The Private Lottery
MD recently met a group of NHS oncologists, most of whom did private work and most of whom had private health insurance. The private work allowed them to supplement their NHS income and practice the standard of medicine they’d want for their friends and family (longer consultations, quicker access to treatment). And their private health insurance allowed them to get the care they’d want for themselves and their family. As one put it; ‘NHS waits are increasing and for some cancers, that dramatically reduces the effectiveness of treatment and your likely survival.’
Private health insurance, and self-pay for private care, is on the increase for those who can afford it, or whose employers wish to pay. With nearly 4 million people on the NHS waiting list after 7 years of flat-line funding, private insurers and providers are eyeing a big opportunity that will only get bigger with any drop in national income and loss of EU health workers accompanying Brexit. The Conservatives lifted the cap on the amount of private work NHS hospitals can do, to allow them to reinvest profits in NHS services. But as one Oxford consultant put it; ‘The local private services offer taxis to and from treatment. If you’ve got cancer, the extra stress of taking an hour to park at an NHS hospital and worrying about a fine if the clinic overruns shouldn’t be underestimated.’
The private sector has the extra assurance of knowing it can use the NHS as a safety net. A recent report by the Centre for Health and the Public Interest (CHPI) based on an extensive review of 177 CQC reports into English private hospitals has estimated that in the last three years, the NHS has picked up a bill of £250 million for sorting out complications that happened in private hospitals. Some argue that going private takes the strain off the NHS, and that these complications can also happen under NHS care. But transferring patients between hospitals carries its own safety risks and staffing levels in some private hospitals are still scandalously low. Many private providers also resist full scrutiny and make it hard for patients and the CQC to compare safety and quality with the NHS, even though many private hospitals treat NHS patients under contract.
The CHPI report – ‘No safety without liability: reforming private hospitals in England after the Ian Paterson scandal’ – makes 5 excellent recommendations. 1. Private hospitals should directly employ the surgeons and other consultants who work in their hospitals, rather than subcontracting the work out and having less control over rogue surgeons like Paterson, who was jailed for 20 years for grossly negligent breast cancer treatment. 2. Private hospitals will not be truly safe unless they have adequate facilities to deal with situations where a patient’s life becomes endangered following an operation, ending the hazardous transfer of patients to NHS hospitals. 3. Private hospitals must end the reliance on a single junior doctor (a Resident Medical Officer) working extreme shift patterns to provide post-operative care for patients. 4 Private hospitals should be required to adhere to the same patient safety reporting requirements as NHS hospitals in order to enhance the possibility of detecting any risk of harm to patients. 5 The legislation governing private hospitals should be amended to make clear that all those who are registered with the CQC should be fully liable for all the services which are provided within them, including the actions of surgeons and other healthcare professionals.
The inquiry into Paterson will doubtless be interminably protracted, so well done the CHPI for nailing the legislative and operational changes that need to happen now. The current situation is summed up by one of Spire’s legal representatives wrote to one of Paterson’s patients; the private hospital is ‘under no obligation to provide competent surgeons to perform breast surgery at the hospital.’ Private providers argue that it is the job of the NHS and GMC to ensure consultants who play for both sides are competent. But as a CQC inspection reporting to Kent Institute for Medical Services found; ‘The very large number of consultants with practising privileges posed a risk that they would see patients and provide treatment in an unfamiliar environment where they were not used to the equipment and did not know the local policies.’ And as one insurer told me; ‘There are still consultants who play the system, overcharging and over investigating. In some cases they claim to have removed, say, a breast when the breast is still there. We repeatedly warn them but a few just carry on overcharging.’
There is some excellent private treatment available if you happen to know who the best, most ethical NHS consultants are who also practice privately, and do so in well-staffed, familiar surroundings. But it tends only to be local doctors who have that local knowledge. Everyone else is currently in the dark.