The private healthcare sector and patient safety – will it ever change?

There are plenty of reasons why the private healthcare sector is a booming business because there are plenty of reasons why a patient will choose private healthcare over that provided by the NHS. These include quicker access to treatment and care, greater choice of when and where to be treated and by whom, and the option to have treatment that is not offered on the NHS. Further, many companies offer private healthcare insurance as a perk to employees and there are even beneficial packages offered by private healthcare companies to incentivise “self-pay” patients. Whilst the chronically under-funded and under-resourced NHS creaks ever more, especially with the added pressure created by the pandemic, the private health sector arguably does fulfil a beneficial role in enabling access to treatment for some patients who otherwise might not be able to receive it or who might be significantly delayed in receiving it on the NHS – although I emphasise the some in that sentence and I also acknowledge the argument that the private sector drains the NHS of staff and resources.

Whatever the arguments are regarding the merits or otherwise of the existence of the private healthcare system, its use is rapidly increasing yet there have been and remain many concerns with it with respect to patient safety. I have a particular interest in the private healthcare system stemming from my time shortly before I retrained as a lawyer during which I spent several months working in various locum posts in and around London to save up to pay for my law school fees. One of the longer posts I worked in was several weeks as the single RMO (Resident Medical Officer) in a private hospital near London. Having spent nearly five years working as a junior doctor exclusively in the NHS up to that point, my time during those weeks in the private healthcare sector was an absolute eye-opener, and sadly not in a good way. I discovered that, behind the façade of a smart nicely decorated hospital housing individual patient rooms each with its own television and plush long pile carpets, the reality of patient safety was really rather different.

I had a number of experiences during my time as the RMO in that hospital that probably coloured my view of the private healthcare sector forever. In particular, I recall one incident in which a patient suffered an unexpected acute and profound upper gastrointestinal haemorrhage, needless to say in the middle of the night. However, the patient’s consultant refused to come to the hospital to see them despite my repeated requests, and ultimately pleas. In the end, whilst resuscitating the patient as best I could, I resorted to having to call the on-call anaesthetist and then the on-call surgeon. The patient was taken to emergency theatre a short while later and had a large bleeding duodenal ulcer oversewn. I cannot properly explain the extent to which the conduct of that patient’s consultant astonished me at the time: it was, of course, deeply unacceptable. Worse still, no-one seemed to care. It was, I am certain, sheer luck rather than judgement on the consultant’s part that I had had a few years’ worth of experience behind me so I knew what to do with a patient with acute haematemesis (vomiting of blood) – I had by sheer fortune done 18 months of gastroenterology by that time and had treated it before – many RMOs would have been considerably less experienced and may not have known what to do, potentially with disastrous results. Although the patient in this case never knew exactly what had happened, a personal room, television and a plush carpet will not make one iota of difference if the consultant cannot be bothered to attend when a patient becomes acutely ill. As noted above, this was not the only incident at that hospital that I experienced, but it was certainly the worst and, as a result, I developed a rather deep suspicion of the private healthcare sector.

A couple of years later when I started in law as a trainee solicitor in claimant clinical negligence work, I discovered my experience was by no means unique. A little while before I joined my firm, my then boss had settled a case of a patient who had died in a (different) private hospital following routine surgery, in which the attendant treating consultant had refused to leave a dinner party to attend to their deteriorating patient. This was rather déjà vu I thought.

Since then, I have done many cases involving the private healthcare sector, including cases concerning private GPs, private hospitals and patients looked after in private wings of NHS hospitals, the latter which creates an interesting dynamic to say the least. Some of the cases involve issues which could, and do, arise in NHS hospitals, but some appear to have arisen mainly because of the vagaries of the private hospital system, including issues such as: delay in recognition of a patient’s deterioration due to being in a side-room (I was brought up on Nightingale wards and remain a die-hard fan); lack of appropriate emergency facilities, such as an HDU or ITU; lack of a proper cardiac arrest team; a broken and non-functioning defibrillator; carrying out unacceptable experimental treatment; performing unacceptable experimental surgery; and the list goes on. Ultimately, financial profit and medical care are often unhappy bedfellows.

Although my experience as a junior doctor in the private healthcare sector was well over 20 years ago, I worry that not a huge amount has changed in that time, in particular when one considers the recent Ian Paterson scandal. A very interesting paper[1] published in November 2017 by CHPI (Centre for Health and the Public Interest) following the Ian Paterson debacle, entitled “No safety without liability”, is well worth a read. It makes five recommendations to the present private hospital model, including that consultants should be directly employed (the serious issue of the inadequacy of private medical indemnity/insurance for consultants is an issue all of its own), private hospitals should have adequate facilities to deal with life-threatening emergencies, reliance on a single RMO must cease, private hospitals should have the same reporting requirements as NHS hospitals and private hospitals registered with the CQC (Care Quality Commission) should be fully liable for all the services provided within them. Fundamentally, the report concludes that “The Ian Paterson scandal represents a major failing of the private hospital business model and exposes the ineffective way that private hospitals in England are regulated”.

Sadly, from what I have seen both medically and legally over the years, I remain unconvinced that much has really changed with respect to patient safety (bar perhaps some window dressing) since my brief medical sojourn into the private sector all those years ago; I am also not convinced that many of the public are truly aware of how the private healthcare sector functions and the lack of regulation and accountability. As the CHPI report states in its conclusion: “… unless private hospitals have full legal liability for all the actions which take place in their facilities there can be no guarantee that they are safe places for patients to be treated. With legal liability comes an incentive to make sure that patient safety incidents are reduced and to ensure that those who work in the hospital are safe and fit to practise”. I agree.

However, if change cannot or will not be implemented, all we can do is the best we can to ensure patients are properly educated as to the risks of the private healthcare sector, so they are fully informed when they choose to use it.

*Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

[1] https://chpi.org.uk/wp-content/uploads/2017/10/CHPI-PatientSafetyPaterson-Nov29.pdf