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PRIVATE HOSPITALS IN BRITAIN
A Critical Examination of the Private Healthcare System
© Richard Ennals & Raeto West 1998, 1999, 2000, 2001
... private practice offers fewer of the safeguards and supports that help to minimise adverse events and reduce patient risk in the public sector...
Andrew J. Vallance-Owen, Medical Director, BUPA (1996)
2. KEY POINTSMEDICAL
3. KEY POINTSADMINISTRATIVE
NOTES AND REFERENCES
Key Points: Medical
Key Points: Administrative
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PRIVATE HOSPITALS IN BRITAIN
In Britain, 6.4 million people currently have private medical insurance (PMI), and more than 1 million people were treated privately in 1998. The total value of health services supplied by the private sector (including voluntary suppliers) for 1998 was estimated at £14.4 billion. Almost half of this is long term care; about a quarter, drugs and medical equipment. Private medical treatment in private and NHS (National Health Service) hospitals accounts for 18% of this total, £2.6 billion. In 1998, there were just over 220 private acute hospitals, providing 10,050 beds. About two thirds are commercial, for profit, hospitals, and of these about a quarter are owned by overseas concerns. The remaining third are hospitals registered as charities. Most private hospitals belong to: BUPA (British United Provident Association), or to Nuffield Hospitals, or to the General Healthcare Group (also known as BMI Healthcare). All but twenty private hospitals have fewer than 100 beds, and many less than fifty; they are usually much smaller than NHS hospitals. Private healthcare, including nursing homes, employs more than half a million people and in employment terms is the tenth largest industry in Britain. Most patients' treatment in private hospitals is paid for by health insurers. Typically, a policy offers £10,000 to £15,000 cover a year. This system coexists uneasily with the NHS.
Here we set out problems specific to treatment in private hospitals, which can result in unnecessary suffering, permanent injury and avoidable death. Our claim is that actual numbers of serious untoward incidents in British private hospitals are far greater than publicised cases would suggest, and that this situation will continue until the government finally addresses these problems.
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2. KEY POINTSMEDICAL
The patients consultant, who has overall responsibility for the patients care in hospital, is not always on site when treatment is needed. The consultant is almost always an employee of the local NHS Trust Hospital with an individual part-time contract, which sets out the proportion of his or her working hours to be spent treating NHS patients. If the private patient requires emergency treatment outside the hours that his consultant is on site there may not always be the specialist expertise to cope with specific complications.
Furthermore, there is little monitoring by trusts and health authorities of consultants working days: fatigue may lead to risks to patients in both sectors, and consultants may favour private patients. And there can be cases where surgeons operate with smaller teams than in the NHS, without full backup, and where operations are finished by unsupervised junior doctors.
Also, consultants suspended from practice in the NHS pending investigations of alleged incompetence, can sometimes continue to practice in private hospitals. Private hospitals claim that, if subsequently cleared, the consultant can sue them for loss of earnings.
There may also be longer NHS waiting lists in those specialties which are the most lucrative areas of private practice. (A recent report asks whether medical bodies have restricted consultant numbers for members' financial gain, doing so by influencing legislation. See Notes and ReferencesRestrictive practices).
Generally, private hospitals have single rooms: unexpected complications can sometimes go unnoticed behind their closed doors. A patient in severe distress may not be able to operate an emergency call button.
If complications are spotted in time, resident staff may not have the expertise to identify and cope with them. Resident Medical Officers (RMOs) are frequently junior doctors, working alone, whilst nurses, some of whom may be agency nurses, may not have the appropriate specialist knowledge. The hospital staff may be reluctant to take independent action when the consultant is not present.
, in a large district general hospital, patients with specific conditions or illnesses will often be treated in specialist wards where medical and nursing staff will have had extra training and experience in that condition. Patients will ideally be treated by a proper healthcare 'team' under the consultant, incorporating charge nurses, staff nurses, houseman, senior house officer and registrar. The patient's medical records are kept at hand whereas in private hospitals accidents have been caused by staff not having the patient's consultant's notes or not being left proper instructions.
A recent newspaper report also raises concerns over the training of technical staff in private hospitals. The Royal College of Nursing has raised concerns about the treatment of children in private hospitals.
If complications are spotted in time, the private hospital may not always have the range of facilities, specialist staff, drugs or equipment available for emergency or intensive care. In the private hospitals with facilities for intensive care, these are often only Intensive Therapy Units (ITUs, not ICUs) or High Dependency Units (HDUs), largely for the treatment of post operative patients following major surgery (and the beds may be taken). The patient may have to be ferried to the nearest NHS hospital for treatment, by which time his or her condition may have deteriorated. Private hospitals exploit the fact that NHS hospitals rarely turn away seriously ill patients. They generally carry out only what they expect to be straightforward operations, leaving people with complications, people needing expensive treatment, and 'bed blockers' to the NHS.
Crash teams provide emergency resuscitation. The Royal College of Anaesthetists recommends that all hospitals should have crash teams providing 24-hour cover, and that these should include an anaesthetist (to intubate, put up intravenous drips, insert catheters, and administer drugs in the few minutes available to save life). Few, if any, private hospitals are able to provide this level of service. (And private hospitals do not have Accident and Emergency services).
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3. KEY POINTSADMINISTRATIVE
If things go wrong, unlike in the NHS, there are no statutory complaints procedures in private hospitals for aggrieved patients or relatives; the legislation by which they are regulated simply makes no provision for complaints. Whilst registering authorities now expect hospitals to have internal complaints procedures, it may be that complainants will not be told about these.
One effect of this is that, unlike the NHS, where numbers and nature of complaints are recorded, there is no proper picture of the incidence of untoward events in private hospitals; amazingly, no government body appears to be collating this information.
Ironically, even though private patients pay twice (both national insurance contributions and health insurance premiums) and, even though by going private they take some strain off the NHS, they have fewer rights than NHS patients being treated under contract in the same hospital. Unlike the NHS, the private hospitals' complaints proceduresif complainants are told about themare based only on a flimsy voluntary code and carry no right of appeal. And, unlike NHS patients, private patients have no Patient's Charter, no accompanying Charter rights, no ombudsman, and no Community Health Councils (CHCsgovernment-funded local NHS watchdogs) to assist them.
Litigation, which people are often advised is their only option, is expensive, arduous, uncertain, and concerned almost entirely with financial settlement. Cases can be further hampered by falsification of medical records, the rarity of impartial medical experts, and the difficulty of proving negligence in its legal sense, and then causation, central issues which the Woolf reforms ignore. The law courts will also not satisfy those seeking an acknowledgement of their complaints, an apology, and an indication that matters will be improved. (Though there is another optionasking the registering health authority to investigate. See Conclusions, and Notes to Conclusions, later).
Advertising, in TV, press and leaflets, by hospitals and insurers plays a key role in attracting people into the private sector. Its accuracy may come under increasing scrutiny.
Following an untoward incident, private hospitals may be reluctant to honestly admit error since bad publicity may damage their reputations, and customers may go elsewhere. Moreover, insurance companies may threaten to raise, or withdraw, insurance cover in the event of an admission of fault, for fear that this might be interpreted as an admission of liability.
Matters may be complicated when untoward incidents arise from failures on the parts of both the consultant and hospital staff. Whom does one sue? NHS hospitals take responsibility for the mistakes of all employees; but in private hospitals, the patients contract separately with the consultant, who is not employed by the hospital, and the hospital accepts no responsibility. Complainants may have to deal with two sets of defendants, insurers, and solicitors.
Furthermore, the hospitals are dependent on the consultants to bring in business, and may play down consultants' mistakes.
The legislation (the Registered Homes Act 1984, and Statutory Instrument 1578 of 1984) was designed with nursing homes in mind, and health authority inspection and registration officers in their twice yearly visits are for the most part obliged only to evaluate the adequacy of the secondary hotel aspects of patients caresuch as for example [in Regulation 12 of SI 1578], the hospitals adequacy in its provision of curtains, crockery, and washbasins.
Astonishingly, there is little or no scrutiny of the quality of clinical care, which would obviously be more appropriate for patients receiving medical treatment. With much more complex surgery now being undertaken than in 1984, this is a significant failing.
(It's hard to believe that the civil servants who drew up this legislation forgot about private acute hospital patients. Probably it was deliberately drawn up in this way under pressure from the medical establishment and the private hospital and health insurance industries, wishing to remain unaccountable).
The quality of the twice-yearly compulsory health authority inspectionssuch as they are under this legislationis also sometimes open to question. For example, the Royal College of Nursing found
that inspection units were not always well staffed, that some inspectors needed better training, and that in some areas both visits were being announced, in breach of the legislation. A quarter of all the health authorities surveyed carried out inspections with only one officer, the risks of which the RCN identified as including Seeing the premises in a good light because of familiarity or individual bias and Being intimidated by less co-operative owners and staff.
Inspections can also be compromised, according to a healthcare lawyer, if the health authority is contracting with the hospital to treat NHS patients. And a healthcare academic raises the possibility of corruption in some health authorities. (See notes to 4. Conclusions).
Many private hospitals imply in their defence that accreditation, by the Kings Fund or British Standards, guarantees high quality clinical care. In fact, this is not so. The audit is primarily organisational.
Hospitals' Medical Advisory Committees (MACs) are supposed to regularly meet and
monitor the performance of consultants, but generally do nothing, as such high profile cases as those of Drs. Ledward and Neale indicate. Composed of admitting consultants, hospital management and senior hospital clinical staff, their concerns probably lie more with protecting the reputation of the hospital, on which their income rests, than with the welfare of patients, and thus in reality they may be instrumental in concealing bad practice. Their meetings are held in private. Their findings are unpublished.
As regards costs, lessons might be drawn from other fields: schools are inspected, buildings being remodelled are inspected, prisons are inspected, factories are inspected.
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4. CONCLUSIONS AND
Many people turn to private hospitals because of the lengths of some NHS waiting lists, a fact which hospitals and health insurance companies exploit in their advertising. Patients should not, however, be misled by the image of a private room, pleasant furnishings, and an à la carte menu. This may not be coupled with high standards of clinical care. When things go wrong, they can go spectacularly wrong, with devastating consequences for patients.
In effect, accidents are rare enough for the system to take risks; it is cheaper to employ lawyers to attempt to limit damage, than to have adequate levels of staffing that might prevent accidents.
There is little doubt that improvements must be madeall the more so with the interest of multinationals in British healthcare, for whom the lax regulation is probably an added attraction, and with the increasing numbers of NHS patients being treated in private hospitalsand certainly, in opposition, the Labour Party frequently called for tighter regulation of the private healthcare sector.
The Department of Health in recent statements to the media has warned the public that if they opt to use private as opposed to NHS hospitals, as things stand now they are taking a chance.
[See Notes to ConclusionsComments: Political]
Despite the number of statutory bodies and healthcare 'watchdogs' that claim to protect and serve the interests of patients, some of which patients or relatives may turn to in the wake of untoward death or injury, e.g. the Department of Health, the health authority, the 'professional' bodies, patient organisations, think tanks and university research departments, in reality few seriously tackle the status quo. Core problems are almost invariably ignored (e.g. profit-motivated understaffing, lying about untoward incidents, falsification of noteswhich should be made a criminal offenceprejudiced experts, and the link between consultants' private hospital work and the length of NHS waiting lists) [See
Notes to Conclusions
Pressure from a recently formed campaigning group, Action for the Proper Regulation of Private Hospitals (APROP), set up by bereaved relatives, coupled with continual adverse media coverage of injuries and deaths, eventually led to a 1999 investigation into private acute hospitals by the Commons Health Select Committee, as part of a wider inquiry into private and charitable healthcare. Section 41 of its ensuing report lists most of the deficiencies and dangers of private hospitals listed here, including the risks of single rooms; lack of specialist wards and resident specialist nurses and doctors; hours of consultants unmonitored with the risk of misjudgements from fatigue; lack of resuscitation and back-up facilities; inexperienced RMOs; and absence of even informal peer review as clinicians in private hospitals don't work in NHS-type teams. (Sadly though perhaps unsurprisingly, the directors of the main private hospital groups, the director of their trade association and representatives of medical bodies failed to acknowledge any of these findings in their oral and written evidence. They seemed more concerned with coming under the aegis of the new NHS audit scheme, the Commission for Health Improvement, probably as nothing more than a business exercise to gain the respectability of NHS accreditation and thus to attract new customers).
The Health Committee's report concludes, however, that even with the improved registration and inspection system it recommends, the small size of the average private hospital, and the need for it to operate commercially, may continue to jeopardize patient safety. A disproportionately high number of the Committee's 39 recommendations for improvements in private healthcare generally, related specifically to private acute hospitals.The former Health Secretary, in a covering letter to the first of several DoH consultation documents, acknowledged that the current regulatory arrangements 'are out of date, unsatisfactory, and not sufficiently independent..nor do they provide the protection to which the public is entitled.'
Plans for a new regulatory system were announced by the Queen in her speech at the opening of Parliament (18 Nov 99: ".. a Bill will be introduced to improve standards and stamp out abuse.. in private and voluntary healthcare.."). Private hospitals are to be regulated by a new body, the National Care Standards Commission, rather than a separate inspectorate, broad details of which are outlined in the Care Standards Act (recently through Parliament), and in the DoH document
Developing the Way Forward.
Whilst the latter promises some significant improvements on the present situation, a number of key issues are not clearly addressed. These include:
The need for a safe NHS-type 'team' system of staffing in private hospitals, especially at night-times and at weekendsalmost all of the untoward incidents listed at the end of this website illustrate failures in this area;
whilst private hospitals will be legally required to have in place a scheme for assessing quality of care, e.g the King's Fund (now 'Health Quality Service') system, too much store is set by such schemessome of the worst hospitals in terms of untoward incidents and subsequent conduct are King's Fund accredited;
whilst private hospitals will be legally required to have an internal complaints procedure, this is still a voluntary code and there is no guarantee of its effectiveness. The past experience of victims is that they were not even told about any complaints procedure. There should be an independent, statutory complaints procedure, and the new regulatory body should be involved at an early stage; tampering with medical and nursing noteswhich can happen as much in the course of a complaints procedure as in litigationis not even mentioned;
private hospitals and their managers must be made accountable for the mistakes of consultants who use their premises, as now happens in NHS hospitals;
referral of clinicians to the GMC or UKCCcited by the Government's Lord Hunt in the House of Lords recently as an effective course of actionshould be discounted. Neither of these organisations properly investigate incompetence;
hospital managers and operators responsible for, and then for concealing, some of the most horrific incidentswhich helped bring about the succession of inquiries and demand for proper legislation in the first placeare not only being allowed to continue in situ, but are even being actively consulted by government for their advice. Some of these people should be sacked.
The new legislation will not come into effect until April 2002. The current fear of campaigners is that ministers and certainly DoH civil servantswho knowingly did nothing for yearswill allow its detail to be dictated by private medical interests. Such legislation as Statutory Instrument 3208 of 1995, the Public Interest Disclosure Act 1998, and the Freedom of Information Bill contain evidence of influence by vested interests.
The consultation group drawn up by the Department of Health to assist in preparing new regulations is composed of private hospitals groups and medical bodies some of whose members have been responsible for some of the most serious incidents, and for frequent dissembling; whilst the 'patients groups' chosen are mostly government-funded organisations that have done little or nothing to advance the cause of private patient safety and often have little contact with private patients. Action for Victims of Medical Accidents (AVMA) with direct, first-hand experience of the problems from the patient's point of view, has been omitted.
The recent much publicised 'concordat' that has been drawn upafter long secret negotiationsbetween the NHS and the private sector, whereby private hospitals will be used more frequently to help reduce NHS waiting lists, may also lead to the proposed legislation being watered down. A reduction in waiting lists may boost the present government's diminishing lead in the next election, and thus it may be more responsive to the dictates of the private sector. The more radical but probably more fruitful solutionthe recent proposal of scrapping the consultants' maximum part-time contractthe principal cause of long waiting listsappears to have been quietly set aside, probably due to the government succumbing to pressure from those medical bodies whose members gain most from this system. Baroness Nicholson said (
, 6 Aug 2000): 'I am aghast that a Labour Government wants more operations to be carried out in private hospitals which are unregulated and, quite honestly, not up to the job. It is a terrible mistake.'
The recent claim, made by the private sector, that Labour's previous opposition to the use of private hopsitals was purely ideological, is untrue. For example, the
reported (9 Dec 98): 'One reason the Ministers refused an offer of beds from the private sector before last winter was because they feared emergency care might not be up to NHS standards.'
In the meantime, and until such time as legislation is introduced that, hopefully, will genuinely protect the private patient, complainants dissatisfied with a hospital's response to their complaints should exercise their right to approach the health authority that registers the hospital; this is a right that is poorly publicised by hospitals and health authorities alike, probably deliberately. The NHS Confederation's
Independent Acute Hospitals and Services
(1993) has comprehensive guidelines (Appendix 5) for authority investigations of complaints in private hospitals, in particular where breaches of the current registration requirements are indicated. The authority should interview staff involved, produce a report, make recommendations where appropriate, and ensure that they have been implemented.
Cases of misconduct must be referred to doctors' and nurses' professional bodies, the GMC and the UKCCfor what that's worth. [See
Notes to Conclusions
for more details].
Until new legislation is in place that properly protects patients, those contemplating private treatment should consider using the private wings of NHS hospitals, rather than private hospitals, even if a premium on insurance is requested, or a switch to another insurer is required: these hospitals (1) are fully equipped, (2) have better staffing levels at all times, (3) have better back-up when things go wrong, (4) have better complaints procedures. Consultants stay on site. All profits are returned to the NHS.
With private health insurance costs rising by up to 30% a yearpremiums are amongst the highest in Europeand with policies riddled with exemption clauses, those who want to go private might also consider ditching private insurance altogether and paying the same premiums into a private high-interest fund, self-paying when necessary.
If you must queue-jump, why not do it intelligently?
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NOTES AND REFERENCES
*Quotation at the head of this piece
This extraordinary (and very recent) admission is taken from an article 'Accreditation of doctors in the private sector', by Andrew J Vallance-Owen & Natalie-Jane Macdonald, respectively 'Medical Director' and 'Head of Clinical Services' of BUPA, in
journal (Pearson Professional, 1996) 2,
27-30. They continue: 'Consultant led' care is a term with greater practical significance in the private sector than in the NHS where team working is more the rule. Sound junior staff and a sharing of responsibility may minimise the limitations of a consultant's competence whilst consultants in a Trust tend to have closer links with each other than are possible or desired in the private sector.
2 Aug 98: He said his comments.. on fewer safeguards in the private sector were about a "theoretical risk"..
[BUPA, British United Provident Association: Britain's largest private health insurers. And owners of one of Britain's largest private hospital groups.]
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Notes and References to 1. Overview
6.4M people, and the figures for 'total value' and breakdown of private sector, and the number of private hospitals and their beds, are taken from Laing's
Healthcare Market Review 1999-2000
More than 1M people 'treated privately' from
review section, 1 Feb 1998,
The Last Place You Want To Be
by Jay Rayner.
The 'tenth largest industry' is from a letter to
16 Jan 1997, letter from B S Hassell, 'Chief Executive of Independent Healthcare Association' ['IHA']: '... The independent health and social sector employs 500,000 people. In addition to performing 20% of the country's elective [i.e. planned ahead, non-emergency] surgery, it provides 76% of the nation's long-stay provision and is the tenth largest employer... [in Britain]'
It's difficult to estimate the proportions of part-time workers, untrained workers and so on. Obviously the private sector wants to represent itself as largeperhaps larger than it really is. (Similarly, Jay Rayner's
article says 'If they all immediately decide to get their treatment on the NHS, .. our publicly funded healthcare system would collapse.' However, Jay Rayner gives no evidence for this claim).
On foreign ownership, John Studd, consultant gynaecologist (
24 Dec 94), on private hospitals in London: .. the great majority of these.. hospitals, although boasting proud British names such as Lister, Cromwell, Wellington, Devonshire, Churchill, etc., are owned by foreign companies.
