The Perils of Private Medicine
This week Jeremy Hunt ordered private hospital bosses to take action to improve patient safety, click here to read more. A recent report from the Care Quality Commission rated 30% of private hospitals as requiring improvement. The CQC’s report which highlighted many examples of poor practice, wide variations in provision of care and in some cases rather ad hoc and informal arrangements in relation to governance and management.
Jeremy Hunt in his letter to the private sector made the following comment:-
“If the sector is to partner with the NHS and benefit from our world-leading medical training we need urgent assurances that the independent sector will get its house in order on safety, as well as a commitment to take rapid action to match the NHS’s world-recognised progress on transparency”.
This information is not new. It mirrors the information provided by the CHPI (Centre for Health and Public Interest) which itself completed a report last year and comments from a variety of sources on the need for reform from the late 1990s onwards, click here to read more.
In November 2017 the Centre for Health and Public Interest revised their report which set out a series of recommendations for the reform of the private hospital sector. They have in fact completed several reports. It is noticeable that almost half of patients within the private hospital sector are in fact funded by the NHS. Many private hospitals simply do not have sufficient emergency facilities and over the last 12 months or so some 7,000 patients were transferred from the private sector to the NHS because of need.
There are some clearly political and financial issues here about patients having to be transferred as emergencies back into the NHS having received inadequate care in the private sector or being treated in units where emergency situations cannot be dealt with adequately.
Further still there are some patients treated who are referred by the NHS as part of schemes to resolve waiting lists and to deal with backlogs in specific geographical areas. This is perhaps most notable in mental health care where NHS provision is wholly inadequate.
From the negligence point of view, as lawyers we deal with this at Anthony Gold on a frequent basis. Private medicine presents its own challenges legally. Anecdotally. there are concerns about whether the insurance of individual consultants working within the private sector is sufficient for the problems that may arise. There are a number of consultants working in hospitals who know or ought to know that the facilities of those hospitals are not adequate if problems arise with patient care.
I recently dealt with a bariatric surgery case which was dealt with in the private sector. The client developed complications but there was no consultant available. The junior doctor who did not have any great experience of bariatric surgery was left to deal with the matter and was seeking advice by telephone from other consultants who were available at least to discuss the patient but did not have bariatric surgery experience themselves. Ultimately, finally, a bariatric consultant from a completely different private hospital was drafted in to deal with the situation, but not before the client suffered significant injury and several days of distressing complications which should not have arisen. This situation is not unusual.
Many private hospitals are not designed for emergency issues. They do not have intensive cares, high dependency units or adequate staffing for them. Often the consultant will do a list of surgical or other procedures and leave early afternoon. On staff will be junior doctors who may not have worked with that particular issue and have a large number of patients over a long period of time without any adequate supervision.
Private hospitals receive significant NHS funds. In addition, through the private health insurance, they are well-paid for the services they provide. They do not however provide all the care and facilities that may be required if a problem arises. According to the CHPI the cost to the NHS of the patients being transferred back from the private sector in emergency situations is approximately £60 million per annum.
Making a claim against a consultant working in the private sector can be more difficult. There are several legal complications including whether they are working under an NHS contract, with whom they have contracted, what insurance they may have in place, and whether they are even available. Added to that is the general poor medical recordkeeping in the private sector which causes significant problems for both parties.
In addition, if a hospital needs to be involved, they are quite often a separate party to the doctor, whereas dealing with an NHS hospital generally the Trust is liable for all the issues that arise. The more parties, the more complicated, the more difficult funding issues can be.
I can do no other than recommend that if a person is considering private healthcare, they research the hospital, facilities and the consultant (and his or her insurance) in detail. Further information is available at the Centre for Health and Public Interest and they provide general information about private healthcare and safety. Private healthcare is not better healthcare, just arranged differently and with the potential for problems which cannot be dealt with on site.