Rogue private healthcare requires government action

July 3, 2014

Ali Malsher is a clinical negligence partner in law firm Anthony Gold and a former nurse. The opinions expressed are her own.–

The private healthcare sector is booming. Cut backs in the NHS mean more people are taking out health insurance and looking to private hospitals to provide their care.

In May a private hospital in Berkshire introduced a new ‘GP’ service, which will see patients paying £95 for a 30-minute consultation, as a result of what it perceives is the frustration of patients in obtaining a timely GP appointment. In addition to necessary medical treatment, there is an increasing consumer demand for cosmetic surgery much of which takes place in the private sector.

Most members of the public believe that by going private they’re paying for speed and attention, and that the quality of care is the same or even better than that in the NHS. Private hospitals encourage this perception in their advertising and it is compounded by the fact that many consultants routinely work in both the public and private sectors. So in the mind of many, the service must be the same or better.

However, the public is not being made aware that the private healthcare sector is held to very different standards from the NHS, and that it isn’t as closely or consistently regulated. The quality and safety of private hospitals and clinics is now at least to some extent regulated by the Care Quality Commission and Monitor, but does not have the same degree of accountability as the NHS where national standards are enforced across all hospitals.

Each private company/hospital/consultant, etc. remains ultimately individually responsible for its own services and, like any private business, is dependent upon market forces, supply and demand, quality of service, and the professional regulation of individual practitioners in the private healthcare sector. Practitioners are individually regulated by (depending upon profession) the General Medical Council or the Nursing and Midwifery Council, which give them a licence to practice and publish advice on expected standards.

In my experience as a clinical negligence lawyer, record keeping in private hospitals is notoriously bad, again because of the issue of poor regulation. NHS doctors are required to make records of any conversation with a patient. If they failed to do so this would be apparent, because when a doctor ends their shift somebody else has to read their notes and take over the case.

At a private hospital a new consultant doesn’t usually take over the case. This is because in private hospitals, unlike in the NHS, a full medical staff is not maintained at night because private hospitals do not usually deal with emergencies and many do not have intensive care facilities. Members of the public are not generally aware of this or of the practical measures they can take to protect themselves, against the consequences of poor record keeping. For example, when having an initial consultation with a surgeon in a private hospital, they should ask about the surgeon’s success, failure and complications rates. Most patients certainly don’t consider taking careful notes of their conversation with a private doctor, but there is no reason not to do so. My experience is that nurses’ record keeping in the private sector is not so bad. But doctors’ record keeping is generally poor.

There are some excellent doctors working privately, but they often work from a number of hospitals or clinics in addition to their NHS practice. NHS consultants often work long hours, and a good proportion of those hours are worked in the private sector. Their NHS employers don’t clamp down on these moonlighting practices, even when the consultant is overworking, because the NHS has come to rely upon the fact that top consultants are happy to work on an NHS salary because they’re able to boost it in the private sector.

I know of an NHS surgeon who used to go to a private clinic in Harley Street at lunchtime on Friday and carry out ten vasectomies in his lunch hour. I and my fellow clinical negligence lawyers encounter plenty of consultants working up to and at these types of levels.

The NHS is frequently criticised for being bureaucratic and over managed, However the result is that doctors have long lists of protocols with which to comply and usually some form of check on behaviour or treatment choices. In the private sector there is almost no such thing as protocol, the consultant can just wander in unobserved and have a one to one consultation with a patient.

It’s easy to warn people against the private sector, but people need healthcare and will seek it where they can. Change needs to take place at government level. The Office of Fair Trading referred the privately-funded healthcare services market to the Competition & Markets Authority for further investigation after the scandal about payments for private referrals. Its final report was published in April, but it focuses on measures to increase competition, and this is not enough. The government needs to legislate urgently to address the issue of inadequate regulation in parts of private healthcare.

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