He continues: We must support the opening of a ward of NHS pay beds [in a London NHS hospital].. We have a simple choice of allowing considerable amounts of money to leave this country to the American, Kuwaiti, Pakistani, and French companies who have a major investment
in the private hospitals in London, or using the pay-bed revenues to support the NHS. And Margot Norman,
16 Dec 94: If there are profits to be made, let them be made in, and returned to, the NHS.
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Notes and References to 2. Key PointsMedical
RMOs and Absence of Health Teams
Dangerous Staffing Practices
Facilities, Equipment, ICUs, Resuscitation
NHS Waiting Lists and Private Hospitals
Costs to the NHS of Private Treatment
On consultants and the founding of the NHS, Dr D. Gould's
The Medical Mafia
(1987): To get the grudging cooperation of the consultants, [Nye] Bevan had to make.. concessions. They were to be given a proper professional salary.. However, the senior and already established specialists were determined not to sacrifice their own extremely lucrative private work. Nye was forced to strike a bargain whereby any consultant could work part-time for the NHS and part-time for himself. Since then about half have elected to work on the so-called maximum part-time basis, whereby they receive 9/11 of the full-time salary appropriate to their posts in return for a notional nine half-day NHS sessions a week. For the rest of the time they can do their own thing. In effect, this means that they can order their affairs pretty well as they choose.. [A notional half-dayNHDis three and a half hours; this has since been extended to 10/11ths.]
Independent Medical Care,
NHS Must Set the Standards for All
: It is almost the universal practice in the commercial sector not to employ consultants, but have a convenient and clever arrangement whereby the consultants treat patients without employer/employee's contractual arrangements. [He then compares it to 'the lump' on building-sites]. .. It is my view that this type of arrangement with consultants is a cop-out for the commercial medical companies. Often patients are unaware, or do not understand, the relationship, or the lack of it, between the consultant and the hospital.. A private or commercial hospital should be forced to employ the types of staff, with the requisite qualifications, and numbers which are at least on par with NHS hospitals.
On consultants' sole responsibility, and operations, in private hospitals, the TV documentary
(1992, World in Action) comments: In the NHS it is different. Patients are cared for by consultants and teams of qualified doctors in the process of being trained as specialists. Dr John Lunn, a consultant anaesthetist, added: No such team approach exists in the independent sector. There is a consultant surgeon and a consultant anaesthetist, usually, but no medical staff necessarily to help and to overlook the management from day to day and from moment to moment.
On operations in private hospitals, a doctor (personal communication, 1992): Although you pay your money for a consultant to do the operation, it is often finished off by junior doctors, coerced by the shut up if you want a reference line. And: I have known some patients reach the operating theatre without being examined first.
15 Dec 92, John Illman, in an article on the Ruth Silverman case (see below): Treatment usually depends upon an individual consultantsometimes severalworking without supporting senior registrars, registrars, housemen, and specialist nurses in what time he has free from the NHS.
On consultants, the TV documentary on private hospitals
Don't Stay the Night
(1997, Channel 4,
), comments: Professor Davenhall [Prof. of Nursing who has been employed by both a private hospital group and the private healthcare trade body, the Independent Healthcare Association] found areas of weakness in the private hospital structure, a consultant based sector where the consultants just weren't there all the time. Without adequate backup, it was a recipe for potential disaster. Prof. Davenhall stated: The problems [with private hospitals] relate when things go wrong. The consultants who are employed in the public sector and who do part-time work in the private sector are not there, at the end of a phone, often. So the nurses have to be extremely able in terms of their judgement.. it is a distinction from the situation that prevails in the NHS, which is that there are many, many, doctors to support the nurses, and there is other help available to them at the drop of a hat. When the system breaks down, it breaks down very badly, because of the lack of fallback, the lack of recourse to other opinions and support. .. Consultants only spend brief periods of time within the hospital.
(The IHA in this programme maintained that standards are at least as good as those in the NHS.)
It seems to be generally the case that the higher status a consultant, the smaller is the contractual percentage of time spent with NHS patients. (Remark made by an academic to RW). However, his/her time may be divided amongst private hospitals and private NHS wings. So statements about consultant availability are difficult to make precise. John Yates's book
Private Eye, Heart and Hip
(Institute of Health Services Management 1995; the title refers to the commonest private operations), e.g. pp. 73-76, discusses the proportion of surgical procedures carried out by 'junior doctors' but seems not to define this expression or draw definite conclusions.
9 Aug 1998, Andrew Grice: There are no safeguards to prevent unscrupulous senior doctors from skipping their NHS clinics and leaving junior doctors to see patients so that they can spend more time in the lucrative private sector. Some surgeons may spend as little as four hours a week operating on NHS patients.
20 Aug 98: .. the department of Health confirmed.. that it is looking at ways of cracking down on those [consultants] who cash in on private work while failing to fulfil NHS commitments..
1 Oct 98: Dr Jenny Tonge MP [speaking at a BMA meeting].. said the consultant contract needed to be "blown wide open" to stop consultants "moonlighting" in the private sector.
Yates stresses there's little monitoring of adherence to contracts by doctors in the NHS and private sectors. This includes therefore the issue of tiredness of doctors, which is also mentioned e.g. in
The Good Doctor Guide,
2nd edition: The danger this situation is creating is .. that consultants.. are overworking. Among London's medical elite, there is a macho ethic of never being tired. This is the danger posed to NHS and private patients alike. ..
A Commons Public Accounts Committee reported (
27 July 90): Health Authorities need a more accurate picture of the level of consultants' commitments to ensure that their responsibility for the treatment of patients is not put in jeopardy through working excessive hours.
On consultants' hours, Gordon Craig,
Independent Medical Care Journal,
Sep/Oct 1986: The problem of consultants working in commercial hospitals over and above their NHS commitment, which is sometimes full-time, or maximum part-time, also needs to be tackled, as it can risk patient care in both the NHS and the commercial sector. We do not allow airline pilots to work unrestricted hours, and we put tachographs in long-distance lorries.. Surely, we should restrict the number of hours which a doctor, particularly a surgeon, should be allowed to work. .. The danger with consultants is that the lure of additional money may impair the self-discipline and judgement necessary to restrict themselves to what they can cope with. (
9th Aug 1998: .. some [top hospital consultants] receive more than £500,000 [$800,000] a year in basic NHS pay, merit money and private practice income. And in:
Dec 98, reporting on the high charges of a neurosurgeon, Mr Chris Adams, for giving expert evidence in court: He submitted a bill for £32,000. When this was challenged, he produced details of his earnings in the private sector, which amounted to approximately £1M a year.)
Commercial Medicine in London
(1985): ... NHS doctors work hard already, extra private work may result in less efficient, and certainly more hazardous, medicine.
Dec 98: One suggestion [to monitor consultants' hours], made by Prof Alan Maynard.. is that private hospitals should be compelled to report the amount of private work a consultant does to the NHS Trust for which he or she works.. If consultants are made to be openly accountable for how they spend their time, it would give them a chance to document the long hours they say they do for the NHS, as well as answer charges that their private work is to the detriment of NHS patients. (The same article explains why the Government may not have undertaken a review of consultants' time: The British Medical Association's Mr Johnson.. also said that it would be 'unwise .. to upset the apple cart' and warned that, if restrictions were put on consultants' private work, there would be a mass exodus from the NHS. He added that any restrictions on private work should be matched by restrictions on NHS hours..')
On the accountability of consultants in private hospitals: Sir Richard Bayliss, assistant director, research unit, Royal College of Physicians,
21 May 1988: In the independent hospital, the consultant lacks the critical comments of junior staff.. nor is there peer review.
BMA News Review,
David Hinchliffe MP, Chairman, Commons Health Select Committee: There is serious concern that certain operations, primarily in the private sector, are not performed by those sufficiently qualified to do so.
Dr Andrew Vallance-Owen, Medical Director, BUPA,
: There has been a reluctance at times for providers [i.e. private hospitals] to tackle specialists whose practice they believe to be suboptimal.. it has proved difficult for management to gain the support of the specialist's peers in raising issues of clinical competence or appropriateness of care.
On consultants, suspended from the NHS, being
allowed to continue to practise in private hospitals, see cases of Drs. Ledward, Neale, Ingoldby and others listed below.
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On the dangers of single rooms, consultant orthopaedic surgeon Michael Laurence states (
Don't Stay the Night
): .. speaking personally, Id much rather be [a patient] in a large ward, where if anything.. went wrong, or if I needed to get in touch with a nurse, or call somebody if she's not immediately available, the chap in the next bed [can call her for me].. Accidents get noticed.. in an open ward; in a private room, they don't.
Dangers of Care outside the NHS, 20 Aug 1998, Dr E. Walker, A & E Doctor: Patients do not receive a better standard of care in the private sector.. They.. get a private room which can be a double-edged swordfew people can press the call button just after suffering a respiratory arrest.
1 Feb 1998: Finally, there is the issue of those private rooms. They may be comfortable and free of moaning from the post-operative patient in the next bed, but they may also place you out of sight of the nursing staff. If you do have incapacitating problems, nobody will be there to see it.
, 5 March 99, on Carole Burwash [see below]: Carole was given a massive overdose of painkiller. Then, when she went into respiratory collapse, she wasn't noticed for some time because she was behind the closed door of a private room.
BBC Radio 4,
, 16 Nov 99, Baroness Nicholson: "The benefits of the private room dwindle into nothing when you realise that severely ill patients need constant monitoringyou don't get that in a private room."
, 26 July 99: 'Patients occupying single rooms tend to be less well supervised than those in the wards.'
(Readers might be amused by Norwich Union Healthcare's
Evidence to Health Select Committee
, Appendix 16: '.. there is much proxy evidence to support the quality of private sector work. In particular, private patients are treated quickly by high quality staff, in high quality facilities (often with BSI or King's Fund accreditation) and in single rooms which helps minimise the risk of cross infection.' ['Much proxy evidence' is, unsurprisingly, not supplied. And infections can also be carried by staff - RE])
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RMOs and Absence of Health Teams
RMOs get a bad press: e.g. Joan Higgins' 1988 book,
The Business of Medicine
(Macmillan) p 183: '... Those hospitals which do have a resident doctor often employ overseas doctors who have been unable to find work in the NHS and, because most private hospitals have not been accredited for training purposes, they cannot attract the high calibre staff they would wish to employ. A number of hospital managers have expressed disquiet about the quality of staff they employ as resident doctors and at their high turnover. Some hospitals will also take on junior NHS doctors (who already work long hours in their normal jobs) to provide part-time medical cover. ...'
There's a similar remark in
Banking on Sickness,
a book by Ben Griffith, Steve Iliffe, & Geof Rayner (Lawrence & Wishart; however this was 1987). P. 197: Doctors unable to find NHS hospital posts or suitable vacancies in general practice provide a pool of casual labour for the larger private hospitals in the South-East of England. They add: .. it would be wrong to assume that private medicine is superior to NHS treatment. Private clinics are typically very small and not very well-equipped. Only one in three has a resident doctor providing 24-hour medical cover. The close commercial relationship between a private patient and his or her doctor means that junior doctors are less willing to intervene in the consultant's absence. As the Consumers' Association (publisher of
) gently puts it, this 'can mean an unpleasant delay for the patient.'
Dating from about the same time, a July/Aug 1986 article in
Independent Medical Care
on RMO cover, written by the owner of an agency that employs RMOs, says that AMI [an American chain of commercial hospitals, now BMI Healthcare] placed ads in the early 1980s drawing attention to their provision of RMOs in all their hospitals. The article also states: .. "Some doctors have great difficulty in feeling able to accept RMO posts because of fear of jeopardising their careers.. I have known doctors to be told categorically by a consultant to forget promotion if they take an RMO post. ... many RMOs feel that the registrar/houseman type of relation between a junior doctor and his consultant in the NHS is not always duplicated in the private sector. .. .. it is a 'mark-time' job.."...
The Health Scandal,
Dr Vernon Coleman 1988: .. many people pay the exorbitant fees charged by private hospitals and private insurance companies because they assume the quality of care will be better. They are wrong... if you go into an NHS hospital you will almost certainly be seen by at least one doctor every day. In practice, you will probably be seen by several doctors several times. And there will always be doctors resident in the hospital. If you fall ill during the middle of the night or at the weekend there will be a doctor on call who can be at your bedside within minutes. If you go into a private hospital, however, you may well go for several days without being seen by any doctors at all. And [some] private hospitals don't.. have resident medical staff. If you fall ill during the middle of the night or at the weekend, there may well be a delay of some hours before a doctor can be found.
29 Apr 1993,
How to pick a hospital and keep alive,
Margot Norman: Many of these hospital-hotels [i.e. private hospitals] .. have few facilities beyond their thick carpets and comfortable beds and, as the resident medical officer who held the fort alone at night.. told me, The only reason I'm working in a place like this is that it's quiet, so I can get on with swotting for my fellowship exams.
, 20 Aug 98, Dr.E. Walker, A&E doctor: 'As an impoverished casualty officer in London, I.. applied for a place on the resident medical officer bank of a large private hospital. Duties included covering emergencies on the ITU until a consultant arrived. So green was I that I hardly knew my own arse from my elbow, let alone anyone else's. But the medical director offered me a post, saying I was 'just what they were looking for', meaning, of course, that I was white. Common sense prevailed, and I never took up the offer..'
15 Dec 92, John Illman: Private hospitals have fallen down because sometimes there has been only one junior doctor, perhaps qualified little more than a year, on the full-time staff.
Baroness Nicholson, House of Lords, 13 Dec 99: "It [the private sector] does not provide healthcare for love or as a public service; these hospitals and medical staff provide healthcare for money. Therefore, these private hospitals are exceptionally competitive. To drive down their costs, they have hired staff who are inadequately trained, under-provisioned, under-funded and are not supported sufficiently for the tasks they are asked to undertake."
Here and Now,
14 Sept 1998, Caroline Buckley (see case of mother Carole Burwash, below): My family and I find it astonishing that for one of London's top private hospitals with over 100 beds [the Princess Grace], overnight there is only one doctor covering every single patient and that doctor in this case had no life-saving skills whatsoever.
Dr Michael Crow (letter to BBC, Sept 99): 'As an ex-RMO back in the late eighties, I can remember not being able to contact the consultant in charge when an emergency arose at the weekend and the nearest pathology services were a taxi ride away.'
BBC TV Panorama 20.9.99: Prof John Ward, consultant physician and member of the GMC, on RMOs and lack of teams: "The unexpected is what makes medicine difficult and risky and if the unexpected happens you need to be in a hospital where teams of trained staff can cope with it. I stress 'teams' because often a medical emergency can be quite a performance and to ask one doctor to deal with it is too much. I believe that private hospitals without the medical cover that we have in the NHS must be rather riskier."
, 26 July 99, Andreas Whittam Smith, former editor: 'The risk of something going wrong in independent hospitals are greater than in NHS establishments.. as clinicians tend not to work in teams in the private sector, as they do in NHS hospitals, sub-standard staff are less easily noticed. The fact is that the independent sector is, on average, less competent.'
, 23 June 1999, in a feature comparing care in a private and an NHS hospital, by an NHS nurse: 'On the ward [of Northwick Park NHS Hospital] there are five consultants, each with a registrar and SHO, and they tend to be around all day.. at BUPA Bushey Hospital..we only have the consultants [when they are around - RE] and the resident medical officer.'
11 Aug 1998,
Perils of jumping the queue,
Dr Mervyn Singer: Nights and weekends are the dangerous time. The staffing of the private sector at junior level is not very glamorous. The sector is often manned by British-trained doctors seeking temporary work, or by doctors from overseas. The quality is variable, and there may be a total lack of supervision. .. There lies the tragedy: inexperienced doctors go into the positions and the hospitals don't make too much of an issue. ...
(This does not appear to accord with Paragraph 40 of the GMC's
Professional Conduct and Discipline: Fitness to Practice,
1993 [Delegation of medical duties to professional colleagues]: ..doctors.. engaged in private practice on either a part-time or a whole-time basis, should seek to ensure that proper arrangements are put in hand to cover their own duties, or those of their junior colleagues, during any period of absence, by doctors with appropriate qualifications and experience. Consultants and other senior hospital staff should delegate to junior colleagues only those duties which are within their capabilities. [This important provision was largely omitted in the GMC's 1995 update entitled 'Duties of a Doctor''Good medical practice.'])
The article continues Dr Singer believes that all private hospitals should insist that their doctors attend courses in advanced life support. If the Department of Health isn't going to monitor private hospitals, this would be a step forward. If a hospital cannot assure people that they have someone on duty at all times who is trained in life-supporting techniques, they should go elsewhere..
Dr. Phil Hammond, in
Trust Me, I'm a Doctor
(1999): 'Private hospitals are not the best places to be in an emergency.. I worked in one private hospital where the cardiac arrest trolley consisted of a bottle of port and the death certificate book. The protocol was that if critically ill patients were spotted in time, they should be transferred to the nearest NHS ICU. But it's hard to hit the help button when you're critically ill and most of the deaths occurred very privately indeed.' Another example: 'Private hospitals do now have resuscitation equipment and a few even have their own intensive care units - but not always the staff to use them. Surgeons insist on doing major operations in isolated Georgian buildings and then going home for dinner, leaving a single inexperienced junior doctor and three agency nurses to cover the entire hospital. A few years ago I met a New Zealander who was that doctor, and was horrified to find that when one patient started to choke after a neck operation, no one knew how to intubate her. She died well before her consultant was out of his pyjamas.'
Letter to BBC, Sept 1999, from 'Dr. Richard': 'I'm a doctor. I've worked as a locum in several private hospitals over the years and would not send any member of my family to one.. I would not recommend a private hospital to anyone for inpatient treatment. Corners are cut everywhere with little, if any, regard for safety. Stick to the NHSit's a lot safer.'
On teams in the NHS:
15 Dec 92, John Illman: Writing recently in the Guardian, a consultant cancer specialist told how she became the fourth consultant looking after an elderly, dying patient in a private hospital. She recalled: As so often in private work, there were no clinic notes available. Each consultant had filed his own case summary in his own private system. He needed treatment on a machine rarely available in a private hospital. He needed care from specialist nurses used to talking with frightened, dying patients. He died quite soon, before he could be transferred, pain controlled by drugs, to the NHS oncology unit. It was a posh death, but a sad and lonely one.
How does this differ from the NHS? This relies on medical firms or teams. There is: The newly-qualified houseman, who writes up practical case histories for everyone's use as he builds up skill, turning himself into a safe pair of hands. The senior house officer, who is taking a series of posts introducing more specialised work, while studying for membership of a Royal College. He knows about the latest tests and remedies. The registrar, who is working in his chosen speciality. He is responsible for clinical organisation and for diagnosis and treatment. He keeps his seniors fully informed and should know when to seek their help. The senior registrar is by now a Royal College fellow who can quote the latest research and keep abreast of new treatments. The consultant has overall responsibility with tough decisions about resource management. The sister or charge nurse is a specialist in his or her own right: a support for both junior medical staff, nurses, and, most important, patients. The staff nurses are developing specialist knowledge and are highly skilled in practical tasks. This is the team I would like if I am seriously ill.
Here and Now,
Dr Roger Clements, editor, 'Clinical Risk': [In a private hospital] you are usually consulting a doctor who is a specialist in one subject and who does not have a team of doctors around him. Contrast that with the NHS, where there will be a team of doctors: a consultant at the top, and two tiers of junior doctors underneath him. BBC: That team includes a Registrar who will often have a better grasp of general medicine than his boss, the specialist consultant. Roger Clements: When something goes wrong in the [NHS] system the Registrar, more recently qualified, with a general background of medical and surgical knowledge, more up-to-date and more alive than that of his boss, is much more likely to spot it, and I think that that system protects the patient in the NHS.
AVMA, Feb 99, submission to the Commons Health Select Committee Inquiry into the regulation of private hospitals: The evidence from the cases that AVMA has dealt with suggests that the present system of RMO clinical cover is woefully inadequate. Unless the independent sector is going to provide hospitals which mirror the staffing and facilities offered by some of their NHS counterparts, it is difficult to see how the independent sector can provide the standard of in-house expertise necessary to cater for the needs of a diverse patient population.
And Caroline Buckley, APROP oral evidence to Health Select Committee, March 99: "I think it is very important within new legislation if hospitals could be graded according to the cases they can look after."
And Prof. Felicity Reynolds, Obstetric Anaesthetist: There is absolutely no doubt that when things go wrong you're better off in a well-staffed large NHS hospital.
