissions to the Golden Jubilee and 478 to other boards, but said that “information was not collated in a way which would make this [the costs incurred] possible.

Shetland referred 1282 patients (including 193 to the Golden Jubilee) at a cost of £7.68m.

NHS Borders referred just 46 to the Golden Jubilee – cost £146,132 – 42 to the private Glasgow Nuffield (£229,609) and six to Murrayfield (£35,225). The board spent over £18m on referrals to other boards in Scotland and to NHS Newcastle, Cumbria and Northumbria.

Greater Glasgow and Clyde sent 3,487 patients to Golden Jubilee in the last year, to ease waiting lists and at a cost of £2,955,380. A spokesman said that “NHSGGC does not refer patients to other NHS hospitals, unless NHSGGC does not provide that service locally eg. to NHS Lothian for liver transplantation, Golden Jubilee for cardiac surgery.”

A Scottish Government spokesperson said: “There are often very good reasons why patients are treated in another health board area, particularly if they need specialist treatment that is provided at a regional or national centre. In some cases it might be easier for a patient to go to a hospital in a neighbouring board area, because it is nearer to their home.

“Indeed, in the case of the Golden Jubilee, the hospital has a strategic role as a regional and national resource providing specialist services to patients from across Scotland.

“Where services are best provided locally, we expect boards to do so. However, providing specialist treatments on a regional or national basis often leads to better outcomes for patients, because clinicians have a sufficient volume of cases to maintain and improve their skills.”

CASE STUDY

Eileen is in her mid-sixties and lives on the outskirts of Aberdeen. Her sight had been worsening for several years but in the last six months seemed to plummet. It got so severe that she became afraid to drive and driving was necessary to visit relatives and in the part-time voluntary work she does.

“I hadn’t properly taken care of my eyesight, I suppose,” she says, “not getting the regular check-ups I should have done. But it got so bad that it was scary even to think about driving so I went to the optician and was told that not only had I cataracts but that they were severe and needed urgently dealing with.”

She was referred to an NHS Grampian ophthalmology clinic. “The hospital said that I needed the cataracts removed but that the waiting list was long. They wouldn’t say how long at first but I pressed saying, 'Are we talking six months? More?' and there was a nod. I said I couldn’t possibly wait that long, that I was almost blind, couldn’t drive and that’s when they said they could refer me to the Golden Jubilee Hospital at Clydebank where I could get the operation done within days probably.

"I said, almost as a joke, ‘My eyesight’s so bad I’m not sure I could find the way’. And there was also the cost. They told me, ‘It’s fine, we’ll pay the costs and you can also take someone with you to help and we’ll pay their costs too. It should be in and out in a day’. They added that if it required an overnight then we could stay at the hotel attached to the hospital.

“I was amazed. I didn’t realise that this kind of thing happened. I didn’t realise you could be sent across the country, I just assumed it had to be done locally. It’s a relatively simple procedure so I really don’t understand why you need to be sent over a hundred miles away to have it done. And it it must cost a lot more than having it done in, say, the Royal [Aberdeen Royal Infirmary].”

In the end, and after talks with her husband, she decided that the delay and the inconvenience was not worth it and decided to have the operation done privately.