A Report published on 20 August 2014 by the Centre for Health and the Public Interest makes for a very interesting insight into the world of private healthcare.
According to the Report, authored by Professors Colin Leys and Brian Toft, there are 1.61 million admissions to private hospitals in the UK each year and a staggering 420,000 (26%) of these are funded by the NHS. Notwithstanding these substantial figures, in its Executive summary the Report states that, “little is known about the quality and safety of care provided to these patients, due to a dearth of independently verifiable performance data”. The Report goes on to say, “The lack of reliable data means that regulators are unable to assess the risk of harm posed to patients in these hospitals, and patients are unable to make informed choices about where to receive their care”.
There are some other rather interesting statistics and points that arise from the Report:
- Private hospitals receive 28% of their income from treating NHS patients (the NHS spent £1.196 billion on private treatment in 2012, of a total annual budget of about £100 billion).
- About 6,000 patients per annum are admitted to NHS hospitals from private hospitals to treat complications that occurred whilst a private patient – however, the reasons for the admissions and the cost to the NHS is not currently determinable.
- Funding of private patients in 2013 was: private medical cover (£2,397m, 55.1%); NHS (£1,196m, 27.5%); self-pay (£631m, 14.5%); and overseas (£131m, 3%).
- Between October 2010 and April 2014 there were 802 unexpected deaths and 921 serious injuries reported by private hospitals – the significance of these in the context of risk is not determinable because of the lack of reporting requirements in the private sector.
- Save for central London (which has 8 private hospitals averaging 137 beds each), private hospitals (in 2013) have between 30 and 50 beds each, compared to between 300 to more than 1,000 in NHS hospitals.
- Consultants working in private hospitals are not employed by them but are granted “practising privileges” and work in a self-employed capacity. Almost all work in nearby NHS hospitals and their private work is performed in non-NHS hours.
- Trauma and orthopaedics represents the greatest share of total admissions (both inpatient and day case) (27%) and provides the greatest revenue (30.5%), followed by general surgery (13.5%, 9.5%) and obstetrics and gynaecology (7.6%, 6.9%). Plastic surgery represents 4.0% and 3.1% respectively.
- Less than half of private hospitals providing cosmetic surgery in 2010 had a fully-equipped operating department and most do not have intensive care facilities.
- The consultants who work in private hospitals often do so in isolation from medical colleagues and post-operative patients are often left to the responsibility of junior Resident Medical Officers.
- 14 of 132 (>10.5%) private hospitals who responded to an enquiry about resuscitation did not have a resuscitation team.
- There are significant concerns over the efficacy of the current clinical governance arrangements.
- There is a significant lack of private hospital performance data, described by the Competition and Markets Authority as “poor” and “insufficient to promote competition between private healthcare facilities”.
The authors of the Report make a number of recommendations:
- Private providers should be subject to exactly the same reporting requirements on patient safety incidents (including mortality data) as NHS Trusts and this should be a requirement of registration with the Care Quality Commission (CQC).
- Private hospitals should be required to report on their performance in the same way of NHS providers.
- The remit of the Parliamentary and Health Service Ombudsman should be extended to cover the whole of the private healthcare sector.
- The clinical governance methodology of private hospitals needs to be subject to a wider review by the CQC to determine whether the current arrangements are effective in protecting patients.
- Full participation in all national clinical audit and data collection programmes should be a requirement for registration with the CQC.
- Patients should be made aware of the different risk factors between being treated in a small private hospital and a much larger NHS hospital, to include that information given to enable informed consent must detail risks stemming from the nature of the facilities, equipment and staffing of the hospital.
- The regulations governing the provision of care in hospitals must include some which are private hospital specific, in particular pertaining to the level and/or qualifications of the doctors and nurses on-site in each speciality and the arrangements for on-call anaesthetists.
- There should be a review by the Department of Health as to the nature and cost of the 6,000 annual admissions to NHS Hospitals from the private sector.
Based on my own personal experience, I do not find the Report’s findings at all surprising and I welcome the authors’ recommendations.
I have had a significant number of clinical negligence cases over the last few years that have arisen out of private healthcare treatment and these have mainly resulted from a lack of proper and appropriate staffing and support, with responsibility at key times being given to insufficiently qualified and/or inexperienced staff, and the carrying out of complex procedures in hospitals with inadequate facilities and/or inadequately functioning equipment. For example, having had a number of cases between the late 1990s to date which have involved inadequate resuscitation equipment and staffing, it remains astonishing to me that over 10% of hospitals which responded to the enquiry admitted that they still do not have a dedicated resuscitation team. Not only is this demonstrably potentially dangerous to patient care, but no doubt most, if not all, of the patients at these private hospitals were wholly unaware of the fact.
While the Report acknowledges that many of the recommendations have been made elsewhere following other inquiries or reports, it emphasises the continuing lack of any clear picture as to the risks to patients in private hospitals and that action on the recommendations remains long overdue. Let us hope that the various bodies requested to act do so with suitable haste. In the meantime, potential private healthcare patients would probably do well to research very thoroughly their chosen hospital and its staff; to ask pertinent and searching questions as to facilities, equipment, staffing levels, morbidity and mortality data (both of the hospital and the individual consultant), amongst other things; and to shop around, compare and contrast private healthcare providers before they decide to commit to private treatment.