And Arnold Simanowitz, Chief Executive, AVMA,
14 Aug 98: As soon as something goes wrong, patients are more at risk in the private sector than they are in the public sector. And the reason for that is obvious: because the private sector doesn't have a 'team' in the same way as a hospital in the NHS will have. Very often something can go wrong and there isn't even a consultant on duty.
(On teamwork in private hospitals, an Independent Healthcare Association statement in
Here and Now
claimed that team work in their sector is as good as in NHS hospitals, if not better, because patients are given the personal attention of their consultant.)
20 Aug 98, Dr E Walker: Cock-ups happen everywhere. If people think they will avoid them by going private, they are wrong. And at least in an NHS hospital there will be someone immediately to hand..
18 Feb 99, Dr Walker: ... The private hip replacement, who gets a deep vein thrombosis and is admitted to an NHS ward... the gastrectomy patient who needs an intensive care bed after having their operation done.. at a local private
clinic. ... Who has to foot the bill when any of these has to receive life-saving treatment? Me and you, mate. That's who.
[Back to Notes...]
Nurses, and the UKCC (UK Central Council for Nursing, Midwifery and Health Visiting)
On nurses in private hospitals, Prof Maureen Lahiff formerly of the Royal College of Nursing (
): ML: It's very difficult for nurses to challenge the consultant's management of a particular case, unless they have a very good working relationship, or unless the management of the hospital is willing to support the nurse. Interviewer: Do hospitals support the nurses? ML: Not always, no, and of course the possible outcome of that is job insecurity. Interviewer: So the nurse might actually lose her job if she complains? ML: Yes. Interviewer: And does that happen? ML: Occasionally, yes.
Prof. Davenhall in
Don't Stay the Night
: .. what the doctor says, goes. The nurses will respond to that. So the ordinary rapport that exists within the public sector, where people will question each other, healthily, does not exist in the private sector.
On nurses' expertise, Prof. Davenhall: The traditional nursing in the NHS.. really is directed at specific areas of care, so that a [e.g.] .. medical nurse or a surgical nurse.. would have a particular area of expertise, but in the private sector the nurse is expected to be able to nurse any condition that is admitted to the hospital. .. The only thing that's wrong is that she is not trained to do that.
And (a doctorpersonal communication 1992): Nurses attracted to the pay and conditions of private medicine are often not
with emergency treatment.
27 May 97: She [Prof. Davenhall] carried out a survey of the nursing staff in all the hospitals [the thirty private hospitals of BMI, now BMI Healthcare] and found that most had no qualifications beyond the basic SRN, yet had more resting on their shoulders than in the NHS, because of the smaller number of doctors at night. There was poor medical supervision, particularly at night, said Prof Davenhall, who has now left BMI.
Health Service Journal
11 March 99: .. AVMA says inadequate specialist medical and nursing cover is a critical factor in failures to diagnose post-operative complications at private hospitals. It says such errors are an inevitable consequence of the way private health services operated and their small patient populations.
Dr Michael Crow, letter to BBC, Sept 1999: I have long advised that it is inappropriate to use private hospitals for major procedures as they do not have adequate nursing staff (or indeed continuity of nursing staff) as well as totally inadequate medical cover out of hours.
And Baroness Nicholson on BBC Radio 4
, 16 Nov 99: "I've had hundreds of letters from other families and I've discovered that private hospitals do have a grave shortage of regular staff - they seem to rely upon different agency staff so these different nurses come and go and come and go, and many of them are not necessarily trained in different hospitals for the particular wards they are put on, for the particular specialties.." A month later, she said in a House of Lords speech, 13 Dec 99: "A doctor wrote to me: 'In my experience many of these private hospitals are badly run and.. some of the consultants working in them are not at all mindful of their post-operative responsibilities. In many of these private hospitals the nursing care lacks continuity and is haphazard, the management relying upon temporary, agency and stand-by nursing staff. There is a complete lack of communication between the different shifts and between the nurses and the consultants. I have seen auxiliary nurses doing the work of staff nurses and sisters'."
And Tim in a letter to the BBC, Sept 1999, after
feature on private hospitals: I am a London intensive care nurse with four years' NHS experience and would not dare or desire to set foot in a private hospital for either work or treatment purposes. It is common to hear nurses who have worked in London's private hospitals talk of their amazement and frustration at the lack of support and guidance available from medical teams who are represented by doctors who are not at all accessible. This would not happen in NHS acute care settings. Why is it so difficult for private hospitals to support teams of acute care and surgical nurses? [Because (i) it's bad for profits, and (ii) most patients haven't got a clue - RE]
And Journalist Anna Blundy, describing her sick infant's nursing care at London Portland private hospital,
, 17 Dec 99: 'We had aready had some terrifying experiences with the night nurses at the Portland. There are no laws governing clinical care in the private sector, and it appeared to us that many of the Portland nurses had obtained their qualifications abroad and that these qualifications in no way matched what we in the UK anticipate.. Three of the nurses did not know what the oxygen saturation machine attached to Lev's foot was for. One of them did not know the English for oxygen, mask, nebuliser, drip or bottle.. I buzzed the nurse to tell her that one of the machines was not working. She checked it and said it was.. She called in two of her colleagues and they all agreed it was working. A fourth nurse from another unit eventually appeared and fixed the machine.. Dr. Rosenthal from the Royal Brompton and Harefield NHS Trust: "The standard of nursing is generally higher on the NHS".'
And Journalist Polly Toynbee,
, 25 Jan 00:
'The private sector poaches and adds to the serious shortage of nurses and doctors instead of relieving pressure in the NHS.'
More on the UKCC, the nurses' regulatory body, and its limitations
. They should, but don't, monitor such inadequate nursing practices. [
Back to Notes...
Dangerous Technical Staffing Practices
, 26 April 1999, reported a hospital technician's claims that she was asked to play a key role in laser operations after just six hours training [at the £300-a-day Mount Alvernia private hospital in Guildford, owned by nuns of the 'Congregation of Franciscan Missionaries of the Divine Motherhood']. She claimed that her training was inadequate and that this could have endangered patients. 'I hadn't even seen the laser manufacturer's manual during the training', she claimed. 'On the last day of my training they had people booked in for operations, for which they were paying four-figure sums, and they just wanted me to get going on them'. She 'claimed she had never been asked to perform anything so dangerous in her 22 years as an operating theatre technician. Her solicitor, Paul Gilbert, said his client's case could be the tip of an iceberg. 'I'm very concerned about the issues the case raises with regard to safety in hospitals in the private sector,' he said.'
Baroness Nicholson (House of Lords, Third Reading of Care Standards Bill, 13 Dec 99): "A nurse wrote to me following the Panorama [TV] programme.. She said she found that worrying circumstances still existed.. with regard to staff vulnerability.. she wrote: 'The situation I refer to is that of surgeons who arrive to carry out major surgery and rely upon the theatre staff to act as their assistants. Major surgery such as hip replacements, spinal operations, major abdominal surgery..all carried out virtually single-handed. In the NHS the consultant would expect to have at least one if not two or even three assistants for such operations. And they need them. Good assistance is crucial to the speedy and efficient execution of such surgery. Making do with nurses.. is just not the same.'"
Dr 'P' in his report [see section 'Restrictive Practices']: 'Lack of proper theatre assistance in private hospitals. Many specialists will operate alone with no assistant surgeon. They often operate assisted by a scrub nurse. This situation applies even for major surgical cases.
In the NHS they would be assisted by another doctor or a team. Patients are at risk if a case is particularly difficult, or the doctor suddenly falls ill in the middle of an operation.'
Steve McCabe MP, House of Commons, 18 May 2000: We should be concerned about the fairly substantial numbers of people who are transferred to national health service hospitals following failed treatments or procedures originally carried out in the private sector. Many of the operations are quite substantial. If they were carried out in the NHS, the consultant would be supported by three or four assistants, but in private hospitals he often performs operations without their help. It is probably no great surprise therefore that so many errors and mistakes arise. It seems to me that that is another are ripe for some degree of regulation.
[Back to Notes]
On 'cherry picking', cf. John D Ward, Professor of Diabetic Medicine at Sheffield University (
7 Feb 1994):- '.. easy predictable surgery, the bread and butter of the private sector. Their costs are low because they leave the management of chronic [i.e. where the condition may not improve with timeRW] disease, the elderly and the complex costly surgery to the health service, while using staff trained .. at the taxpayers' expense. .. when.. on occasions, a surgical patient develops a serious complication in a private hospital and requires intensive care.. this costly patient elects to use the health servicethe good, safe, free health service. ..'
Health Service Journal
, 8 Apr 99, Dr D Crosby, Honorary Consultant and Chair, Cardiff Community Healthcare Trust: The private sector [undertakes] 20% to 30% of all elective surgery in the UK by 'cherry picking' commercially
attractive and effective treatments, leaving the NHS to deal with the mass of incurable and uninsurable chronic illness.
[Back to Notes...]
Facilities, Equipment, ICUs, Resuscitation
On private hospitals not always having adequate facilities and equipment for treatment and emergencies, Dr Vernon Coleman: .. if you go into an NHS hospital the doctors and nurses looking after you will have access to some of the most sophisticated medical equipment in the world. And if the specialist looking after you doesn't have something he needs, then he will be able to refer you to a specialist elsewhere.. In a private hospital, however, the specialist will not have access to such a wide range of important and potentially life-saving equipment. And he certainly won't find it as easy to refer you to a specialist working in a better-equipped NHS hospital.
2 Aug 1998: Roger Clements, editor of Clinical Risk, published by the Royal Society of Medicine, said private hospitals needed to develop broader expertise and stocks of equipment to become safer.
And Sir Richard Bayliss,
21 May 1988: Unbeknown to the patient things may go wrong and the independent hospital lacks the necessary facilities.
Baroness Nicholson, House of Lords, 13 Dec 99: "Many of the intensive care units should not be called 'intensive care units' in that they do not have the necessary resident anaesthetist or highly qualified staff. The risk to patients in many of those private hospitals rise so inexorably that patients lose their lives unnecessarily or unnecessarily early.. a nurse wrote to me, stating: 'My experience with Intensive Care in the private sector led me to resign my post within 3 months as I felt sure that one day I would inherit a disaster.. the permanent staff working in the high dependency unit were virtually all untrained and had little concept of the implications of accepting responsibility for their sick patients'."
A delegate at APROP's inaugural meeting, whose business was medical equipment supply, stated that it's common practice for private hospitals to buy second-hand equipment.
A hospital consultant who works in private hospitals (letter to BBC, Sept 1999): It is a myth that private equates to better equipment. For many years, until a recent upgrade, I used equipment that I would not use on my pet at a private hospital, whereas my NHS practice had relatively state-of-the-art equipment.. the true state of private medicine [is] an accident waiting to happen.
On 'crash' teams and 'crash' trolleys, cf.
21 July 1985: Private Hospitals Call for Watchdog by Brian Deer: .. more than half of the 190 private hospitals have no doctors on the premises at night and almost none has resident anaesthetists. NHS hospitals generally have 'crash teams' of a senior doctor, an anaesthetist, and two junior doctors on 24-hour emergency call. Even private hospitals with heart units and doing major surgery, such as the Princess Grace in London, manage emergency cover with only one doctor and nursing support. But providing for resuscitation with this number is condemned by the medical profession because an anaesthetist is needed... It is very hard to handle a patient single-handed said Dr Peter Nixon, a consultant heart specialist at Charing Cross Hospital. You could dispense with one of the people, just as you could dispense with a wheel on a four-wheeled car.
Don't Stay the Night
(1997): Dr Mervyn Singer, UCL Hospitals NHS Trust, referring to a fatal 1995 incident in the Princess Grace hospital where the services of an anaesthetist were required, In the NHS, there would be, in addition to a physician who would lead the resuscitation team.. also an anaesthetist who would insert a tube into the patient's windpipe to administer directly oxygen into the lungs.
, 20 Aug 98, Dr. E. Walker, A&E doctor, Dewsbury Hospital, W. Yorks., in a piece entitled 'Dangers of Care outside the NHS':- 'There is a private hospital near to where I grew up. Some years ago, when it was staffed by Irish nuns but was taking in seriously and acutely ill patients, a friend did some nursing shifts there. She asked what the cardiac arrest procedure was. With a quizzical expression, the matron removed her chained half-moon spectacles and rested them on her matronly bosom. 'Sure and we just dial 999, dear.' And they did. Anyone who arrested there was taken to the nearest NHS hospital. They have a resident doctor now, but only a couple of years after this story someone having a hip replacement there arrested on anaesthetic induction. He was transferred to our intensive therapy unit, dead on arrival. He had been dead some time.'
The patient is often ferried to the nearest NHS hospital for treatment..:- There are innumerable references to this practice; e.g.
letter 21 Feb 1992, Usually the private sector transfers serious problems to the NHS as they do not have full medical emergency cover.
(Action for Victims of Medical Accidents) Report, 1992: Medical accidents are not restricted to the NHS. We have experienced a marked increase in the number of cases arising from the private health care sector, ranging from cosmetic surgery being performed by non-specialists to deaths occurring after routine surgery. .. cases arising in the latter group often reflect a lack of in-house facilities and/or suitably qualified staff to monitor and treat post-operative complications...
lecture by Sir R I S Bayliss, 21 May 1988: It is not uncommon to move before the operation a surgical patient with perceived anaesthetic or medical risks to an NHS pay bed or another independent hospital where there is intensive care.
1992 correspondence with a doctor: Private hospitals have no casualty departments. All on-site emergencies (if they are spotted behind the closed door of a side room) are ferried across to NHS hospitals, who have to pick up the tab for treatment.
Independent Medical Care
journal, Sept/Oct 1986, Gordon Craig (of the trade union ASTMS) writing when many hospitals were being planned and built, ..it is not without [sic] coincidence that many commercial hospitals are situated in very close proximity to large acute NHS hospitals... Too often the patient is rushed from the commercial to the NHS hospital when things go wrong.
1992: Dr David Bihare, Director of Intensive Care, Guy's Hospital: Since I went into intensive care back in 1981, I can remember many cases coming from the private sector, because essentially the private sector could not cope with the severity of illness in these patients.
Unsurprisingly, the glossy brochures for private hospitals (and for medical insurers) generally avoid or are vague about such topics. The Labour Party in
1994:- As the market has become more competitive, irresponsible marketing and [health insurance] advertising campaigns have proliferated. As one would expect, these often engage in virulent campaigns against the NHS, but rarely illustrate the limitations of commercial cover.
On the use of NHS ICU facilities for private hospital emergencies/complications, Channel 4 news (6 Feb 98): Emma's case [see below] typifies the concern of a number of NHS consultants that many private hospitals have become over-reliant on the NHS, especially for intensive care backup. Dr Peter Nightingale, Intensive Care Society, states: The .. problem is that intensive care is a very scarce resource, and it's hard enough to get your patient in your own [NHS] hospital into an NHS ICU bed without having to import them from other peoples' hospitals, certainly private hospitals. Channel 4 news: One particular concern is that if private patients are unexpectedly moved into NHS intensive care beds, NHS operations may be cancelled or postponed which would only serve to lengthen waiting lists.
Former Health Minister Baroness Jay: Private medical insurers are quick to point to the alleged deficiencies of the NHS when selling their policies, but many are just as quick at moving patients to the NHS as soon as problems occur.
, 11 April 1999, Botched Private Surgery Patients Take NHS Beds, Richard Ennals: The reason [there are] all these emergency transfers is that private hospitals are doing operations when they are not [always] equipped to deal with the potential complications
3 Jan 00, Dr. Ceri Brown, Intensive Care Unit, North Manchester General Hospital, letter: 'Sadly, the problem of the availability of NHS intensive care beds is exacerbated by the private sector. An intensive care admission, costing approximately £1,000 per day, is incapable of generating a sufficient 'return' for health insurance companies, who limit such claims to a maximum of three days' stay only. After this period, patients must fund themselves. Understandably, patients are often transferred to the NHS for further treatment, which puts extra pressure on a scarce resource.. the taxpayer contributes unreasonably to the profits of the health insurance companies.'
April 2000: Dr.Carl Waldmann, Clinical Director of ICU at the Royal Berkshire NHS Hospital in Reading: 'We have between 60 and 100 days a year when private patients are occupying beds in this ICU. Each bed costs in excess of £1,500 per day, which equates to around £100,000 a year. That would pay the salaries of six nurses. How can it be practical for private insurance companies to say to patients, "We'll take your money and insure you, but if you become very ill the NHS will have to take over".'
And on BBC
, 20 Sept 99: "If we are full up in our ICU it can have all sorts of repercussions. For instance, if it is our last bed, it may mean we cancel an elective procedure on an NHS patient the next day or the day after. It may mean we have to transfer patients to other ICUs if we're full. So there is some degree of embarrassment to the NHS by us taking these patients."
And on BUPA sometimes refusing to pay: "I and all other ICU doctors are livid.. it would be a very small percentage of their turnover and it would help us keep extra beds open." And Prof John Ward on ICU transfers: "...I think this is a factor that upsets quite a lot of doctors working in the NHS."
Baroness Nicholson on
: "I find it repugnant that NHS beds should be used as a final resource by the private hospitals who see themselves as being able to cope and yet demonstrably cannot. I don't see why the NHS resources should be leached away in this way."
1992, Arnold Simanowitz of AVMA said: It's all very well to say that patients can go and choose their healthcare, but patients don't know very often that what they're choosing is not the best. .. We've seen many cases where something has gone wrong in a private hospital and there hasn't been the equipment to deal with it. I think that mainly private hospitals can deal with the routine, simple operations where nothing goes wrong. When something goes wrong, then they very often end in serious trouble.
And: Interviewer: "How can the client of a hospital find out whether they are in safe hands?" John Scurr, Consultant surgeon: "I don't think you can... you're referred, hopefully by your GP to someone he trusts, .. you're solely reliant on the judgement of the surgeon who's going to operate on you.. I personally wouldn't operate in a hospital that didn't meet my criteria, both in terms of their equipment and in terms of their medical staffing." Interviewer: "Have you come across cases [in private hospitals]and you've read manywhere that equipment and staffing have not been adequate?" JS: "Yes. We do see cases where facilities have been really quite inadequate."
1 Feb 98: .. as one consultant put it: "I would know which private hospital is OK, but you wouldn't."
10 Oct 98: .. If you were to stagger into any private hospital spilling blood on their carpeted atrium, the receptionist would summon security first and then call you an ambulance. At least one or two NHS hospitals still have a casualty department.
Channel 4 TV
, 5 Mar 1999: Samantha Ryb (see case list below): "I think people are very much misled into thinking that when they go privately, because they can choose their consultant, they are getting the best of treatment. What they don't realise is that when something goes wrong they are not."
Judith Milne, NHS Private Patient Managers Forum, speech to the 1996 Annual Acute Healthcare Conference: These 'facilities' or trappings [the TV and furnishings of a private hospital] are hardly going to help the patient who takes a turn for the worse, and has to be rushed to an NHS hospital as an emergency in an attempt to save his life. To add insult to injury, when this situation does occurand believe me, it does occurthe NHS is expected to pick up the bill for this emergency treatment.
On private hospitals not having 24-hour anaesthetists' cover for resuscitation, the Royal College of Anaesthetists publishes its
Guidance for Purchasers
(i.e. of anaesthetic services) which includes e.g. recommendations on resuscitation, such as The typical resuscitation team includes an anaesthetist and a physician, both of SHO or Registrar grade. ... The cardiac arrest team should always include an anaesthetist who is available 24 hours. Typically, this is the same anaesthetist who is resident on call for the ITU because he or she is likely to be available and will be responsible for the patient's post-resuscitative care. ... the patients can be particularly challenging and if this person is relatively inexperienced .. a more senior anaesthetist should be quickly available (10-15 minutes). ...
9 Dec 98: One reason that Ministers refused an offer of beds from the private sector before
last winter was because they feared emergency care might not be up to NHS standards.
[Back to Notes...]
