How do you choose your private hospital and consultant?

A few months ago, I wrote a blog about patient safety in the private healthcare sector in which I flagged some concerns about patient safety in that sector. This was based primarily on my experience over the years as a claimant solicitor acting for clients in cases against private hospitals and doctors but also from my (now rather distant) personal experience as a Resident Medical Officer junior doctor working in a private hospital.

However, I additionally observed that, at a time when the NHS is overwhelmed for well-documented reasons, the private healthcare sector is likely to be utilised more than ever, which is in part why patient safety in that sector is so important. On that background, it is likely that there will be many patients who are currently contemplating private healthcare treatment, some of whom may not have used it before. Therefore, more than ever it is important to choose carefully the private hospital you want to be treated at, which private consultant you want to be treated by and what information you feel you need before agreeing to proceed with treatment.

There are plenty of things to think about when choosing a private hospital and a consultant, in particular in choosing a surgeon if you are having to have surgery. I thought it might be helpful to highlight a few of these things. The below list is by no means exhaustive but hopefully it may prove to be some food for thought before taking the plunge. I have divided it into three parts: first, things to think about in choosing your hospital; secondly, things to think about in choosing your surgeon/doctor; and, finally, things to ask your surgeon/doctor when you first meet.

Part 1: Things to consider when choosing the hospital

I will flag a few things that you may wish to consider when researching which private hospital to use. Different factors will assume greater or lesser importance to different patients, of course, and ultimately it is a matter of personal preference, but nevertheless it may be important to identify certain key things at the outset.

1. 1. It has been noted in surveys in the past that hospital location is one of the key determinators of patient choice of hospital. Generally, people do not want to travel too far to have treatment. This may be especially so if they will be in hospital for a while and family and friends will be visiting regularly.

1. 1. Waiting times. Another important factor can be waiting times. Generally, one of the advantages of private healthcare is that the waiting list is short, but a short waiting list is not a given even in the private healthcare sector so it still may be worth checking how long it will be before you can see the consultant or have the treatment/surgery.

1. 1. Hospital infection rates. This can be an especially important consideration if you are having surgery, as some hospitals have considerably lower infection rates than others. It is probably worth looking at the Care Quality Commission (CQC) website to research the hospital[1] , which should give plenty of information about the particular hospital and how it has performed in CQC inspections. This should include hospital infection rates. If you cannot find the data, ask the hospital.

1. 1. Hospital outcomes and success rates. Along with infection rates, these can also be helpful factors worth considering. The Private Healthcare Information Network (PHIN)[2] publishes outcome data for independent hospitals and is worth exploring. It is also worth considering “return to theatre” rates if you are having surgery.

1. 1. Patient and staff experience. It may be worth looking at what experiences patients generally appear to have had at the hospital. This can be through patient reviews on websites. Many hospitals publish patient satisfaction scores on their own websites (although be wary of a lack of independence). You can obtain useful local information from the NHS Staff Survey website[3], with one of the scores being “quality of care” and another being “safety culture”, so you can learn about what local staff think of the hospital on various issues. Staff are likely to be more technically aware than patients, so staff reviews are probably more worthwhile on technical matters.

1. 1. Hospital safety. As noted above, hospital safety is potentially a very important factor. Again, the CQC is a good place to start, as well as PHIN, and ask the hospital if the data is not readily available elsewhere. Consider morbidity and mortality rates of the hospital generally and specifically relating to your condition or treatment.

1. 1. Funding and insurance. Another relevant factor is that choice of hospital may be limited by the insurance company whom you are with, so you will need to check which hospitals are authorised by your particular insurance company. It is also worth finding out from the hospital what the anticipated costs will be if something goes wrong and you must stay in hospital longer than planned. This may be dealt with through your insurance arrangements, but it is a potentially important consideration if you are a self-pay patient. You might also want to consider finding out what the extent of the hospital’s legal liability is if something goes disastrously wrong and you end up being seriously injured; it would be better to have sorted this out beforehand than after the event.

1. 1. Hospital specialisation. Some hospitals specialise in particular treatments more than others, so it is always worth ensuring that the hospital you are considering is specialist in your particular problem or treatment.

1. 1. Availability of HDU/ITU. Perhaps surprisingly, not all private hospitals have an HDU or an ITU; many patients will not be aware of this before they have treatment. This is a particularly important consideration if you are having surgery or a major procedure. What happens if something goes wrong? You might feel that you want the safety net of an HDU or ITU on site rather than risk the potentially problematic delay involved with having to transfer you by ambulance as an emergency to another private hospital or even a local NHS hospital.

1. 1. Finally, if you want a particular doctor, this may affect which hospital you end up choosing because the doctor may only work out of one or two private hospitals. This point neatly leads me on to a few things to consider when choosing a particular doctor.

