More Privates on Parade

The NHS has always had an awkward relationship with doctors who also practice privately. Unlike schools, where teachers choose state or private, consultants can serve two masters simultaneously thanks to the ‘stuff their mouths with gold’ compromise agreed by health secretary Nye Bevan in 1948, to try to win around the 85% of doctors who had voted against joining the NHS in a BMA plebiscite just 5 months before the new service was due to launch. Bevan – and the consultants – preferred option was to have NHS pay beds which allowed doctors to stay ‘on site’ and not bugger off to Harley Street leaving their junior staff to fly by the seat of their pants. And it also gave private patients the benefits of NHS facilities and emergency care if their treatment went badly awry.

In the event, the creation of the NHS and the provision of universal healthcare made private practice much less popular, with fewer than 100,000 people having private medical insurance in 1950. In the sixties, it made a comeback as a company perk for rewarding workers who couldn’t be paid in cash and by 1974, 2.3 million people were covered (4% of the population). Half of them were treated in NHS hospitals, a much safer option that being stranded in the upgraded nursing homes that masqueraded as private hospitals but had no emergency cover. Only consultants benefited financially from private practice, which led to resentment from junior doctors and other NHS staff who were often roped in to look after precious patients. There was also evidence of consultants using NHS equipment for private patients without reimbursing the NHS and manipulating waiting lists – keeping them artificially long to tempt patients to go private, or to allow private patients to jump NHS queues when they had run out of money (see John Yates book ‘Private Eye, Heart and Hip’ – Eyes passim).

In 1974, ancillary workers “blacked” private patients at Charing Cross Hospital, and Labour health secretary Barbara Castle legislated to phase pay beds out of the NHS completely but ‘only when alternative private provision was available locally.’ This lead to a massive increase in private hospital building – an 80% increase in beds up to 1979 alongside widespread industrial action and lengthy NHS waiting lists. By 1980, 26% of the population had private health insurance and Barbara Castle was dubbed ‘the patron saint of private medicine.’ The danger for patients of this new arrangement was that although many private hospitals had plush rooms and nutritious food, they still didn’t have cardiac arrest teams or intensive care. MD’s only foray into private practice was to be the only on call doctor covering an entire hospital over a weekend in 1988. There was no hand over, I didn’t know anything about any of the patients and the cardiac arrest trolley consisted of a bottle of port and the death certificate book. The only hope of survival if something went wrong was for someone to spot you were ill in your private, secluded room and call 999 to transfer you back to the NHS safety net.

How safe are private hospitals today? Last week, the Health Service Journal reported that assistant coroner for Manchester West Simon Nelson has written to Jeremy Hunt warning about poor processes for emergency transfers, the lack of responsibility private companies have for consultants they use, and junior doctors working alone for 24 hour shifts with a lack of training and monitoring. He has given Hunt until next month to respond, following his investigation into the care of 77 year old Peter O’Donnell. Mr O’Donnell, who was an NHS patient, died in January 2017 after hip replacement surgery at BMI Healthcare’s Beaumont Hospital in Bolton. His hospital-acquired pneumonia was not promptly recognised by staff, who dialled 999 to rush him to the Royal Bolton Hospital four days after his surgery, where he died from a cardiac arrest, organ failure and sepsis. The coroner cited an excellent report by the Centre for Health and the Public Interest, which is also investigating the rogue breast surgeon Ian Paterson (Eyes passim). CHPI points out private hospitals are likely to have profited handsomely from his malfeasance. ‘The 750 patients who underwent breast surgery and numerous other unnecessary procedures will have generated a very large amount of revenue stream for Spire Healthcare, which employed him as freelance surgeon. This large income stream could have meant that there was no strong incentive for the hospital management to look closely at the nature of Paterson’s work’. CHPI recommends consultants be directly employed by private companies who should have responsibility for monitoring performance, and the coroner agrees. Whether Hunt will agree remains to be seen, but with a substantial number of NHS operations now outsourced to the private sector, the safety holes in private hospitals could trap anyone. FFI www.chpi.org.uk