NHS Waiting Lists and Private Hospitals
You and Yours
, 31 Mar 1999: "It's no wonder the NHS waiting lists are so long, say critics. The average NHS surgeon operates on patients less than one day a week.. Research indicated the problem [of the length of NHS waiting lists] could stem from pure greed. One half day in private practice can double an NHS salary." The Consumers Association: "We found that on average the consultants [in a survey] were setting aside over two half days a week for private patients.. it's hard to see how they can fulfil their NHS commitments and do this amount of private work each week.." BBC: "Their findings supported a major study by the Audit Commission. It found evidence of a clear trade-off between NHS and private work. 25% of consultants who did the most private work did less NHS work than the rest. It also backed earlier research by Dr John Yates of Birmingham University who found specialties with the longest waiting lists were also the main and the most lucrative areas of private practice." Professor Donald Light, international healthcare consultant from the University of Pennsylvania: "There's a real lack of accountability and this fundamentally has to change.. very large numbers of surgeons are operating less than a day or even less than just a morning a week on NHS patients." BBC: David Hinchliffe [Health Select Committee Chairman] says if the government is really to grips with the issue, it needs to understand the problem lies at the very heart of the NHS."
, 12 July 1999, Dr Vernon Coleman: "Consultants who do things privately have to have an NHS waiting list, otherwise who would want to see them privately?"
, 26 Jan 00, Polly Toynbee: 'New research from Bristol University shows that wherever doctors move into the private sector they create the demand as they go, not vice-versa. Hardly surprising since they also control demand through their own NHS waiting lists. The Audit Commission tells the obvious truth that doctors who do more in the private sector do less in the NHS.'
19 Mar 00, in a piece
NHS surgeon dismissed for doing too much private work
: 'Michael Gray, a surgeon in Kent, has become the first hospital consultant to lose his NHS job for spending too much time with private patients.. he was found [
] to be working in a nearby private hospital when he was meant to be on call for the NHS.. The case.. will send shock waves through the country's 20,000 hospital consultants, many of whom have substantial private practices.'
30 Sept 99, Dr. Vincent Argent, letter: '..the main driving force for private healthcare is the existence of waiting lists in the NHS. It would be hard for consultants to deny that their private income benefits greatly from waiting lists and it may be in their interest to accumulate a waiting list in the NHS. A professor of anaesthetics once remarked that appointing a new surgeon never reduces waiting lists and that the amount of surgery performed expands to fill the time available.'
17 Dec 99, Dr. Helen Jackson, letter: '.. most doctors who work in the private sector are contracted to work in the NHS. The more private patients they see and treat, the less time they spend in the NHS hospitals. There would be much shorter waiting lists if all doctors contracted by the NHS completely fulfilled their contract.'
Consultants also sometimes take NHS junior doctors to assist at private hospital operations, worsening the situation.
27 May 99: 'BMA Junior Doctor Committee chairman Mr. Nizam Mamode claimed juniors were frequently asked to assist at operations in private hospitals with little training benefit. "The trust is losing the junior doctor for that periodthey are effectively lost from the service" he said. He also said accused some consultants of frequently asking their specialist registrars to carry out their fixed commitments in order to carry out private practice.'
29 Oct 97, Prof Donald Light: 'You have a sweetheart contract guaranteeing light, vague duties for a life sinecure of £45,000.. and the right to earn about ten times as much per hour on as many patients as you can persuade to relieve their pains and fears by paying private fees. You control the waiting list, which isn't a list or queue at all, but a pool of sick and disabled patients trying to keep their heads above water as you pluck out a few a week.. So you control which patients, needing which operations, wait how long.. if NHS surgeons operated just two days a week, waiting lists would plummet to the levels of waiting times for private patients.'
Long NHS waiting lists are also necessary for the £2 billion private health insurance industry to attract new customers. In fact, this is the main selling point in their advertising. Thus, a BUPA insurance advertisement in the
, 27 July 1999, reads: 'Take the wait off the NHS. As you read this over a
million people are waiting for an operation. And that's why around three million more put their trust in BUPA. BUPA membership enables you and your family to benefit from prompt treatment and private care.'
[Back to Notes...]
On children in private hospitals,
Health Service Journal
, 6 May 1999: Clearer guidance is needed on the care of children in private hospital beds, the Commons Health Select Committee has been told. Royal College of Nursing consultant Sally Tabor told the committee that the RCN was concerned that very young children were receiving unnecessary surgery, and that there was a lack of suitable staff and equipment to care for them properly. The RCN wrote to the Department of Health raising concerns in 1997, and was told: Standards for the care of children in private facilities [including] in a private hospital, are not the concern of this department. And
, 5 May 1999, RCN policy director Pippa Gough said to the Committee: We hear stories about poor care standards and non-skilled staff taking a nursing role with children. We also hear about nurses who complain, being asked to leave their jobs.
, letter, 5 Nov 1998, Dr G Evans-Jones, clinical director, women's and children's services, the Countess of Chester Hospital trust: I have always found it ridiculous that we [in the NHS] have made progress in recent years to ensure children having surgery are nursed in children's wards by paediatrically-qualified nurses under the supervision of paediatricians, operated on exclusively children's lists by surgeons with regular experience in children's surgery, and anaesthetised by similarly paediatrically trained anaesthetistswhile
at the same time in the private sector these requirements are often completely ignored.
[Back to Notes...]
We haven't considered the question of the restricting of the numbers of consultants by the Royal Colleges. A confidential report,
Restrictive Trade Practices of the Medical Royal Colleges
(1997), by Dr KP, has been sent to MPs, MEPs, and EC Commissioners. We have a copy. It deals
with the effects that the limiting of the numbers of consultants has on the length of NHS waiting listssomething invariably omitted from newspaper reports. It also investigates whether Statutory Instrument No. 3208, 1995, was drafted with the help of British medical officials, and whether, whilst claiming to enact EC legislation concerning the free movement of doctors in Europe, it was actually designedfor reasons of financial self-interestto obstruct EC-accredited specialists from British private practice.
On consultants, a doctor (personal communication, 1992) stated You need to be an NHS consultant to practice private medicine, and no-one can be in two places at once. We have less [sic] doctors per head of the population than any other country in Europe partly because, whilst private medicine has remained a cottage industry, each consultant has wanted a fair slice of the cake and numbers have been limited. Consequently, everyone else has to work 100 hours a week to keep the NHS afloat.
July 1992: The eagle-eyed European Commission took a mere fifteen years to spot that a 1977 law to ensure fully-qualified doctors could practice anywhere in the community was being flouted in the UK. .. The royal colleges, the BMA, and the GMC have long been running a secret cartel to ensure that only suitable (i.e. UK-trained) applicants receive UK accreditation or progress to consultanthood. Since the vast majority of private health firms only employ consultants or UK-accredited specialists, this restrictive practice has conveniently sewn up the private market too. .. Britain boasts fewer consultants per head.. than any other country in Europe, ensuring NHS waiting lists are the longest in Europe.. and forcing patients into the private sector, where the relatively few consultants divide the spoils. .. Competition for consultant posts is so fierce that junior doctors continue to work inhumanely and without supervision to protect their references.. Although UK accreditation is not essential to become a consultant, its absence is a useful spoiler to prevent overseas or otherwise unsuitable doctors from progressing too far or muscling in on the BUPA jamboree. However, European law decrees that EC-accredited specialists should have been on an equal footing with their UK colleagues since 1977, and both the commission and the Office of Fair Trading may well decide that UK accreditation, and hence consultant selection, are illegal. .. The outlook is now so dire for a wilfully fraudulent medical establishment that meetings between it and the Department of Health are held in private with all parties sworn to secrecy. Independent observers, such as the Hospital Doctors' Association, (a prime mover in calling for restructuring of medical training and an end to the one man, one reference patronage system) have sadly been excluded. Whether the threat of litigation stops consultant election committees overlooking the best applicant in favour of the right sort of chap remains to be seen.
30 Jun 98,
Doctor to challenge medical hierarchy
: A consultant anaesthetist.. is to challenge the "closed shop" run by the medical royal colleges which have refused him consultant status in the UK. Dr Richard Kaul, who qualified as a doctor in Britain before moving to work in the US, alleges that the system for admitting doctors from overseas to the register of specialists who can apply to be consultants is shrouded in secrecy and operates unfairly and arbitrarily.
9 Aug 99, letter from Dr D Bell: '.. In a competing market for private practice, reluctance to increase consultant numbers at a local level has often come from the consultants themselves.'
23 Sept 99, letter, Prof Wendy Savage, senior lecturer in obstetrics and gynaecology, St.Barts: 'Manpower in the NHS has been a lamentable failure. For too long the UK has taken doctors from third world countriestrained at their expense, not oursand used them to make good NHS deficiencies. The profession's leaders have not been wholeheartedly behind expansion of medical students and consultant posts and one can only speculate that this has something to do with lucrative opportunities in private practice, mainly in the Southeast where the British Medical Association's headquarters is situated.. A full-time contract without private practice.. is long overdue.'
Dr Andrew Vallance-Owen, Medical Director, BUPA,
: The system should be transparent and equitable to comply with the European legislation on free movement of doctors.
(Note: Another consideration relevant to consultants is the division between academic specialists, for example professors, and the applied, clinical, specialists. The former may have pet theories, or simply follow modern theoretical errors, which the unfortunate latter may have to try to put into practice. This happens with
all diseases which are not understood; 'AIDS', arthritis, Alzheimer's, multiple sclerosis, schizophrenia, Parkinson's, cancer... - RW)
[Back to Notes...]
We haven't considered either the questions of superfluous treatment, overtreatment, and ineffective drugs, nor the issues involved in controlled trials of effectiveness of techniques.
In 1979, Prof John B McKinlay commented on a US Senate investigation which reported that 2.4 million unnecessary operations were performed annually in the USA, causing 11,900 deaths. (From e.g.
Martin Weitz, 1980, pubd David & Charles, a guide to useless, unnecessary and hazardous treatment).
Not much has changed. In Britain, John Yates in
Private Eye, Heart and Hip
(1995) pp. 57-59 on the 'top ten' surgical procedures (a quarter of all operations) comments on numbers 4, 5, 7, 9, and 10, which are curettage of the uterus, surgical removal of teeth, removal of tonsils, hysterectomy, and drainage of the middle ear. Yates' comments include a
leading article describing curettage as diagnostically inaccurate and therapeutically useless, removal of tonsils described as discretionary ('It is over 50 years since Dr Glover graphically told the story of huge variations in tonsillectomy rates..'), claims that at least one-third of all hysterectomies.. are unnecessary and a
leader in 1993 describing the growth in the number of 'glue ear' operations with 'grommets' as an epidemic.
Yates adds: In fact, few of the operations listed in the top 10 can be classified as carrying a high degree of scientific approval.
(More evidence from Britain: Over treatment is the norm... many patients are given unnecessary X-Rays, blood tests and ECGs (at a grossly inflated price). (from a private letter from a doctor, 1992). And Dr B. Webb, Chairman, Medical Advisory Committee, Pinehill private hospital, letter,
19 Sept 98: I would suggest that unnecessary operations [in private hospitals] are a problem, some being performed by doctors who have had only basic training in the techniques while they were passing through a specialty.)
(On ineffective drugs, the Professor of General Practice, Prof. Jarman, now Sir Brian, in a lecture on 23 Oct 1995 claimed there must be 10,000 although he was including those not proven effective in controlled trials. As an example, he cited patients with ulcers who asked for Zantac, which they'd heard of through advertising, but if I were to prescribe an equally useful drug, cimetidine,
we could actually save the cost of more than one health authority per year, just by changing that one drug out of 30,000 we have.)
[Back to Notes...]
Costs to the NHS of Private Treatment
Long-term care following complications or accidents: BBC TV
4 June 1996: Mrs Darley-Jones' case [see below] has concerned public health officials. Although the [procedure] was carried out in a private hospital, she'll spend the rest of her life being cared for by the NHS. When her private insurance ran out, the NHS had to step in. Ross Tristrem, NHS Trust Federation [now NHS Confederation]: Theoretically, if somebody is treated in a private hospital, and then has to be transferred to the NHS, and is there for the rest of their life, then I think that perhaps the NHS should be examining whether they ought to be claiming back the cost of this from private insurers. (
2 June 96: The NHS is now paying £750 per week for her care.)
NHS ICU costs:
May 1996: Of course, whenever there's a cock-up, patients who survive will be ferried back to an NHS intensive care unit for the taxpayer to pick up the tab.
And Prof John Ward, letter,
7 Feb 1994: .. when a surgical patient develops a serious complication in a private hospital and requires [NHS] intensive care.. [this costs] £1,000 a day..
And four doctors, Lower Clapton Health Centre, London, letter,
21 Feb 1992, Picking up the tab in emergencies: .. the NHS, not the private sector, always picks up the costs of emergency treatment. The costs are huge compared with those of providing planned elective surgery. An NHS hospital may charge more than a private hospital for elective procedures [the reason some GP fundholders send NHS patients to private hospitals] to cover the cost of emergency services.
And Labour, David Blunkett MP, Going Private, Sept 1994: Reliance on the NHSthe independent health sector provides only a limited range of medical procedures and treatment. There is clear dependence on the NHS as a backup for treatment that the commercial sector can not, or will not, provide.
And Channel 4 News, 29 Apr 1999: There are no official figures published on the number of botched private operations, and private medicine doesn't discuss how often it has to depend on the NHS to put things right when it doesn't have the expertise or the facilities to do it itself. But we can say that one thousand times a year an intensive care bed in an NHS hospital is taken up by a private hospital patient.
Costs of staff training, and of equipment and supplies:
Commercial Medicine in London
: Private hospitals depend on staff [doctors and nurses] trained by the Health Service at the taxpayers' expense.. The private hospitals' contribution to post-basic training is.. negligible. [Letter in
Health Service Journal,
15 Oct 98, said It costs more than £200,000 to train [sic] a doctor from scratch. The average for a nurse is estimated at £30,000 (BBC, 1998)]
The authors also state: Generally speaking, it is the private sector that relies on the NHS rather than the other way around. The average private clinic, according to the most recent official figures, has just 43 beds. These clinics are often built near NHS hospitals in order to make use of their services, and certainly to attract their staff. ..
11 Jan 1990: The private sector relies heavily on health service staff, with 85% of consultants doing some private work.. The National Audit Office reports argued that the private sector had recruited many nurses from the NHS while making only a small contribution to the training of medical and nursing staff.
Health Care in the United Kingdom,
1982: A further argument against the private sector.. is that it is parasitic on the NHS in that it does not bear the cost of training the professional staff it employs. Fifteen years later:
10 Oct 98: The public subsidise private medicine. The NHS trained the vast majority of the people who work in the private sector. Many consultants in private hospitals are moonlighting employees of the health service.
The Business of Medicine,
p 188: The basic problem for many health authorities is that they tend to lose staff to the private sector or from those groups whose training is long and expensive (such as intensive care nursing or operating theatre staff). There seems little doubt that in parts of the country such as central London, where there is a concentration of private facilities, this leads to direct and overt competition.
On the effect of private practice on NHS waiting lists: BBC Radio 4,
You and Yours
, 31 Mar 1999: It's no wonder the NHS waiting lists are so long, say critics. The average NHS surgeon [with a private practice] operates on NHS patients less than one day a week. And [Consumers Association added] We found that on average consultants were setting aside over two half-days per week for private patients.. it's hard to see how they can fulfil their NHS commitments and do this amount of private work each week. BBC: The Consumers Association's findings supported a major study published three years ago by the Audit Commission. It found evidence of a clear trade-off between NHS and private work. Twenty-five percent of consultants who did the most private work did less NHS work than the rest. It also backed earlier research by Dr John Yates at Birmingham University, who found
specialties with the longest waiting lists were also the main and the most lucrative areas of private practice.
[Back to start]
Notes and References to 3. Key PointsAdministrative
Managers of Private Hospitals
Incidents Specific to Private Hospitals
Poor Record-Keeping and Lack of Statistics
Collusion to Suppress Figures
Lack of Complaints Procedures
Registered Homes Act 1984 and Inspection Visits
Note: the legal system is different in Scotland.
The National Consumer Council [set up by government in 1975 to champion the interests of consumers] wrote in its submission to the Commons Health Select Committee: We note that cases regularly appear before the advertising standards authority about misleading claims for clinics and health products. We would welcome examination by the Committee of the extent to which firmer regulation is needed for the advertising of private health care services and products sold on the open market.. The Advertising Standards Authority (
Click for their Internet home page
does not have great powers, but is at least able to adjudicate on private hospital advertising. (It specifically does not deal with advertisements in journals intended for doctors). To date it seems to have dealt mainly with cosmetic surgery (click for
ASA and cosmetic surgery
testimony to the health Select Committee). Possibly this will change if realisation of the misleading nature of some private hospital advertising becomes more widespread, and if the government decides it has other things to do than try to control private hospitals. The Consumers Association in their oral evidence complained: .. much of the information that is available and provided is advertising and promotional information. Consumers are at a great disadvantage if they actually do wish to pursue some questions or to get more information about the services that they are offering.
(Advertisements for private hospitals make fine-sounding but generally vague and unprovable claims e.g 'We are committed to excellence and quality through the provision of healthcare services' or 'We believe our hospital offers care in a class of its own'. A computer search will throw up many examples.
Even the findings of the Health Select Committee and continual adverse media coverage have not deterred Norwich Union Healthcare from its flyer 'Top quality hospital treatment' with a smiling nurse, nor BUPA's claim in a recent
Express on Sunday
Magazine ad: 'Private Medical Cover with BUPA.. offering the highest quality medical care..' -RE).
[Back to Notes...]
Managers of Private Hospitals: Should They Take Responsibility?
26 July 99: 'The management of private hospitals also leaves much to be desired. Often more attention is paid to decor, and to achieving hotel levels of luxury, than to standards of treatment and care. Internal controls.. are weak.'
Magazine report on private hospitals, August 1999: '.. we think it's vital that the new regulations ensure that private hospital managers are made legally responsible for all medical treatment carried out in their hospitals.'
Camden New Journal
19 Aug 99, Solicitor Louise Christian: 'The only real deterrent to stopping large companies putting profit before safety and people at risk is the fear their directors will go to prison.' [Referring to railway companies. The same could apply to private healthcare - RE]
John Lambie, Chairman of APROP, speech to the 1999 Annual Acute Healthcare Conference: "People with complaints are treated with callous indifference and the best words to describe the reactions of private hospital managers are procrastination, prevarication and obfuscation. You must learn that the effect of losing a loved one without explanation or apology can have a devastating effect on next-of-kin, extending far beyond the natural grief to be expected in
such circumstances. Their struggle for justice goes on for years, can split families, and cause divorce and bankruptcy. It is no wonder that feelings of many APROP members towards managers in private hospitals borders on hatred."
[Back to Notes...]
Incidents Specific to Private Hospitals
See the newspaper montage below, with notes. NB: the paucity of figures makes a full comparative analysis very difficult. International comparisons are even more difficult.
On private practice, the second edition of
The Good Doctor Guide
(Simon & Schuster, 1st edn 1989; 2nd edn 1993) by Martin Page, which lists or recommends medical specialists, and which according to Page was obstructed by both the BMA (which is but a trade union) and the General Medical Council, states: ..we surveyed a sample of over 250 doctors practising in Harley Street. More than a quarter of them were not accredited or qualified in any speciality. Page also states: Of the doctors listed in this edition, only sixjust over 1 per centare in full-time private practice.
1 Feb 1998: .. few private hospitals are equipped with the intensive care units and crash teams needed to deal with major complications;
if problems do occur, you have a good chance of ending up in an ambulance on the way to the accident and emergency department of the local NHS hospital, where they can pick up the pieces or declare the time of death. .. (NB: This article does not attempt to quantify risks). [
Back to Notes...
Poor Medical Record-Keeping, and Lack of Statistics
, July 1999, David Hinchliffe, Chairman Health Committee on private hospitals report: 'There was evidence that the patient's consultant would take the medical notes away with him. If problems arose the doctor may be an hour away.'
report on private hospitals, August 1999: 'The hospital and the consultant may each have their own set of records, which also complicates the process. Standards of record keeping also vary and, according to AVMA, are often poor.'
'John Corless [see list of cases] complained to the Wellington and asked for his medical records, which he was legally entitled to see.. these failed to arrive..'
, 21 July 99, Caroline Buckley, APROP: "Private hospitals still don't collect or publish statistics on things like the number of patients who have to be referred to an NHS hospital as an emergency, which I'm sure would make very shocking reading."
survey of 26 lawyers specialising in medical negligence revealed that of 300 cases on their books, 163 involved complaints against a private consultant.'