Part 2: Things to consider when choosing the doctor

I have focused in particular on choosing a surgeon but many of the principles apply equally to all forms of doctor and other healthcare practitioners.

1. 1. The doctor’s training, qualifications, experience and expertise. It is always worth checking into a doctor’s past and present to see whether they fit the bill of who you are looking for. Try to find out their qualifications such as their basic medical training, when they qualified, their higher medical or surgical training, e.g., whether they are a Member or a Fellow of one of the Royal Colleges, how long they have been a consultant, etc. Some more specific points are:

1. 1. General Medical Council (GMC) Registration: For starters, it is worth checking the doctor’s GMC registration[4]. You will be able to see on the website if there are any issues with the  doctor’s registration and any caveats attached to it, such as extra training, supervision, etc.

1. 1. NHS Profile: It is then worth researching the doctor on the internet. You may want to check their NHS profile if they are still working in the NHS to see what role they have and what experience they have had.

1. Speciality: Think about looking at the website or registry of their speciality, such as the National Joint Registry (NJR[5]) for joint replacement orthopaedic surgeons, the Society for Cardiothoracic Surgery (SCTS[6]) for cardiothoracic surgeons, the Association of Surgeons of Great Britain and Ireland (ASGBI[7]) for surgeons generally and the Association of Coloproctologists of Great Britain and Ireland (ACPGBI[8]) for colorectal surgeons. There are plenty of other websites for particular specialist disciplines which contain helpful information; for example, there is a list published on the Royal College of Surgeons’ website[9]. A word of warning, though: a doctor who is a president of this body or that association is not necessarily a technically brilliant doctor; rather they may simply be a very ambitious one. It may also mean that they spend more time on their extra-curricular activities rather than their medicine or surgery or their patient care. You may want to ask yourself whether you think they would rather be at their association’s gala dinner than attending to your post-operative complication out of hours.
2. Publications: You may also want to do some research into what medical literature and research papers the doctor has published: have they published considerably in relation to the particular surgery you are having and in authoritative journals?

2. The doctor’s own data.

1. 1. NHS: It may be worth looking at the surgeon’s NHS data on the NHS website[10]. You can look up NHS consultants by name, speciality and location and some of the information can be helpful, although to be honest it is rather limited.

1. 1. Private: It is also worth looking on the PHIN website referred to above. This may be of assistance, although again some of the data is rather limited but nevertheless it can be a helpful starting place. If material data is missing, you might want to be suspicious of whether the doctor is hiding something; you may want to ask them specifically about their missing data when you meet with them (see below).

1. 1. Number of operations: See if you can find out how many of the particular operations, procedures or treatments you are having the doctor/surgeon has done, how frequently and for how long. You might be concerned if they have only done it once in the last 5 years, even if they did 50 a year before then. You may well want to have your surgeon being someone who still operates on a regular basis.

1. 1. Surgical, procedure or treatment outcomes: Are you able to find out what the doctor/surgeon’s own outcomes (rather than the hospital’s) are for the specific surgery, procedure or treatment you are having? What are the doctor/surgeon’s success rates, infection rates, return to theatre rates, complication rates, etc.?

1. Website: Some doctors have their own specific websites independently of the private hospitals which give them their practising privileges. Such a website may contain important data, so it can be worth looking at, with the caveat that the website is not independent, and it is in reality the doctor advertising themselves. Sometimes there can be helpful videos that can assist in your understanding of the procedure or surgery that you are about to undergo.

3. 3. Website reviews. There are several independent websites that carry reviews of doctors. A well-known one is doctify.com but there are plenty of others that can be found by searching the internet, although they vary as to reliability and quality.

3. 3. The anaesthetist. If you are having a surgical procedure, you will need an anaesthetist. Surgeons tend to use particular anaesthetists that they like to work with, but the patient is often never offered a choice of anaesthetist. Anaesthetic accidents can and do occur (and can be catastrophic when they do) and you may wish to ensure you are entirely comfortable with the expertise and experience of the anaesthetist as much as the surgeon. As such, you may want to find out more information about the anaesthetist before agreeing to proceed with the surgery. You will/should probably meet the anaesthetist before the surgery at the pre-operative assessment, but it can sometimes be quite brief, so do not be shy either of asking the surgeon more about the anaesthetist or spending time asking the anaesthetist directly questions when you meet.

3. 3. Funding and insurance. As above with the choice of hospital, if you have health insurance you may to some extent be limited in your choice of consultant to those who are on that insurance company’s “books”. This is something you will need to discuss with the insurance company if it is an issue. Also, doctors vary in their hourly rates and, in particular if you are self-pay, their fees may be an important factor in your choice.

3. 3. Personal recommendations. As with many things, personal recommendations from people you trust, such as friends and family, may ultimately be the most valuable information that you can obtain about a specific doctor, so do not be shy of asking around.

