Private Hospitals – A risk worth taking?
A recent report from the Centre for Health and Public Interest (CHPI) has found that there are inherent dangers in seeking medical and surgical care from private hospitals not apparent in an NHS setting.
Private hospitals have long since provided only limited information in relation to safety issues. However using information from the regulator the Care Quality Commission under the Freedom of Information Act the CHPI has managed to find information relating to NHS patients who are receiving private care.
Under the drive to reduce waiting lists in the NHS many patients whose surgical procedures have a relatively low risk of complications have been transferred through to the private sector . These are monitored and reviewed by the NHS. However patients who are operated on purely in the private sector and not referred by the NHS are not subject to the same data analysis from the private healthcare organisations.
In essence this means that the mortality and complication rates of private hospitals could be higher than reported because they do not have to report a number of the private patients who may have suffered serious complications or died as a result of surgical procedures.
In total the CHPI found that 802 people died unexpectedly in the last 4 years and a further 921 had suffered serious injuries in the private sector. Bearing in mind that these were relatively low risk procedures, it does raise a concern about the general safety standards of independent hospitals. There is a lack of information about private hospitals and the way they provide services. Private hospitals are not obliged to tell patients before treatment whether they have deficiencies in their facilities, equipment or staffing such as for example a lack of intensive care facilities or a lack of a resuscitation team should one be required.
Some private hospitals do not have access to an anaesthetist on call at all times. Some hospitals do not have on site at all times a surgeon or doctor at registrar or above level for each speciality which the hospital is treating. This means that at night, for example, some hospitals do not have on site a senior surgeon who could deal with an emergency situation. Vital minutes may be lost whilst waiting for a surgeon to arrive if an emergency arises. At the moment private hospitals do not have to inform patients that this facility is not available.
Insurers for the independent healthcare providers say that patients who attend hospitals without intensive care facilities do not need them. Whilst true in theory, anyone can suffer a complication which requires sudden and immediate treatment.
For the vast majority of patients undergoing what appears to be straightforward simple procedures they expect that the hospital will be able to deal with all relevant complications. They don’t anticipate problems. However the absence of an anaesthetist and intensive care facilities if complications do arise represents a potential greater risk to their lives. The trouble is that people are not aware of this when they agree to treatment in the private sector.
It is proposed that in the future the Care Quality Commission will start inspecting independent hospitals. They will then inspect information about performance and facilities. It is clear that there are a few hospitals operating in the private sector that are not conforming to even basic safety levels. Whilst the majority of NHS care which is delivered by independent sector hospitals is safe clearly there is a element that is not. That information is also not being provided to patients.
The lack of information in the private sector is a common problem lawyers deal with all the time. Medical records that come from an NHS hospital are generally far superior to those provided in the independent sector. The operation notes, the consent forms and the nursing care generally provides much more information than you would normally get in the private sector. Private sector records are often very brief to the point of non-existence .
What is worrying is that the private sector has been used to such a degree to clear backlogs in operation lists whilst there has been no requirement for the provision of similar facilities and information. What is further worrying is that the Care Quality Commission isn’t going to receive a significant increase in resources to inspect the private healthcare industry. There is therefore going to be a lengthy period in which some private hospitals are unlikely to be thoroughly reviewed . This leaves patients more vulnerable. In addition, the failure of some private hospitals to keep full records means that those who are injured have a more difficult task in establishing what has happened.
Further for those who are concerned about funding the NHS, it should be remembered that the NHS remains liable for those patients who are injured in the private sector/NHS collaboration in most cases. The NHS is paying the bill for the private sector errors and poorer facilities.
These figures point to a small but important problem with the way the private sector continues to work even when dealing with NHS patients. We do not know how many deaths occur solely in the private sector as a result of failing in care or provision. We have difficulties as lawyers investigating those events due to poor record keeping. This is the first detailed review of the part of the private healthcare sector of its kind. It suggests that anecdotal knowledge about the reduced safety of some independent hospitals is true. It also suggests little is going to change in practice for some considerable time.