On the lack of information available to potential private hospital users, Dr. Phil Hammond,
Trust Me, I'm a Doctor
(1999): '.. people going private [should be] given all the information that allows them to make an informed choice. Some surgeons do major operations in private hospitals without emergency
facilities or support, and patients should be aware of this risk.' And the
, 26 July 1999, Andreas Whittam-Smith, former editor, in an article 'Why patients get a raw deal from private health care': '.. customers are often badly informed and obliged to take everything on trust.'
[Back to Notes...]
Collusion to Suppress Figures
consultant surgeon John Scurr said: Those cases that are really negligent are settled before they ever get to court, and of course nobody ever gets to know about it. What makes me cross is the fact that we have these cases, there are lessons to be learnt from them, and nobody knows anything about it. They are just dismissed, settled, no records, and I think that's very sad. (Patients who receive out-of-court settlements are sometimes required to sign an undertaking to remain silentactual figures on non-disclosure are unobtainable).
In June 1998, the British government announced that comparative death rates (adjusted for risk) will be published for hospitals in England and Wales. Press announcements used the phrase every hospital in England and Wales. In fact, The league tables will not cover private hospitals. (
7 June 98). [There is a curious British tradition of exempting private medicine, private education, private clubs, some churches, governmental organisations and so on from legislation. At least, I'm in the habit of viewing this as peculiarly British; in fact, no doubt the same thing applies elsewhere - RW]
29 Apr 1993, Margot Norman: When my husband was recuperating after surgery in one of those swanky private clinics near Harley Street, I used to sit by his bed late at night and hear the trundling of trolleys, accompanied by panicky whispering from the staff, as desperately sick Arabs were transferred to the nearest teaching [NHS] hospital with room in its intensive care unit. This always seemed to happen after all the other visitors had gone home, which struck my suspicious mind as convenient. Convenient, also, was the fact that their deaths would be recorded, not at the clinic, but at the teaching hospital.. Private hospitals do generally appear to have a respectable death rate, but that has a lot to do with midnight flits.
2 Aug 1998: The Department of Health collects no detailed figures on the performances of private hospitals.
On the General Medical Council's failure to collate information on poorly performing doctors in the private sector, Jean Robinson, in
A Patient's Voice at the GMC
(1988): .. as the Preliminary Screener [of complaints] does not usually provide information on rejected cases, we have no idea how many complaints are received about private doctors, what subjects they cover, and how their numbers are changing.
[The extraordinary atmosphere of dissociation from responsibility within the medical world (and other similar closed groups) is illustrated by this extract from the 1985 autobiography of existentialist psychiatrist R D Laing: '.. He had a patient in psychotherapy with him. A consultant anaesthetist. This patient had led him to suppose (he told him directly, in so many words) that he had killed three people in the last year, while he had been in therapy, by unobtrusively curtailing their oxygen in the course of long, complex, surgical operations. He kept his overall statistics normal.. Anyway, he had had a good run for the last three months or so [and] was now about to kill the next victim. He would choose someone with a bad heart, poor lungs or what not...
... Could this chap simply be having him on? Over the years, all psychiatrists are told some extraordinary stories..
Nevertheless, Abenheimer had become almost sure (how could he be
sure?) that his patient was telling the truth. It was fantasy acted out in fact. Now he was asking himself whether he should do anything. ..
After a year of treatment, the existential-Jungian-psychoanalytic psychotherapy
was not working. ...' [Laing goes on to discuss what his best chance was of dissuading the 'patient' - RW]
[Back to Notes...]
Lack of Statutory Complaints Procedures
article 1 Feb 1998: One thing is certain; if he [Owen Ennals] had been treated in the NHS and something had gone wrong, his family would have been able to use a rigorous complaints procedure. They would have been able to convene independent panels to study the case, and could have appealed to an ombudsman if they still weren't happy. The system would have been open and thorough and, even if the Ennals hadn't liked the answers, at least they would have known their questions had been fully considered.
The private sector is a different country; the complaints procedure is anaemic, the regulation flimsy. It took Owen Ennals's wife and son five years to receive any kind of complete report into what happened...
Channel 4 News, 29 Apr 1999: In all likelihood [in fact no figures are available-RE] private medicine makes as many mistakes as the NHS. The difference is that when things go wrong for private patients, they are outside the NHS safety net, up against a multi-billion pound industry. NHS patients can rely on the Patient's Charter, the Community Health Council, and the Health Service Ombudsman. Private patients cannot. The NHS has statutory complaints procedures and an independent review panel. Private medicine has not.
BBC Radio 4,
7 June 96:- Since April 1st , the NHS has operated a streamlined complaints structure which contrasts with the position in private hospitals where the procedures to deal with grievances can be non-existent. .. Barry Speker, lawyer specialising in medical negligence law:- In the NHS.. there is a recognised clinical complaints procedure which patients can take advantage of and ensure that their complaints are properly investigated. Whether a private hospital has one just depends upon the appropriate level of care and organisation of that private hospital. There's certainly no guarantee that either there will be a proper complaints procedure, or that it will be utilised and adhered to by the organisation itself.
1 Feb 98: Within the NHS, there is a clear, independent, complaints procedure. Within the private sector, you are relying on them to deal with your complaints. And frankly you are up against a commercial concern. You've got the insurers telling the hospital not to say anything. And you've got the hospital guarding their reputation. They know your only [proper] option is civil law, which they also know you won't be able to afford.
Whom does one sue? .. in private hospitals, the patients contract separately with the consultant, who is not employed by the hospital, and the hospital accepts no responsibility.Barry Speker, Radio 4,
You and Yours,
7 June 1996, 'Private Hospitals', said:- With a private hospital, you might be suing the hospital or you may find that you are suing the surgeon or other doctor individually because he is not actually employed by the private hospital.. Mistakes can be made where a plaintiff actually sues the wrong person, and that can prejudice the outcome of the claim.
Channel 4 News, 29 Apr 1999: It was only when they tried to hold BUPA to account that the Carmons [see listed cases below] realised how easily private hospitals can effectively wash their hands of any responsibility and instead blame the doctor responsible. Dr Andrew Vallance-Owen, BUPA Medical Director: .. at the end of the day, in the strict legal sense, liability in this country lies with the treating or investigating doctor. However,
4 Mar 99: Mr Carmon says BUPA should be legally responsible for quality of care as an incentive to raise standards.
BBC TV Newcastle,
26 Mar 98, quoted in a feature on Christine Maloney: Private health is not publicly accountable. This is wrong. We think all healthcare providers should be accountable to one regulatory body so private and NHS patients can be confident that they can make a complaint and have it heard.
On litigation: by delaying the legal processtime-wasting by supplying incomplete records, not replying to letters for months, not answering relevant questions and so ona skilful defendant's lawyers can hamper the plaintiff's preparation of the casethree years are allowed under the Statute of Limitations to issue writs.
Litigation can be further hampered:
if the hospital or doctors or nurses have tampered with the patient's medical and nursing recordsthere are frequent reports of this, e.g.
10 May 97, 'Consultant Altered Notes After Baby Was Born Brain-Damaged',
14 Feb 97, 'GP Missed Dying Man's Symptoms Then Forged Medical Notes',
4 Feb 96, 'Hospital Altered Notes On Dead Patient',
29 Nov 95, '.. panel ruled that.. nurse re-wrote and falsified entries on notes',
7 May, 94, 'Doctor Jailed For Attempting To Cover Up Fatal Error',
Journal of the Medical Defence Union,
vol. 8, No. 1, 1992 (p 11), '.. doctor admitted that he had fabricated the notes..'
If the hospital draws up an untrue but plausible version of events. If the hospital dissembles, and the notes have been 'doctored', it is extremely difficult for an expert, working from such documents, to report properly.
By the difficulty of finding experts, if there has been negligence, who are prepared to say so. The medical (and nursing) expert report-writing industrya lucrative sideline for consultantsis unregulated and unaudited by the state [unlike e.g. Francesee
New Law Journal,
6 Feb 98], and it is likely that some experts produce so far and no further reports, sufficiently critical to justify their fee, but not sufficiently critical to risk landing a fellow doctor in the dock, no matter what may have happened to a patient. [Cf. a barrister, in
: It is depressing to see how many reports are.. inadequate.. it may be that they are, consciously or not, interested to exonerate the management. And
Medical NegligenceA Plaintiff's Guide,
in a section
: It is common knowledge that it is extremely difficult to prove that a physician has been negligent. The usual reason given for this is that you cannot find an expert who is willing to accuse a colleague. This is known as the 'closing ranks' syndrome, and it no doubt contributes to plaintiffs difficulties, particularly where the specialty concerned is a narrow one, for its practitioners will almost certainly all know each other, so that the reluctance to accuse of negligence is all the more pronounced. And
, 11 Aug 1998, John Lambie, Chairman, Action for the Proper Regulation of Private Hospitals: ".. there is the additional obstacle of finding an expert witness who will testify against a fellow specialist."]
There is also the problem of the poor quality of some experts' reports [cf.
a barrister specialising in medical negligence: I find time and again that the experts instructed are not coming up to scratch in the presentation of their reports or in the attitude to the case.. An expert needs to appreciate that if he [=she/he] accepts instructions he must review the treatment the patient has received carefully, thoughtfully, and in detail. A quick scamper through the records and a short declaration that he finds nothing to suggest negligence will not do. He must also beware of the attitude that he is doing the patient a favour in agreeing to act. This despite
New Law Journal,
24 July 1998: The expert.. owes a duty of care to his lay client.. And the opinion of a deputy judge in
New Law Journal,
15 May 1998 that an expert should be liable for poor advice.]
By the difficulties of proving negligence to the very high standard required by British lawthe forty-year old Bolam test (details of which poorly-briefed experts may in any case be unaware of), and then, in addition, of showing causation, and to the degree required, the balance of probabilities [i.e. had the negligent omission or commission not taken place, there would be a greater than even chance that the damage to the patient would not have happened, or would not have been so great.]
By the fact that the plaintiff will be up against a well-resourced insurance company and/or medical defence organisation, using experienced defence lawyers [
Medical NegligenceA Plaintiff's Guide
(1987): The opponents are usually tough and experienced, particularly if a medical protection society is involved, and the solicitor, inexperienced in medical negligence work, can find himself and his client very much at a disadvantage.]
By the inexperience and incompetence of some lawyers, cf. AVMA,
Aug 95, on a case of a couple with a brain-damaged son. They went through three sets of solicitors: .. many people who have suffered a medical accident have felt let down by the way they have been treated by the legal profession subsequently. It is not uncommon to find solicitors handling medical negligence claims inexperienced in this complex area.. and ill-equipped to deal with the medico-legal issues that are involved. Claims flounder before they ever have a real chance of progressing and it has been known for solicitors to give up on a case before even obtaining the medical records and The fact that a firm of solicitors advertises that they do medical negligence work does not guarantee that they do it well.
By the prohibitive costs and financial risks of legal action in Britain (and patients who can afford private medical insurance are unlikely to be eligible for legal aid). Plaintiffs, unlike in the US, must deal with two types of lawyer, the solicitor, who investigates and prepares the case (if in the light of the above you have a case); and the barrister, who argues it in court. The cost of the former can start at £200 an hour ($325) and the latter at £400 an hour ($650). The plaintiff in a relatively straightforward medical negligence case reported in
26 July 1996, [who did have the means] spent £310,000 in legal costs ($500,000). Arnold Simanowitz,
: Basically, if you don't qualify for legal aid, you can't get justice, because litigating in medical negligence is extremely expensive.. Most people who [use] a private hospital don't qualify for legal aid. That means that they can't get compensation even if they're entitled to it. And [Law] Lord Woolf, 1994: It is only those with the deepest pockets who can risk going to law And Lord Bingham: It is no use having the best jurisprudence in the world [sic] if those who need it cannot afford to tap into it. And sociologist Max Weber,
Economy and Society
: The court procedures (and legal costs) in England amounted to a far-going denial of justice to the economically weak groups (written in 1915).
By tactical paying into court. Plaintiffs are encouraged by their advisors to accept an often inadequate amount paid into court by the defendant's insurers on the grounds that, if the judge later awards an equal or lesser sum in court, they will be liable for both parties' legal costs. Any compensation can be wiped out or even result in loss.
By the length of time of legal action, which can be especially wearying for injured patients. The above case took four years to come to court. Some patients or elderly relatives may conveniently die during such a period.
By the absence, unlike in the US, of juries in medical negligence cases. A barrister in
identifies the problems: There are a number of difficulties a plaintiff faces in proving negligence. They include the problem of.. overcoming any possible pro-doctor prejudice in the mind of the judge [and, in a section entitled Judicial Prejudice].. the anti-patient prejudice of the courts.
[A right in fact did exist under 1933 legislation for the litigant in a personal injury action to apply for jury trial, but the effect of this provision was largely nullified by a 1966 Court of Appeal decision]. - RE.
Figures supplied by the defence organisations to the Pearson Commission are telling: these showed that, out of 500 claims of medical negligence referred to legal advisors in one given year, 305 were abandoned, 170 were settled out of court, and only 25 or 5% went to court, of which only 5 or 1% of the original were successfulfrom
Medical NegligenceCompensation and Accountability,
King's Fund Institute 1988.
Very high costs of litigation, prejudiced experts, and falsified records could constitute a breach of Article Six of the European Convention on Human Rights, the right to a fair trial, now incorporated into British law, effective from 2001.
In fact, all a private hospital [or possibly a defence organisation] has to do after a serious incident is to find out whether the complainant can afford the high costs of British civil law, and in the likely event that he cannot, simply prevaricate. Conceivably this actually happens - RE
The Woolf Reforms.
It's too early to say whether these will genuinely benefit the injured patient or relative. One lawyer commented in the
20 Oct 99: 'Already the larger firms are finding ways of bypassing the reforms or turning them to the advantage of their wealthy clients.. the corporations and institutions.. will continue to have the best lawyers money can buy.' Costs will be higher in the early stages:
26 Oct 99: '.. many lawyers with first-hand experience of the new rules are finding not only that post-Woolf litigation is as expensive as under the old system, it can be even more expensive in the early stages and litigation costs are being 'front-loaded' as never before.' AVMA criticised the initial proposal to have medical experts from both sides debating the issue behind closed doors without solicitors. With insurance companies now insuring against losing, there is the likelihood that they will take only cases with exceptionally high chances of success (so also with lawyers' no win, no fee arrangements). And the problem of falsified notes is not addressed. Cases can still founder if the expert, if an impartial one is found, is operating from such documents. The experience of many victims, speaking from meetings at patient conferences, is that they would prefer not to have anything at all to do with lawyers in the wake of a medical tragedy, and to have instead some sort of medical negligence police who could step in and take over, as with traffic and transport accidents.
On private hospitals not honestly admitting error. Hospitals are under no legal obligation to tell the truth about an untoward incident, and complainants may find that they do not receive an accurate version of events, something found by a large number of the people in our list of cases. (Although the NHS Confederation in
Independent Acute Hospitals and Services
quotes Registered Homes Tribunals' definition of the fitness legally required of the person-in-charge of a private hospital as including such qualities as: trust, integrity, truthfulness, undeviating honesty, morality, and a strict adherence to a code of ethics. In theory, therefore, the fit hospital manager should always respond to complaints honestly and truthfully). Similarly the June 1998 GMC Guidelines for Doctors
Duties and Responsibilities of Doctors
[which include private consultants] state: .. you must take reasonable steps to verify any statement before you sign a document. You must not sign documents which you believe to be false or misleading. The private doctor, therefore, should also, in theory, respond honestly and truthfully. However, these are only guidelines.
Other complainants may be threatened by lawyers acting for the hospital. (Cf.
2 Aug 1998: Some patients who complain find themselves threatened with legal action. And
1 Feb 1998: Rose and Jack [whose 27-year old son died following an operation in a private hospital] fear that if they identify themselves.. the hospital might slap a writ on them. Their concerns are reasonable. A number of people have been sued by private hospital groups after they complained publicly about the care they received.)
If, however, their complaints have been upheld by the Health Authority, and recommendations made for improvements, they should consider
(a) complaining to the Health Authority; the hospital may not be implementing the Authority's recommendations;
(b) complaining to the NHS Executive and/or the Department of Health; a law firm which, acting for a private hospital, disregards the findings of an NHS body, could at the same time be providing legal services for other NHS bodies;
(c) complaining to the Law Society (consult The Law Society's
Guide to the Professional Conduct of Solicitors
available at most law libraries). Recommendations are made by the registering Health Authority to protect other patients' livesthese are public safety issuesand to disregard such recommendations could be inconsistent with the Law Society's standards of conduct for lawyers. (Cf. Practice Rule 1 of the
Law Society's Guide
] which holds inter alia that the public interest must take precedence over a solicitor's duty to his/her clients. Part IV of the
Obligations to Others
] also states that it is a breach of Rule 1 for a solicitor to write offensive letters to third parties. This is described in the
as 'unprofessional conduct').
(d) Repeated intimidatory letters from lawyers may constitute an offence under the Protection from Harassment Act 1997.
(e) (Complainants should be aware, however, that the Law Society's complaints handlers, the Office for Supervision of Solicitors (OSS) receives 32,000 complaints a year and currently has 25,000 complaints awaiting attention, with the backlog rising by 300 a week. According to the
(July 1999), the OSS has effectively shut down for a year, and it may therefore be more effective to complain directly to the President of the Law Society and perhaps to the Lord Chancellor, Lord Irvine of Lairg).
On private hospitals having an interest in playing down consultants' mistakes:
: Prof. Maureen Lahiff: ... the consultant is going to be a longer-term customer [of the private hospital] than the paying patient, because often the patient comes in and goes out, whereas the consultant will work with a particular hospital over a period of years. So it's very important for the hospital's survival to maintain good relationships with its consultants.
Dr Andrew Vallance-Owen, Medical Director, BUPA,
: There has been a reluctance at times for providers [private hospitals] to tackle specialists whose practice they believe to be suboptimal if the specialist brings in significant numbers of referrals to the provider unit. There is.. the risk of losing the specialist's business..
Don't Stay the Night
: Prof. Davenhall: .. Keeping the consultant happy is big business in the private sector.
Medical Accidents Handbook
, (Wiley 1998), Richard Ennals and Liz Thomas: Independent hospitals to a greater or lesser extent rely on consultants to bring in patients and are therefore having to compete to attract consultants' business. This might in turn be an influential factor when it comes to the handling of complaints within independent hospitals; it is possible, from the hospital's viewpoint, that it may be more of a priority to keep the consultant happy than the aggrieved patient.
Effective Management of Private Health Care,
1989 book, Ed. Anthony Byrne (then Chief Exec. of I.H.A., was Independent Hospitals Assn, now Independent Healthcare Assn) & Haydn Cook (then Director, Parkside and Hillside Hospitals, now Chief Executive, Calderdale Healthcare NHS Trust), Cook states: Hospital directors in the private sector, when asked if there is a complaints policy, often respond rather negatively. The reason is that the whole ethic of the private sector is to avoid complaints, ... ultimately the patient will refuse to pay if there is a problem,
so there is a real incentive to sort matters out! [If, that is, the problem hasn't killed the patient - RE]
[Back to Notes...]
19 Oct 1996: Mark Lattimer & Simon Garfield,
Going private at your expense
: Over one-third of private hospitals use charitable status in order to avoid any corporation tax or capital gains tax, and to pocket the standard 80% charitable relief on business rates. The number of private hospitals operating under the guise of charitable status has now reached 84 acute and 11 psychiatric hospitals.
.. the London Clinic [149 Harley Street; '.. new endoscopy unit.. £2 million... recent £5 million.. medical oncology unit.. plastic and reconstructive unit..'] is a registered charity. .. estimated to benefit from £1.7 million in tax breaks every year, at the expense of.. taxpayers. .. Last year's accounts show that it handled £27 million in private business. How much did it spend on providing free treatment for those unable to pay? Just £2,000. ... The main factor that sets charitable hospitals apart from other private hospitals is that they do not distribute dividends or profits to shareholders. .. The law places one other stipulation on charities. And that is that they should exist for the public benefit. ... The Nuffield Hospitals group makes little attempt to conceal its lust for making surplusesprofit in all but name. Reading .. annual reports one is struck not by the group's desire to deliver care to the greatest number at the best possible price, or even just to meet demand, but by its attempt to maximise expansion through increasing financial return. ...
.. Richard Fries, [former Chief Charity Commissioner] accepts that there are legitimate questions to be asked about the public benefit [private charity hospitals] bring. How broadly available to people do health services need to be to justify charitable status, with all that goes with it including tax relief? ..