Part 3: Things to ask at the first consultation

You have chosen your preferred hospital and also your preferred doctor/surgeon, have arranged an appointment and are about to attend the first consultation. If you have followed even some of the above, you should have a veritable wealth of information at your disposal before you even go into the meeting, so should be reasonably well armed. There are a few key things, though, that you may wish to consider doing or asking at that consultation:

1. 1. Take a family member or friend. I always advise that you take a family member or friend with you. It is very difficult to assimilate and retain what is usually a mass of information at a first meeting and studies have indicated that patients often retain as little as 50% after a consultation (and sometimes less). It is, therefore, usually helpful to have someone else present who is less directly involved or invested in the conversation and who can, therefore, concentrate more dispassionately on the detail of the discussion, as well as being able to take notes. It is also potentially helpful to have a witness to the discussion in case there is a subsequent dispute about what precisely was said, especially if something goes badly wrong later on.

1. 1. Take notes. As noted above, either you or your accompanying companion should take notes. This may irritate some doctors (which in and of itself may raise alarm bells) but I believe it is a very important thing to consider doing, in particular to assist if something goes wrong later on. I have had so many cases where it ends up being the patient’s word against the doctor’s word, with the doctor having the advantage of having written notes and a subsequent clinic letter, such that it can be a real struggle for the patient then to prove that what the doctor wrote and subsequently says is wrong or inaccurate. Contemporaneous notes taken by you or your companion can significantly help with this problem.

1. 1. Discuss the factors from Part 2 above. Do not be afraid of raising with the doctor important issues such as qualifications, experience, expertise, number and frequency of the specific surgery, procedure or treatment, complication rates, infection rates, outcomes, etc. Again, if the doctor is reluctant to discuss this information, it perhaps should ring alarm bells.

1. 1. Insurance/indemnity cover. Consultants in private hospitals are “independent contractors”, which means that they are not employed by the hospital and (generally) the hospital is not legally liable for any negligent acts or omissions of the consultant. Accordingly, the consultant should have their own insurance or indemnity cover. This is a GMC requirement and it should also be a requirement of being given practising privileges by the hospital. I think it is really important to find out exactly what the nature and extent of the consultant’s insurance/indemnity cover is: does it cover the particular procedure, surgery or treatment being done; how much is the cover for (£1 million or £20 million?); is it sufficient if there was to be a serious injury (e.g. a brain injury); who is the cover with, i.e. are they are known and reputable insurance company? Please note that many medical defence organisations are indemnity organisations, not insurance companies, and their cover is discretionary and not guaranteed if something goes wrong. Further, in surgical cases, you should ensure that you ask the same insurance/indemnity questions of the anaesthetist. Also ask both the doctor/surgeon and anaesthetist for a copy of their insurance/indemnity certificate as proof that they have adequate and up to date cover.

1. 1. Analyse the doctor’s responses to your questions. It is potentially important to get on with your consultant (although in my view it is not as important as their technical skill and expertise), so analyse them carefully throughout the consultation to see whether you like them and feel you can trust them. Do this through a critical eye, as some consultants can talk a good game, notwithstanding they then cannot play it.

1. Take a deep breath before “signing up”. Major medical treatment can be a daunting experience. It is worth pausing before committing yourself to a surgery, procedure or treatment to make sure that you are entirely satisfied with what you have researched and with the information that the hospital and consultant have given you and you feel you can trust them. Take a little time out to reflect on all the information you have been given before agreeing to proceed.

Hopefully your private healthcare journey will be trouble-free, but things can and do go wrong in medicine and the private healthcare sector can be somewhat of an unknown entity to many patients. It is all too easy just to put faith and trust in a hospital and consultant without question (as many patients do) but then rue the lack of information later on. Although many if not most doctors are excellent and have their patients’ best interests at heart, there are and always will be inadequate, incompetent or rogue doctors, and it is important to do one’s best to avoid them. It is worth carrying out appropriate due diligence beforehand to minimise the risks of an adverse outcome and to make it easier to manage if something adverse does happen. I do hope that the above may be of some assistance in that due diligence exercise.

[1] https://www.cqc.org.uk/what-we-do/services-we-regulate/find-hospital

[2] https://www.phin.org.uk/

[3] https://www.nhsstaffsurveys.com/results/local-results/

[4] https://www.gmc-uk.org/registration-and-licensing/the-medical-register

[5] https://surgeonprofile.njrcentre.org.uk/

[6] https://scts.org/

[7] https://www.asgbi.org.uk/

[8] https://www.acpgbi.org.uk/

[9] https://www.rcseng.ac.uk/patient-care/surgical-staff-and-regulation/surgical-outcomes/

[10] https://www.nhs.uk/service-search/other-services/hospital/LocationSearch/7/Consultants

*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.*