Private hospitals in Britain are subsidised in at least four different ways: their medical staff are largely trained by the NHS; their patients rely on the NHS to provide back-up emergency and intensive care facilities; the charitable hospitals are largely exempt from paying business rates; and the same hospitals pay no tax at all on the large annual surpluses they make. ... the sum lost to the taxpayer in subsidies [of private hospitals] comes to over £120 million ...
An undated but recent
brochure states: We recognise that not everyone who wishes to use our services has the benefit of a private medical insurance policy. In response.., Nuffield are the healthcare group which pioneered the concept of fixed cost surgery. Now 20% of our patients are uninsured.. Presumably before this reform such people were charitably told to go away; Nuffield is registered as a charity.
The Gift of Health,
by Mark Lattimer, 1996: The first, rather obvious, point to make is that.. they [private charity hospitals] have little to do with poverty or lack of financial means. This.. is left almost entirely to the NHS. The charitable hospitals are more interested in the other end of the patient range.. [Not distributing dividends or profits to shareholders, as charities] does not prevent them from paying handsome salaries to their senior staff and managers but it does mean that any surplus generated at the end of the year is retained and invested back into the hospitals workback, that is, into providing services to private patients. The provision of healthcare or, as it is commonly phrased, the relief of sickness is a purpose that is recognised in law as charitable [and].. Charitable hospitals are.. open to anyoneproviding they have the money to pay.
Commercial Medicine in London
(1985): .. there is often a fine line between non-profit and profit-making organisations. .. For the most part, charitable hospitalslike private schoolsretain their charity status primarily for tax advantage, and it would certainly be extremely difficult to obtain treatment in the more commercially-oriented charity hospitals without payment. .. Many private hospitals enjoy charitable status, yet don't behave as charities. Jim Barker of AMI [now BMI Healthcare] prefers to call them non-taxpaying companies .. Some of the tax advantages obtained certainly offend common sense, such as .. clinics registered as charities whose daily bed charges approach £150 a night [1985 prices]
Banking on Sickness
: Many hospitals are charities which results in advantages in relation to donations, freedom from corporation tax, and their rates [property taxes] being halved. .. But some aspects of private medicines' tax status seem anomalousespecially the charitable status granted to organisations selling a luxury service good to the middle class for the benefit of moonlighting, highly-paid, public employees. [I.e consultants] .. the charitable status of private clinics is surely due for revision.
1996: The old rumble is still occasionally heard [sic] What do they do that's charitable?
10 Oct 98: A third of all private hospitals enjoy charitable status, which means that they pay no tax... at any given time, half of them are empty. And yet these "charities" with their enormous surpluses are in no rush to fill these beds with people who have a low credit rating.
Baroness Nicholson, House of Lords, 28 Mar 00: "Only in waiting times does private healthcare win. In virtually every other health activity, measurable, by known indicators, the private sector rarely does better than the NHS and frequently offers lower value service at far higher costssometimes at rip-off costsand under the name of 'charity'."
Private Eye, Heart and Hip,
on the private charity hospitals owned by religious orders [of which there are about a dozen - RE]: Religious order hospitals frequently.. are involved in the provision of care for those who are insured or who can pay privately. The time might now have come for the churches to withdraw entirely from the provision of private health care. There can be no religious ethic that would support the earlier treatment of one patient ahead of another simply on the grounds of ability to pay.
Healthcare Market News
, Oct 98: Charles Auld, Chief Executive of General Healthcare Group.. called for regulation to ensure that hospitals claiming charitable status do not simply take advantage of these subsidies [the tax concessions] to perpetuate their existence, but use it for genuine charitable causes.
Healthcare Market News
, Aug/Sept 99 quoted Auld at a
New Statesman Conference
: '.. Mr. Auld repeated criticisms of the tax concessions received by some charitable hospitals. Paying tribute to 'genuine' charities.. Mr. Auld said: "What is less defensible is the tax break given to hospitals with charitable status who do nothing but provide medical treatment to private patients at commercial rates. As charities they too are being subsidised by the tax payer but do not provide services to the needy with that money. How that money is best deployed should be an important part of the welfare debate".'
And John Stoker, new Chief Charity Commissioner, explaining his decision not to grant charitable status to the Church of Scientology on BBC Radio 44, 12 Nov 99. It did not confer a "public benefit": "The question turns on the question of whether public rather than private benefit is an essential feature of a charity. That's basically the spirit that we've approached it in.. we've really been looking at the question of the law and the conclusion that we've reached is based on how they measure up against the law." [So why doesn't the same principle apply to 'charity' hospitals? - RE]
[More information on the religious private charity hospitals, including questions re financial data, to come, perhaps as a separate Websitethe Fitzhugh Directory, despite claiming to be a comprehensive directory of private hospital annual revenues, still fails to report the finances of most of the religious private 'charity' hospitals.]
[Back to Notes...]
BBC Radio 4, 7 June 96:- Jan Lawson of an independent advisory firm specialising in medical insurance: ..[there's no] right of action against the insurer, because the patient's agreement.. is with their medical practitioner and the hospital.. the medical insurer's role is to reimburse the subscriber.. up to the limits in their policy. They're not.. involved.. in the clinical judgment. Insurers, in practice, have considerable leeway to promote schemes irresponsibly, partly because their leaflets and brochures need not be fully accurate.
Dr Vernon Coleman,
The Health Scandal,
1988: .. there is no point in hoping that your medical insurers will stand by you. Insurance organisations insist that they have no responsibility for the quality of care provided.
Richard Ennals, in the same programme: I think insurance companies ought to take more responsibility when things go wrong.. It is the health insurance companies who are the great promoters of private hospitals.. It is their leaflets.. which present this vision of seamless efficiency, with smiling nurses and beaming, bow-tied consultants, and you're left with the impression that everything [in private hospitals] is wonderful, yet when things do go wrong, from my experience, they just wish to wash their hands of it, they're not interested, they say It's nothing to do with us!
(In 1994, I wrote to all the main health insurance companies and asked how they ensured high standards of clinical care in private hospitals their customers used. Some answers were:
'.. Whilst we are not in a position to monitor and judge clinical standards in respect of medical treatment undertaken in independent hospitals, it is something we are concerned about.'
'.. We rely on the consultants to offer professional advice to our clients and do not dictate protocols etc.'
'.. we accept that registration by the local Health Authority demands adequate standards.'
'.. The local Health Authority has overall responsibility for the registering and qualitative measures of all hospitals and we abide by that decision.' [See section 'Registered Homes Act' below for the inadequacies of regulation under this Act.] - RE)
BBC Radio 4: the same radio programme stated that the definition of acute or chronic is made by the insurance company. The issue characteristically was left vaguewhat happens if the NHS disputes this? Characteristically too the female announcer said .. if the insurance company's own doctors didn't have a say in deciding whod become untreatable and everyone were cared for indefinitely [sic], premiums would explode. She seemed to have no conception of the idea that premiums are calculable, given data, and may not in fact explode.
.. insurance companies may threaten to raise premiums..:
Effective Management of Private Health Care,
chapter by Haydn Cook, then Director of Parkside and Hillside private hospitals, now Chief Executive of Calderdale Healthcare NHS Trust, p. 163: ... insurance premiums are based both on cases brought to court and on cases notified to the insurer even if not pursued.
On insurance companies threatening to withdraw cover, it is possible that the position is analogous to that of the insurers of local councils involved in the Welsh children's homes scandals. Cf.
23 Jan 97: The insurers wrote to Clwyd County Council [where the abuses took place] suggesting that insurance cover could be withdrawn if the company's procedures were not followed.. Gerald Elias QC: The need for public debatelet alone knowledgeof the nature and extent of abuse in homes in North Wales took second place to the 'financial considerations' in the mind of the [insurance] company [Zurich Municipal, handling agents for Municipal Mutual Insurance].. Even the 'truth' was regarded by them as a casualty if financial considerations were at stake. And
20 Nov 97: When the scandals began to emerge the insurance companies, fearful of the large compensation claims that could follow, moved in threatening to withdraw cover if the succession of inquiries continued to publish their findings. And
10 Mar 99: 'The insurance companies argue that they have a duty to their shareholders to fight hard in the adversarial system of our courts against the compensation claims.. the insurers warn them [the councils] that any hint of admission of liability will invalidate their policies.'
There may be problems in getting medical insurance cover for private wings in NHS hospitals. Cf. this letter (
Jan 1997) from Andrew Morris, Chief Executive of Frimley Park Hospital: .. The problem.. is.. hostile action by health insurers, who also have an interest in running private hospitals. Some discriminate against private wings in NHS hospitals and insist that, regardless of the wishes of patient or doctor, policyholders are treated in hospitals which the insurer owns or in which it has an interest. ... (He continued: It is of course a different story if the treatment does not go according to plan; the private hospital is only too grateful that the backup facilities such as intensive care of the NHS are at hand.)
Successful Private Practice,
by Maxine Buchele & Susan Wynn-Williams, written by physiotherapists, says, re legal liability insurance, Never admit liability. Make sure that you have the appropriate insurance and if there is an accident or injury, fill in the necessary forms and send them to the insurers immediately. They will hand them straight on to the underwriters. [In my case, AIG Europe (UK) Ltd and Willis Corroon - RE]
This conflicts with the Independent Healthcare Association's
Code of Practice for Patient Complaints,
which specifically states: .. it may transpire that the hospital and/or consultant was at fault. In such a case, acknowledgement of this to the patient is important, together with the appropriate compensation or rectification proposal. Apologies for errors, with explanations if relevant, should be tendered.
And the Medical Protection Society's
Pitfalls of Practice
: Where it is readily apparent that an apology should be offered, it is the Medical Protection Society's advice that a sincere apology should be made. .. The MPS does not encourage members to withhold objective factual information or expressions of sympathy or to retreat behind walls of silence.
And the Medical Defence Union [MDU]'s
Talking to Patients
: The patient should be given a factual account of what happened in simple language together with an apology, if indicated.
And the MDU in their
Summer 1986: It is the MDU's view that the patient is entitled to a prompt, sympathetic, and above all truthful account of what has occurred. .. It is very important that a sincere and honest apology is made. Any patient who has had the misfortune to suffer through an error, of whatever nature, should receive a proper expression of regret. To apologise that such an incident should have occurred is, after all, only common courtesy.
And the MDU Chief Executive, M T Saunders, letter
26 Apr 1997, The MDU, the UK's largest medical defence body, has been advising its members for nearly forty years that the patient is always entitled to a prompt, sympathetic, and, above all, accurate account of the facts.. [He continues: Most patients choose not to pursue a complaint or a claim because the doctor has given them an immediate explanation and apology, but no evidence is supplied for this claim].
And Lord Donaldson, 1987, then Master of the Rolls, introduction to
: .. doctors and hospital authorities should regard it is a very important professional duty, when things go wrong, to be completely frank and open with their patients, irrespective of whether they think they may have been at fault. [He continues: This, regrettably, is not always the case.]
And the GMC, Duties of a doctor, 1995: In particular, as a doctor you must be honest and trustworthy.
And the GMC, Duties and Responsibilities of Doctors June 1998:
If things go wrong
: Patients who complain about the care or treatment they have received have a right to expect a prompt and appropriate response. As a doctor, you have a professional responsibility to deal with complaints constructively and honestly. .. When appropriate you should offer an apology.
Some readers may be disappointed that we haven't provided figures for the relative danger, or otherwise, of private sector health care; but since the successful practitioners apparently never admit liability, it's easy to see that reliable figures are virtually unobtainable.
On insurance policies, the Labour Party document of Sept 1994
states PMI is rarely comprehensive. nearly all schemes exclude chronic or pre-existing conditions. .. there is no notion of "cradle to the grave" security. Exclusions frequently include.. [long list follows - RW]
Prof. Sir Brian Jarman agrees: I don't know much about it, but what I seem to see is, if you've had any illness, they don't want to know.. travel insurance.. a woman who was not well, said she might have to come home in an air ambulance.. I told her to fill in the forms, apply for the higher premium.. she didn't make it; she died.. the insurance company will not pay to have her returned.. I phoned their doctor.. he said they're paid commission to sell insurance.. they don't get the person to fill in the forms properly, so they can say it's not filled in properly.. they keep their commission.. he said it happens all the time..
As I understand it they offer cover for things you haven't
had.. well, that's not what you want.. If you've had asthma, diabetes, hypertension and so on you want to be covered for them! Not for say epilepsy or one of the other 20 things on their list. They exclude diseases you've had before; they have exclusion clausesthat's the job of an underwriter! I get phone calls from PPP trying to find out, did so and so have such a disease before
taking out the policy? They don't want to pay.
In private medicine, there are at present no insurance policies
which would pay legal costs to investigate medical accidents or cover subsequent legal action. Presumably this is intentional, since money could be made out of them (several million potential customers).
cannot practice if they are not insured against such events.
In the four-cornered struggle between patients, consultants, hospitals and insurers, the insurers don't always come out on top, however.
Thus a WPA (Western Provident Association Ltd) flyer of 1990 gives 'simple rules' for their policyholders, one of which is to demand an itemised bill. They said 2/3 of private hospitals failed to give itemised bills. A WPA newsletter,
of 1992 put the proportion at 1 in 5. WPA seems to have started this 'crusade'; many examples were quoted in the press£23,000 for a two-week stay, £960 for a single night, £130 for talcum powder.
1 Feb 1990: Swabs were also charged at £42.. BUPA could not explain the disparity.. AMI, an American-owned group that recorded a £20 million profit last year, was charging £1 for each suture at one London hospital and £6.47 at another.. Dr Eric Blackadder, BUPA's group medical director, says: We have found that not only do private hospitals have an excessively high mark-up, sometimes 200 or 300%, but the quantities are also excessive.
23 Feb 1990, letter, Dr R Lefever:.. A surgeon told me that he would, of course, be seeing a patient for two follow-up visits because the insurance company would pay. For a benign cyst this has little clinical justification. I believe that such a patently mercenary approach is sensed by the patient who then may question my own clinical judgement and
impartiality, and even wonder if I, as the referring doctor, take a financial cut from these fees..
[Back to Notes...]
Registered Homes Act 1984, Health Authority Inspectors, and Inspection Visits
.. the fundamental aim of the regulation system must be the protection of the publicFormer Health Minister Paul Boateng, Open Reporting Conference, Royal Society of Medicine, 12 Feb 1998.
The primary objectives of the registration and inspection system are to protect patients and maintain standards. NHS Executive Guidelines, HSG(95)41, Sept 95, sent to all health authorities.
Royal College of Nursing (RCN) 10-page questionnaire-based report
An Inspector Calls?,
1994, reprinted 1996, has seven summarised findings, though these are largely concerned with the standards and funding of the inspectorate itself, rather than with what the inspectors had found. The findings include:
.. health authorities' approach to registration and inspection is not consistent, and there is a worrying lack of scrutiny and audit.
Checks on registered operators and persons in charge of private nursing homes and hospitals are not adequate and are often conducted in an ad hoc manner. ..
Authorities undertaking only the statutory minimum inspections are not making any unannounced visits to the private nursing homes and hospitals they are regulating. This may prevent them from getting a true picture of the quality of care..
The inspectorate is under-resourced, secretarial staff provision is poor..
The RCN on the Registered Homes Act: The system for registering and inspecting private homes and hospitals in England and Wales is inadequate.. The Registered Homes Act is concerned with adequacy, not quality. But adequacy is not an appropriate measure for the care required and given in private nursing homes and hospitals.
[The then Conservative government's stance towards the dangers for private patients was shown in the statement issued immediately after publication of the RCN's report by the minister responsible, Baroness Cumberlege, as reported in the private healthcare trade magazine
This Caring Business
, late 1994: '"The present system works well," says Lady Cumberlege. The present system of registering and inspecting private homes does
provide proper protection for.. patients, says Baroness Cumberlege, Parliamentary Secretary at the Department of Health. She said, "... There is no evidence in the report..to suggest that the present system is failing patients..".'
Health Service Journal
, 11 Mar 1999, states that Baroness Cumberlege was recently appointed senior associate at the King's Fund, initially working on political issues in health-RE]
International Journal of Health Care Quality Assurance,
vol 6, no 3, 1993, on health authority inspectors, Yumiko Arai, following a study: .. neither national qualifications nor training are requirements for inspection officers.. Wide variations were observed in the methods and amount of training given to inspection officers.. The study has revealed that neither the 1984 Registered Homes Act nor health authority guidelines.. touch on the issues of quality of care in great detail.. most of the decision-making on quality issues depends crucially on the discretion of inspection officers.. it is entirely dependent on the proficiency and knowledge of the individual inspection officer. This may compromise the objectiveness of health authority inspections. She advocates: .. the establishment of a national accreditation and training system for inspection officers [and] external assessment of the performance of inspection officers [to] ensure the maintenance of high standards.
Inspection visits [Health Authority inspectors are responsible for private nursing homes and private hospitals]: David Robson
(13 Aug 97): Another big let-down was the rare visit of the registration inspectors. They failed to probe into areas such as high staff turnover and lack of activities for residents. They barely glanced at the mountains of incident forms.. And
10 Mar 95: [Following a damning report into the care of a deceased patient in a nursing home] Yet the routine [inspection visit] report three months earlierlast Septemberwas bland in the extreme. It congratulated the home's management and did not even mention the appalling staff shortages exposed in the special report. And
20 May 1997, Linda Grant [with a relative in a nursing home]: Then you turn on the TV and your heart goes cold as you watch a news item about the owners of two private Buckinghamshire homes for the mentally handicapped who have just been convicted of physical and mental abuse of the vulnerable people they were supposed to be looking after. Who, in what has been described as a ten-year reign of terror were slapped, had their hair pulled, forced to eat meals in the pouring rain, denied toilet paper, toothpaste and soap. There is a national scandal about.. care. Over the weekend, a private home for the elderly in Lincolnshire was abruptly closed and the residents moved after allegations of abuse which have resulted in an investigation by police and the health authority.. It took six years for relatives of the residents at the Buckinghamshire homes to obtain justice.
During that time, the homes were inspected twice a year by the local authority.
Royal College of Nursing, written evidence to Health Select Committee inquiry into private healthcare, 1999: 'The problem is compounded as there is currently no agreed or required training for inspectors. Being inspected by someone who lacks the necessary understanding or expertise ..even more seriously could [does-RE] lead to oversights, inadequate inspections, and patient care being compromised.'
1st Feb 1998; Jay Rayner quotes healthcare lawyer Paul Ridout: .. the power of inspection is held by the health authority, which is the worst possible place for it to lie. It is part of the internal market and won't want to upset private hospitals, because they are often used to dealing with some of the more routine cases clogging up the NHS. What we really need is a properly funded, independent inspectorate who can hold private hospitals to account.
An Inspector Calls?
: Inspectors regulating premises under the legislation, who are also monitoring the same premises for standards of services provided to the health authority under contract, face a potential conflict of interest.
Former Government Health Minister Paul Boateng, speech for Open Reporting Conference, Royal Society of Medicine, 12 Feb 98: .. there is a serious problem of the lack of regulatory independence. .. health authorities can have their own problems.. There can be conflicts of interest where the health authority has a purchasing role.
Joan Higgins in
The Business of Medicine
(1987): .. the Registered Homes Act 1984 (and the legislation which preceded it) was not designed for, and is inadequate for, monitoring standards in private acute hospitals. .. it omits scrutiny of procedures and practices which are characteristic of acute hospitals undertaking complex surgical procedures. ...
The report of a King's Fund College Conference on the accreditation of private homes, 25 Jan 1985: The 1984 Act (and the Nursing Homes Act, 1975 before it) gives only the sketchiest guidance to registration authorities on the monitoring and inspecting of acute facilities [i.e. private hospitals]. Both pieces of legislation were designed essentially for a nursing home sector which was made up of relatively small homes offering modest levels of nursing and convalescent care .. regulation under the Registered Homes Act is increasingly becoming an anachronism. [Modern private hospitals] have little or nothing in common with the kinds of nursing home originally envisaged in the legislation and an alternative means of regulating them may be required.
vol. 294, 1985,
Maintaining Standards in the Independent Sector of Health Care,
(by Day and Klein). Standards of care imposed by the 1984 Registered Homes Act are described as weak and ill defined.
Inspection visit reports: The Health Service Ombudsman recommended (1996 Annual Report) that members of the public should now be able to view any previous health authority inspection report of private hospitals and nursing homes, and, now, health authorities must make hospital inspection reports (for what they may be worth) publicly available. However, some authorities only make these available to view on the authority's premises. Copies of nursing home reports, by contrast, are sent to local libraries. Graham Maloney (see below) found Tees Health Authority's April 1996 inspection of the private hospital where his wife died was conducted by only one inspector and lasted only 45 minutesshorter than a car MOT.
A Health Authority inspector speaking anonymously on
Channel 4 TV, 1994, in a documentary on the quality of care in a large commercial chain of nursing homes: [The company] have persuaded other health authorities to disregard the criticisms of their inspectors.. They influence the members of the Health Authority to back off. I know of colleagues who have been told to stop causing trouble, to just get on with their job. And, in the same programme, on the influence, or lack of it, of inspectors on the health authority, the chief executive of one health authority: The inspection service is [only] an advisory one to us.
Commercial Medicine in London
(1985 Greater London Councilnow defunctdocument) by Ben Griffith & Geof Rayner, with John Mohan: Private hospitals are required to be licensed.. All the licence means, in practice, is that a hospital or clinic has been visited .. (..usually once) and management personnel have been questioned on points concerning medical cover, types of surgery performed, etc. Unlike abortion clinics, there is no central DHSS group of officers in charge of them... The standard of care varies widely between clinics, and it is widely acknowledged that some practice occurs at the margin of safety and without the back-up of facilities present in an NHS hospital. ..
The Registered Homes Act is showing signs of age and the time will come when we will want to update it - Tim Yeo, [Conservative] junior health ministerreported in
This Caring Business
Dr A Vallance-Owen, Medical Director, BUPA, BBC,
Here and Now,
Sept 98, on the regulations of the Registered Homes Act: .. they are old and they probably could do with improvement. He went on to aver that the great majority of private hospitals would not worry at all about tighter regulation.
RCN press release,
14 June 1994: Inspection arrangements need to be strengthened.. The numbers of inspectors are inadequate, and the regulations governing nursing homes [and private hospitals] place more emphasis on the physical environment than on the quality of nursing care.
1992 report: The existing regulations covering the private sector are very limited.. With increasing numbers of people opting for private health care, there is an urgent need for much tighter regulation of the private sector to ensure that all private hospitals meet minimum safety standards.
14 Aug 98: .. figures show that cases of medical negligence [in private hospitals] are rising, and with no independent governing body monitoring performance it is feared that patients could be being put at risk.. The glossy image paints a picture of perfect healthcare. But.. paying for treatment does not guarantee better care, and until legislation is brought in to bring the private sector in line with the NHS, there are no guarantees that you are in safe hands.
Community Health Councils, which are the NHS watchdog, have no right of access to private hospitals, unlike NHS hospitals, and cannot assist private hospital patients with their complaints.
On administrative costs generally, Prof. Jarman stated: The US spends 22% of health costs on administration, mainly charging. The amount spent on
administration per head is about the same as the entire NHS per head!.. NHS administration cost is very lowabout 4%..
[Back to Notes...]
Many private hospitals imply in their defence that accreditation, by the Kings Fund or British Standards, guarantees high quality clinical care. They often make this claim in defensive letters to the press. In fact for example the
brochure states: ... The programme does not deal with clinical care or service delivery but with the organisational systems and procedures essential to efficient service provision. ... (The Audit involves self-assessment and is funded by the private hospital).
John Lambie, Chairman, Action for the Proper Regulation of Private Hospitals, speech to 1999 Annual Acute Healthcare Conference: "An advertising claim that has annoyed me for years is that a hospital has been 'accredited' by an external auditor such as the King's Fund. This reads as if the hospital has received an accolade for its work, including clinical. Not so. In fact it is simply an organisational audit.. in no way implying that the medical care had even been considered, never mind approved. In these ways the copywriters dissemble and deceive and very good they are at it too, but don't expect me to approve." [Some of the most horrific incidents listed at the end of this website have occurred in 'King's Fund accredited' hospitals - RE] [Some readers might be amused to note that Julia Neuberger, usually described as a 'Rabbi', has a high position in this organisation - RW]
National Consumer Council, Barbara Meredith, oral evidence to Health Committee, Mar 99: ".. who accredits the accreditors?.. As far as the consumer is concerned, I.. think it might be safe to say that the vast majority of them do not have any idea of what any of the accreditation schemes really mean."
3 June 1998: About a third of Britain's hospitals have participated in the King's Fund Organisational Audit (KFOA programme). Hospitals pay between £15,000 and £17,000
to be given an 18-month going-over and then, if they gain approval, advertise their accreditation as widely as they can.
[Back to Start]
Notes and References to 4. Conclusions
Private Wings in NHS Hospitals
NHS Patients in Private Hospitals
Complaining to the Health Authority
.. cheaper to employ lawyers to limit damage than to have adequate levels of staffing... The actuarial point on the risk of accident, the cost of round-the-clock care, and the cheapest damage-limitation method seems unanswerable. [-RW]
It was said in the 1930s (by Russell) that an unpredictable effect of snobbery was the employment of completely untrained nannies by those who could afford to pay. The private hospital sector seems to rely to some extent on similar psychologymany people simply assume treatment must be better if they pay for it, and persons professionally taking their money are unlikely to attempt to dissuade them. [-RW]
It is important to distinguish the 'granny farming' aspect of the private sector (which has always existed, and which, almost necessarily, started with richer people), from the far smaller private medical sector. Both, however, are covered by the same legislation, the Registered Homes Act 1984. The potential for iatrogenic disasters has led to a situation reminiscent of that of some alternative practitioners, and American doctors who only take on low-risk cases, and perhaps witch-doctors, who are reputed to turn away cases they know they can't help; when the illness turns out to be tricky, the patient is offloaded onto the NHS. [-RW]
On grading of private hospitals, AVMA's written evidence to the Commons Health Select Committee Inquiry stated: Another option which should be seriously considered would be that of imposing far greater restrictions on the type of surgical procedure performed within any independent facility. The proposal would be that hospitals would be licensed
to carry out a restricted list of procedures in accordance with the facilities and the clinical cover available.
[Back to Notes...]
Private Wings in NHS Hospitals
To show how seriously the threat of NHS private wings is taken, cf. this comment from the annual compilation on the finances of the private acute healthcare sector,
The Fitzhugh Directory 1996,
(currently priced at two hundred and forty pounds), the section
Key Trends and Financial Review
:- .. now there is an even bigger dragon to slay [than takeovers of charity hospitals by multinationals]the NHS private units, and the common foe unites the industry. ... And
1994 (reported in
21 Nov 94): The NHS Trusts are emerging as a growing force in competing for private patient revenues. The slumbering giant has awoken.
On the better care in NHS private wings:
Dr Michael Crow (letter to BBC, Sept 1999): The only place I would consider a major procedure privately is in the private wing of an NHS hospital where appropriate nursing and medical staff are on hand. The programme [
on private hospitals] highlighted the fact that even minor procedures can go wrong and the consequences are not reversible.
Health Services Management
magazine, Nov/Dec 1992, David Jones, General Manager, Medical Examiners Ltd, in a piece entitled Competing for private patient revenue: The NHS can deal with more complex cases than the private sector.. [there is] expertise in regional specialties.. the standards of care are often better in NHS hospitals.. Many private patients believe, perhaps wrongly, that they will receive superior care in a private hospital.. Economies of scale.. services could be provided to private patients at a lower cost on an NHS hospital site.. NHS hospitals are more convenient for consultants.. He concludes: It would seem.. that private hospitals have more to fear from the NHS than vice-versa.
Epsom Health NHS Trust, brochure for private wing (the Northey Suite): Being.. situated in a large.. NHS Trust Hospital means that we have all necessary resources on hand to give a round the clock service, using the most up-to-date technology available.. we have on-site backup to cater for every eventuality.. Your consultant is based in the hospital, so.. they [sic] can be contacted very easily.. Should you require any diagnostic tests, you are simply taken within the hospital for these to be carried out, no ambulance transfer or waiting.. And results are swiftly processed through the dedicated hospital teams, who are on-site..
, 7 July 1996: 'There is anecdotal evidence that a private hospital may be a good place for simple operationsingrown toenails or varicose veinsbut for anything more serious, heart operations or neurosurgery, the NHS is the place to go.'
Laing's Healthcare Market Review 1999-2000
: The two major advantages.. for NHS Private Patient Units over independent hospitals are convenience (the consultant does not have to travel from his or her NHS base) and safety, with the on-site facilities and staff of a major hospital to deal with any emergencies.
Ad for 'Norwich Union Trust Care'
5 Feb 99: .. as part of Ashford Hospital [NHS hospital near Staines], the Shakespeare [private] Unit enjoys the back up of the full range of medical expertise and technology of a well-equipped general hospital.
Medical Accidents Handbook
(Wiley, UK, 1998), Richard Ennals and Liz Thomas: '.. patients considering private treatment may wish to consider drawing up a checklist of facilities offered by private hospitals in order to establish what safeguards are in place should complications, minor or major, occur. Where a patient has concerns about the service on offer from a private hospital, an alternative would be to opt for treatment in the private wing of a large NHS Trust hospital.
, special report on private health care, Aug 1999: 'You might want to consider whether you'd be better off in the private wing of an NHS hospital, where there would be specialist and senior staff on hand in the case of an emergency. Also, you will have more rights to redress and safeguards against bad practice. In the future, reforms will mean that NHS paybeds and private wings in NHS hospitals will be treated separately from the rest of the private sector. ..'
, 6 Aug 1999, Andreas Charalambides (see case list below): "My advice is to give private hospitals a very wide berth indeed, and to use instead the private wings of NHS hospitals. Patients are generally safer in such wings as you still get doctors and experts who can spot and cope with your complications when the consultant is not there. ... aggrieved patients have to suffer the consequences for the rest of their lives while guilty parties continue to practice and remain unpunished."
Dr. Andrew Vallance-Owen, Medical Director, BUPA, on intensive care for emergencies, oral evidence to Health Select Committee, 25 Mar 99: ".. of course, if they are in an NHS Trust, and 20% of private patients are treated there.. then it is all covered.. they do not have this transfer issue."
On profits going to the NHS:
St Helier NHS Trust Private Patients Unit brochure: .. profits will directly benefit the National Health Service. Income generated by the Unit is then used to improve facilities for all.
27 Nov 95: Each private patient treated in an NHS hospital contributes nearly £300 to the cost of caring for NHS patients.
National Economic Research Associates
say NHS hospitals, set to become the largest providers of private care, are earning profits of £170,000 on every £1 million of private patients revenue.
Andrew Morris, Chief Executive, Frimley Park Hospital, letter,
15 Jan 97: The management of this [NHS] hospital realised some years ago that private healthcare could come directly to the aid of the cash-strapped NHS.. [Our] private wing.. last year contributed £1 million in extra income to help care for NHS patients
Brochure for Norwich Union Trust Care, a new health insurance scheme for private treatment exclusively in NHS hospitals states While you benefit from lower premiums, the NHS benefits from valuable additional income.
On the benefits of consultants, with NHS private wings, staying on-site: Sir Richard Bayliss,
21 May 88: The growth of the independent sector has had the disadvantage that many consultants with part time contracts have ceased to be geographically whole time. To travel between an NHS and an independent hospital is uneconomical of time. And
16 Dec 94,
Are Private Hospitals Doomed?
: Ian Robertson, private patients' manager, St Mary's Hospital.. says a flourishing private practice strengthens the consultants' loyalty to their hospital: The younger consultants want the place to prosper, and they don't want rooms in Harley Street, so we give them rooms here.
Health Care in the United Kingdom,
1982: Another argument, and one which the Royal Commission thought the strongest in favour of retaining private beds, is that if consultants are allowed to treat private patients, it is better that they should do so in an NHS hospital, where they are available when needed in an emergency..
The Fitzhugh Directory,
1996, states in the introduction, with regard to NHS private wings, that if the NHS were willing to capitalise on its strengths, and its involvement were to be accepted by the public, there is little doubt that the NHS would be preferred, and would dominate the industry. The 1998-9 Directory describes private healthcare as an industry in turmoil and identifies a steady growth in NHS private beds as a key trend, with the NHS on course to win 20% of the market by the year 2000.
NHS private wings might also be cheaper
, 9 July 98, Tim Baker, Commercial Director, Norwich Union Healthcare: 'Through economies of scale, NHS private units can cut costs.. These costs can be passed directly to the consumer, and generate excellent value for money in insurance terms.'
Dr. Phil Hammond,
Trust Me, I'm a Doctor
(1999): 'Your best bet, if you want to go private, is to be even more sceptical and questioning of what is
offered to you than in the NHS, and perhaps opt for a unit attached to an NHS hospital... at least you should sleep more safely.'
[Back to Notes...]
NHS Patients in Private Hospitals
1989 Government White Paper: If health authorities are to make the best use of private sector facilities they will need to be satisfied that the standard of medical care being offered is comparable to the standard expected in the health service.
Robin Cook MP, now Foreign Secretary, then Shadow Health Secretary,
24 Jan 92,
NHS Patients Face Inferior Treatment
[in private hospitals], referring to operations carried out on NHS patients in private hospitals by surgeons without recognised training: So much for all the promises in the Patient's Charter of a high quality health service. These [NHS] patients are being sent for operations with a less well-trained doctor and with no medical records. I find it extraordinary that managers should have picked patients for this inferior treatment without even seeking the advice of the consultant surgeons. I could not have asked for clearer evidence.. showing how standards slip when health becomes commercialised.
, 11 Jan 1990: The National Audit Office report found that treating [NHS] patients in the private sector in order to cut NHS waiting lists cost twice as much as treating them within the service.
Trust Me, I'm a Doctor
(1999): 'I also know of frail, elderly, having NHS operations done in private hospitals as part of the waiting list initiative. This might seem like a sensible use of resources, but the sicker the patient, the higher the risk of the operation and the less you want to recuperate ten miles from an NHS cardiac arrest team.'
18 Sept 98: In the short term Frank Dobson is trying to solve the problem of long waiting lists by paying consultants private-size fees to operate on NHS patients in private hospitals. For example, the orthopaedic consultants in Southampton have received £2.5 million to get their [waiting] lists down. But this strategyused unsuccessfully by the Toriescomes on the back of a report by the charity Actions for Victims of Medical Accidents [AVMA] which has found a disproportionate number of claims are from the private sector. Key factors are the lack of emergency equipment and medical expertise. Private hospitals are not the place to be in an emergency. Conveyor-belt waiting list reductions are invariably very expensive, poorly planned and doomed to faillet's hope they aren't placing [NHS]
patients at extra risk of medical accidents too. [See also Department of Health's view under 'Comments: Political']
[Back to Notes...]
Complaining to the Health Authority
Independent Acute Hospitals and Services
can be obtained from the Publications Department, the NHS Confederation, Birmingham Research Park, Vincent Drive, Birmingham BS15 2SQ. Tel: 0121-471 4444. Price £10.50. (Or ask for photocopies of Appendix 5). Three of our publicised cases were successful with this. The procedure is to go to the Health Authority only if you are dissatisfied with the hospital's response. Insist an investigation is
(a) reasonably promptthe final report of my investigation [by Merton, Sutton and Wandsworth H.A.], a six-page summary, took nearly three years instead of the promised six to eight weeksdelay can cause risk to other patients; and
(b) detailed: the report of a Tees H.A. investigation was 35 pagescomplainants should expect nothing less;
(c) and that all staff involved are interviewed, as the NHS Confederation guidelines indicate. This only happened in one authority investigation.
(d) Ask the authority to involve independent external parties in their investigation to ensure impartiality.
(e) Where there has been misconduct, these guidelines twice emphasise health authorities must report cases to the GMC or UKCC. Failure to do so where necessary can again cause risk to other patients.
(f) Note: If you wish to appeal e.g. about an unsatisfactory report or unwarranted delay or collusion, you may find it best to approach an MP or health minister before the Health Service Commissioner.
The Health Service Journal
reported (8 Oct 98) that the Commissioner's office investigates only about four per cent of the complaints it receives, and takes on average nearly a year to investigate.
The Medical Accidents Handbook,
Wiley, 1998, although mainly a law text, has further details contributed by Richard Ennals.
Details of these guidelines were sent to patients' organisations and advice agencies. Some comments:-
"I was very interested to learn of this non-statutory procedure for making complaints about private hospitals.. I did not know it existed. I think that it deserves the widest publicity possible."
"This will be extremely useful both now and also in the future with the increase in private hospitals and nursing homes."
"In the light of your letter, we shall be expanding the information we have on complaining about private treatment."
"As a result of your letter, I have written to [all of our advice agencies] in England and Wales to inform them of this procedure so that we can pass this information to members of the public."
"This information will be very helpful because, not surprisingly, we do get requests for help in pursuing complaints about private treatment. These are likely to increase as more and more people, including those with little money, are being pushed into using the private health sector."
".. on the basis of your information I will be much better placed to advise in future.."
On health authorities, perhaps deliberately, failing to advise complainants of this avenue of complaint,
Health Service Guidelines
(HSG41), Sept 95.
Regulation of Nursing Homes and Independent Hospitals,
sent to all health authorities: Insufficient weight is being given by some registration officers to the series of guidelines [including on authority
investigations] published by the National Association of Health Authorities and Trusts [NAHAT, now the NHS Confederation].
[Back to Notes...]
The Independent Healthcare Association (income in 1997 of £593,864) describes itself in
Trade Associations and Professional Bodies in the UK,
1994, as: The representative body for independently-owned healthcare providers, whether voluntary or private, funded largely by member subscriptions based on a fee per bed. Its charitable status derives from its objectives to promote high standards of care in the independent sector.
On private hospital risks,
2 Aug 98,
Higher Health Risks in Private Hospitals
: .. representatives of the private sector rejected criticism that patients were more at risk but accepted that data was not available to prove their point. We do not accept that there is any difference in the level of support between private and NHS hospitals, said David Lucas of the I.H.A. I am confident people are not at any more risk than in the NHS. And
27 May 97,
Night Risks for Patients in Private Hospitals
: The I.H.A. .. said that private hospitals usually had a higher ratio of nurses to patients than the NHS, and maintained that standards were at least as good as in the state sector.
And on BBC TV
(20 Sept 1999), Barry Hassell, IHA 'Chief Executive' said: I don't accept that a private hospital is riskier at all. Clearly, the risk is analysed very carefully.. Remember that a consultant will always put in place arrangements that are suitable and appropriate.
On private hospital regulation,
17 Jun 98: Barry Hassell, chief executive of the I.H.A. .. claims that independent hospitals are subject to greater regulation than their NHS counterparts [see our reply to his letter in News Updates]. And IHA Press release following publication of Health Committee report: The IHA has been campaigning for more than ten years for better regulation.
On current complaints procedures in private hospitals, in the same article: If you do have any complaints, make them known to the hospital director at the earliest opportunity, says Barry Hassell. And
Which? Way to Health
(Consumers' Association publication), Dec 93: If things go wrong, Fiona Campbell [former Information Services Manager] of the Independent Healthcare Association.. recommends you to direct any complaints about any problems to the hospital manager. And David Lucas, former Executive Director of Acute Affairs, IHA, in the
1 Feb 98, on statutory complaints procedures: The thing is, we exist in spite of government rather than because of it, so historically we're not that keen on being subject to statute.
An IHA press release, following the Health Committee Report 21 July 99: '.. we want to see the small band of cowboy practitioners driven out of business; they
undermine patient confidence and damage the reputation of mainstream hospitals.' [All the cases listed at the end of this website occurred in 'mainstream' hospitals - RE]
[Back to Notes...]
13 Aug 97: .. Principal Healthcare this year bought Quality Care Homes for £46.3M and signed a joint venture contract with Tamaris, which operates over 2,000 long-stay nursing beds... Ashbourne Homes was bought by Sun Healthcare of Albuquerque, New Mexico, for £95M last year. .. The combined group will have 122 homes and nearly 7,000 beds, making it the second largest nursing home operator in the UK.
Health Insurers PPP recently entered into a partnership with US healthcare multinational Columbia/HCA to run several London private hospitals. BBC2 TV
27 May 99: "Embarrassingly for PPP, their business partners, Columbia Healthcare, are now at the centre of a major fraud trial in Florida. Four executives are accused of plotting to steal $2.8 million in one state alone from the government by submitting
false Medicare claims. Columbia have also been fined for violating anti-trust law in hospital takeovers.. Could such muscle-bound practices cross the Atlantic?" [This also raises questions for the registration and inspection officers of the London health authorities whose assessment and registration as 'fit' of the operators Columbia took place long after the FBI investigation began - RE].
[Back to Notes...]
Joan Higgins, now Professor of Health Policy at Manchester University, and chairman of Manchester Health Authority, in a KF Project Paper: .. Registration staff will need training in business and law. Private care in Britain may be a cottage industry but we already see strong evidence of corporate bodies moving in with their own lawyers and advisers. Some of these people can run rings round local authorities and we must face that issue. ..
She also stated: They must be properly remunerated, not least because the private sector may wish to offer them inducements to behave improperly.. The prospect of corruption should not be ignoredwe need only look at North America to see that it can and does exist. (Potential example in
, 16 Dec 98: 'Police and NHS managers are investigating financial irregularities at Lifecare NHS Trust in Caterham, Surrey. The trust's chair has resigned and the chief executive and financial director are on special leave. A trust spokesperson said the allegations centred on contracting issues.'
reported1 April 2000that the Trust's manager of subcontracted services was jailed for over 2½ years after admitting 28 charges of deception, conspiracy and false accounting in a £650,000 private nursing home fraud.)
An Inspector Calls?
1994: Health authorities should take more seriously the responsibility to regulate the independent health care sector. The providers of private health care take the business very seriously indeed and it is a multi-million pound industry.
2 Aug 1998: AVMA reports a surge of negligence claims against the private sector in recent years, with an estimated 20% of the 5,000 cases it deals with annually now lodged by private patients. It is out of all proportion to what you would expect, said Arnold Simanowitz, the charity's chief executive. It is an illusion that people will go into a private hospital and get better careyou are actually more at risk when things go wrong.
Margaret Cook, consultant haematologist, ex-wife of the Labour Foreign Secretary, in
March 1998: With mounting pressures to maximise quality while containing costs, the Labour government should also take a stand on private practice. The prime motive here is profitand the public should be made aware of evidence that quality comes a poor second.
Christine Hancock, General Secretary of the Royal College of Nursing,
Health Service Journal
17 Dec 1998: .. said the Health Committee inquiry would 'make some headway' in protecting the public from the poor practice that exists in some independent healthcare organisations.
Sir Raymond Hoffenberg, President, the Royal College of Physicians (1983-89), Introduction to
The Incompetent Doctor,
Open University Press, 1995: Within most hospitals in the UK audit meetings take place that provide better information about the performance of individual doctors and departments.. The weak link lies in private medical practice which is not subject to some sort of scrutiny.
Christine Hancock, General Secretary, Royal College of Nursing (
Health Service Journal
17 Dec 1998) 'said the Health Committee would make some headway in protecting the public from the poor practice that exists in some independent healthcare organisations.'
On the Ledward case [see below]: Paul Watkins, Chairman S.E. Kent Community Health Council, BBC TV
11 Dec 1998: The recent case of Rodney Ledward [gynaecologist who damaged many women over many years] really highlighted the situation. Fifty percent of the ladies [at a public meeting] involved in that were in the private sector. What came out.. was the lack of regulation, lack of complaints procedure, the inability of people to pursue a complaint up to the stage of an ombudsman.. the major features are the lack of accountability of the private sector, no clinical governance, no accountability on standards..
Patricia Fearnley, solicitor, in the same programme: It's the standards that prevail in the private hospitals. This is the problem.. shown up in the Ledward cases. You can have a situation where patients are paying expensively.. they think they're going to get the best care. They can have a surgeon who rushes in, carries out a very quick botched operation, then disappears down the road not to be found. They start bleeding during the night; there's no one, there's no doctor on site, and this has happened to many of my clients. There's no one there to sort it out, and the only way at the end of the day they can receive proper care
is to be shunted over to the local NHS hospital.
[Back to Notes...]
The Department of Health,
11 Aug 98: If people go into the private sector, they are opting out of the NHS and thereby taking a chance. [Presumably, NHS patients sent to private hospitals for their treatment by NHS health authorities, NHS Trust hospitals, and GP fundholders are taking the same chance, albeit without any option - RE]
The Department of Health,
14 Aug 1998: This government is committed to ploughing its health reserves into the NHS. There is no place for regulating the private sector using public money which has been raised on the promise of improving the NHS. Meridian TV: What the Government is saying is that when you choose to opt out of the NHS you take your life into your own hands.
of Graham Maloney in a recent letter: It does seem a ridiculous situation that they [private hospitals] are subject to a lot less regulation and control than the NHS establishments, and that there appears to be no statutory and controlled complaints procedure. .. You will have already received the information concerning the European Courts and obviously you may well be abler to take the matter further with them.
A Lib. Dem. MP, recently, after writing to the Health Secretary on behalf of another complainant: .. it appears that.. the Government recognise that there are problems with the regulation of private hospitals.. This is clearly a major issue, and one which will involve many people all over the country. I have therefore asked that, in view of this, the matter is now handled by.. our Health Team from now onward. This will allow a much stronger campaign.. and hopefully get the series of loopholes in the law relating to private hospitals closed.
Lib. Dem. MP, on the Health Team, in a recent letter to another complainant: I have become increasingly concerned that, despite the recent emphasis on quality in the NHS, events in the private sector are being overlooked. It is a disgrace that private health facilities are not properly regulated or monitored. .. It is vulnerable patients who suffer if and when things go wrong in private hospitals and emergency facilities are not available.
Labour MP Melanie Johnson,
Welwyn and Hatfield Times
10 Feb 1999: Ms Johnson contacted the chair of the Select Committee on Mrs Buckley's behalf after hearing her story [see case of her mother Carole Burwash, below]. She said: The main problem is that with private hospitals many requirements for the NHS hospitals are not fulfilled. This may require legislation to change it. A private hospital should be a place where people are relatively safe.
Labour MP Dari Taylor,
The Northern Echo
26 Nov 1988: Dari Taylor has written to the Chairman of the Health Select Committee pointing out the difference between the way complaints are handled within the NHS and in the private health sector.
Dr. Howard Stoate MP, Member of the Health Select Committee, BBC TV
11 Dec 1998: The Health Select Committee is starting an inquiry to look at the regulation of private hospitals and private sector medicine .. because there is no regulation; it's a nightmare out there.. and people quite rightly feel threatened by it; they don't know where to go when something goes wrong. It's up to us to put it right. .. What we need is a tough if not tougher system in the private sector.
Baroness Nicholson, BBC Radio 4
, 16 Nov 99: "At the moment I would recommend that no one go to private care if they have anything major wrong with them at all.
Geoff Martin, UNISON London Convenor, Director, London Health Emergency, in booklet
EMU and the NHS
(1999): 'Private health care is a notorious rip-off, offering no emergency services, and no support for chronic or pre-existing health problems. It is targeted at the age and income groups who are least likely to fall ill and make a claim.'
David Hinchliffe MP, Chairman of the Health Select Committee,
Jan 1999, in an article
Private Hospitals in line for Poor Standards Report
: During a Commons debate .. Mr Hinchliffe berated former shadow health secretary Anne Widdecombe for demanding the increased use of private hospitals to ease pressure on the NHS. He said In the evidence we have taken so far [in the inquiry into private hospitals], we have heard serious concerns about the quality of care provided. Mr Hinchliffe also warned that increased private sector business would exacerbate the NHS staffing crisis because of the poaching of staff.
Hinchliffe on BBC2's
, 20 July 1999, after publication of the Select Committee's report into private healthcare: "There is a major problem and people are obviously suffering as a consequence.. The conclusion I draw from the evidence that we've received within this inquiry is that people are better, wherever possible, sticking with the National Health Service. They're safer, the procedures are safer, and I think they're generally more secure within the National Health Service."
Frank Dobson, then Secretary of State for Health, on the leaders of the private healthcare industry,
Jan 1999: The onslaught on the private sector continued when health secretary Frank Dobson branded the industry's leaders liars in reaction to Ms Widdecombe's claim that he had refused to meet them.
This link is
Frank Dobson's speech on the lack of regulation of private hospitals
in Parliament, 18 May 2000.
Dr Phyllis Starkey MP, Labour Backbench Health Committee, Channel 4 TV
5 Mar 99: The problem is that, although private health establishments are regulated by the local health authority, they cannot regulate the quality of care, nor indeed the experience of doctors, so although all the doctors are registered, they may not necessarily have sufficient experience in the operation they are undertaking. That very often leads to inadequate care for patients.. the patient then has to be treated by the NHS, which has to pick up the problems.. caused by the private sector. I hope the Health Select Committee will come forward with clear recommendations that parliament can take forward to drive up the quality in the private sector.
The Queen, State Opening of Parliament 18 Nov 99: "My Lords and Members of the House of Commons: My Government's ten-year programme of modernisation for health and social care will provide faster, more convenient services to help improve the nation's health. As part of this programme, a Bill will be introduced to improve standards and stamp out abuse
in social services, in private and voluntary healthcare
, and in childcare.
Labour in opposition:
examples include Bob Cryer (9 June 1981) who asked the Secretary of State for Social Services what progress has been made in arrangements for private hospitals to contribute to the cost of training nurses. ... instead of drawing like parasites from the public sector... And Dennis Skinner (21 Oct 1985) asking for information on the numbers of persons who have died following operations in private hospitals in 1984. And Frank Dobson, who became Secretary of State for Health, (28 July 1988) asking about Körner recommendations and data collection; he was told there are no plans to introduce these into private hospitals. He also asked for mortality and other figures for NHS patients in private hospitals, and was told the decision had not been made whether to publish the figures.
David Blunkett, then Shadow Health Secretary, now Education Minister, in
Patient Complaints... a new way forward
(May 1994 Labour Party), wrote Adequate protection for private patients is essential. Private nursing homes are a particular area of concern. Levels of complaint in such homes are rising alarminglythere has been a fourfold increase over four years in professional misconduct cases..
Updating procedures for complaints about GP services [procedures 'have remained largely unchanged since 1911'] is of critical importance .. to those receiving treatment outside the NHS. Better protection is also required for patients who undergo cosmetic surgery through private practice.
Going Privatethe growth of private sector healthcare under the Tories,
Sept 94: .. the poorly regulated private sector.. the increased reliance on private provision, together with the lack of clear and firm guidelines and care regulation, provides great cause for concern.. The Government has faced fierce criticism from many independent professional bodies for its laissez-faire attitude towards [private healthcare].. In August .. a Royal College of Nursing report into the inadequate inspection and neglect by the Government of private nursing homes [and private hospitals].. Complaintsneither the Patients' Charter nor the current patient complaints procedures provide protection for [private] patients..
From Government Ministers' Letters:-
.. this [private hospitals] is an area of prime concern for us. You mention a number of aspects of the boom in private health care which are particularly alarming and we are trying to pull these into our ongoing work. .. [in our] recent.. paper on patient complaints.. we do make a commitment to address the question of complaints procedures relating to private care. The issue of regulation is also of enormous importance and we are striving to bring pressure to bear on the government over this, as well as ensuring that a Labour government will be fully prepared to instigate the necessary safeguards. (Office of David Blunkett MP to Richard Ennals 3 Oct 1994).
Standards [in private hospitals] should at least be comparable to those in NHS establishments. (Health Minister Tessa Jowell to the MP of G Maloney; see below26 Aug 97)
Health authorities.. are concerned with the clinical care provided.. We do recognise that the current regulatory system is not perfect but have not reached a decision as to what course of action would best protect the interests of those seeking medical treatment in such facilities. (Former Health Minister Baroness Jay [who wrote in exactly the same words to another complainant on 10 Oct] to the MP of Anthony Darley-Jones; see below20 Sept 97)
MPs' Questions in Parliament:-
Simon Hughes, 5 March 97: To ask the Secretary of State for Health what percentage of private hospitals provide full accident and emergency services. [the answer is zero - RE].
Anne Clwyd, 16 Jan 98: To ask the Secretary of State for Health what assessment he has made of the adequacy of health authorities' inspections of private sector clinics and hospitals.
Jacqui Lait, 30 June 98: To ask the Secretary of State for Health what plans he has to review Part 2 of the Registered Homes Act 1984.
Anne Winterton, 12 Nov 98: To ask the Secretary of State for Health (1) if he will make a statement on his policy on the regulation of private hospitals; (2) what plans he has to increase the regulation of private hospitals.
Ms Keble, 6 July 99: To ask the Secretary of State for Health what action he is taking to ensure the effective regulation of private health care.
David Hinchliffe, 6 July 1999: 'Has my right honourable friend [the Health Secretary] been able to study the work of Dr. John Yates at Birmingham University, which proves that areas of the country with the
highest numbers of private beds also seem to have the highest NHS waiting lists? Has he had a chance to consider the matter, and if so, what action is he taking?'
[Back to Start]
MEDIA COVERAGE OF SOME PRIVATE HOSPITAL CASES
BUPA Gatwick Park
The seven casescovering ten victims, or alleged victimsin the newspaper montage above are:
1 Christine Darley-Jones:
One of several newspaper reports:
2 June 1996: .. she was referred to a private hospital for a 'simple, 10-minute procedure under general anaesthetic' to investigate a hacking cough. Within seconds of the anaesthetic injection at St Anthony's Hospital, Cheam, Surrey, Mrs Darley-Jones, then 45, suffered a massive cardiac arrest and 'died'. Doctors took 40 minutes to resuscitate her. In the first six or seven minutes of the crisis, her brain was starved of oxygen and she suffered 70% brain damage. Since then, she has been fed by tube. Her bladder and bowels are also controlled by tubes. She cannot communicate or recognise anyone and is confined to a wheelchair. .. When [the husband] asked for an explanation of the accident, doctors told Mr Darley-Jones it was an act of God and a ghastly tragedy. .. Mr Darley-Jones.. has spent £20,000 in legal bills trying to get the consultant or the hospital, a charity run by an order of Belgian nuns.. to explain what went wrong. .. Macro [sic; Marco] Cereste, chief executive of the NHS Trust Federation.. said: 'When something goes wrong in a private hospital, the patient will always end up in the NHS.' .. The charity that owns St Anthony's earned £27 million in 1992-3..
His local NHS health authority has found [in a report by the Merton, Sutton and Wandsworth health authority registration inspector - RW] the anaesthetic record of the incident was inadequate and did not contain signatures, times or dosages. .. The hospital director has been advised to improve record keeping.'
states 'Two months after the incident, her husband Tony received a letter from PPP saying it was ceasing to pay for his wife's care. It enclosed copies of the charges enclosed£25,000 for the hospital and £3,000 for the consultant. The NHS is now paying £750 per week for her care. .. Tony Darley-Jones: If this had happened in the street I could have understood. But she was in hospital. Sadly, it was a private one.'
4 Jun 96: Tony Darley-Jones says he still hasn't had a full explanation of why his wife's routine surgery went tragically wrong.
2 Jane Hipperson:
An account from
Sunday 9 Feb 1997: '.. went into her local private hospital [the Esperance Hospital] for a routine hysterectomy operation. .. But within a week, death looked inevitable after her internal organs were ravaged by the flesh-eating disease necrotising fasciitis. [sic] .. At first the operation on Monday afternoon appeared successful. But at 1 am on Sunday Mr Shardlow [gynaecologist] rang Richard [husband] to say he needed to perform an emergency operation.. By 2 pm [Wednesday] Mr Shardlow rang to say Jane was being transferred to intensive care at Eastbourne [NHS] Hospital. .. Jane and her husband are grateful to the NHS for saving her life.. She and Richard are planning to sue the private hospital over an alleged breach of care. They want to know why she needed a second operation to stop internal bleeding after her hysterectomy, and why staff failed to recognise the first signs of infection when she complained of abdominal pain and numbness in her left leg. My wife went into hospital for what is a simple operation that thousands of women have every year, said Richard, But in two days she turned from someone who was healthy to someone who was not expected to last the night. Lesley Galloway, director, said:- If Mrs Hipperson or her family would like to contact me I would be happy to talk to them.. I would be delighted to answer any questions she might have. I would hate any of our patients to be unhappy about their care.
3 Carole Burwash:
Wed 6 July 1996. The private hospital [Princess Grace] where a woman patient [for a 'routine hysterectomy'] was injected with ten times the correct dose of painkiller was partly to blame for her death, an expert medical report says. ... Professor [Felicity] Reynolds identified seven errors that led to the death. She said Dr Lim was most responsible for negligence because of his incorrectly written prescription and the absence of direct communication with Dr Hornabrook. [Resident medical officer]. The hospital was also negligent because it had no trained resuscitation team, no protocol for epidural opioids and had appointed a resident medical officer without anaesthetic experience.
Professor Reynolds's report said: Probably the most important inherent drawback of a private hospital, or indeed any small isolated hospital, is that there is no resident anaesthetist to top up epidurals and, above all, to provide an efficient resuscitation service. Any medicine or surgery practised under such circumstances is therefore inevitably less safe that a National Health Service Hospital with an appropriate complement of resident staff.
Brian Burwash, husband,
7 July 1996: "I would not go to a private hospital now, nor would I allow any of my family." And two years later, 11 Aug 1998: Some patients in private hospitals don't realise how vulnerable they are, especially at night, when consultants and anaesthetists have gone home.
[Caroline Buckley is a co-founder of APROP; for APROP's testimony to the Parliamentary Select Committee,
see the weblinks
4 Christine Maloney.
The Northern Echo
Fri 13th June 1997: .. after a three-year fight costing him [Graham Maloney, who is a very effective campaigner, who coined the description of the GMC as the Great Medical Cover-up] thousands of pounds, a 35-page report by Tees Health Authority has revealed failures in the care given to cancer patient Mrs Maloney at the 34-bed Stockton hospital [the Cleveland Nuffield Hospital] where she died in the early hours of November 23, 1993. .. The second.. report states: *The system of recording drugs .. was open to error; *.. there were problems with a nursing sister behaving offensively..; *the complaints procedure was unclear.
The Evening Gazette,
19 June 1997, also mentioned a recommendation to establish a local agreement between Tees Health and the Nuffield about steps to be taken in complaints about the care of private patients. However, the Nuffield's response
1 Feb 98 was: We are not aware of any provisions under the Registered Homes Act which requires [sic] the registering health authority to be involved and we do not believe this would be appropriate.
Apr 98: On advice from Health Minister Tessa Jowell he [the patient's husband] is taking legal advice and possible action [in Europe] and is asking advice from the EC-funded AIREAdvice on Individual Rights in Europe. There is a possibility he may have a case.
Independent on Sunday
, 18 July 1999: Mr Maloney said .. The private sector in this country is sold as the Rolls-Royce of health care, yet in many areas the wheels are coming off. It's business first, medical care second in many cases. Graham uses vivid comparisons in his speeches: You get more consumer protection when you buy a tin of beans in a supermarket, Reading the brochures from other hospital groups, BUPA, Nuffield, they are full of mistruths, it is a con, Florence Nightingale would have turned in her grave, I had been lied to by the matron, by the hospital manager, by Mr Irving, the chief executive of the Nuffield Group., You would get better care on a market stall.
Click here for
Graham Moloney's personal Memorandum
to the Parliamentary Select Committee which deals with this issue, and the failure of a surgeon to diagnose his wife's cancer.
5 Sir James Stirling:
Sat 5 Sept 1992: .. who died after a routine hernia operation.. Recording a verdict of death by misadventure, Dr Knapman [coroner for Westminster] commented that it was "unfortunate to say the least" that Dr Hardwick [Peter Hardwick, a consultant anaesthetist] had been out of contact with his hospital [Hospital of St John and St Elizabeth, St. John's Wood] for ninety minutes as Sir James's condition was deteriorating.
13 Sept 92: After the operation, Hardwick went on an organised walk, leaving the hospital without a qualified anaesthetist to supervise the case. [The newspaper reports don't make it clear whether, in their opinion, such an incident is less likely in an NHS hospital, although this seems probable].
.. Hardwick has been involved in two previous actions for medical negligence. In 1982 he was a co-defendant in a claim settled out of court after a two-year-old Saudi Arabian boy was left severely brain-damaged after an operation to remove a minor tumour from his leg. Four years later he faced a claim involving a teenage girl who suffered brain damage after a routine operation to remove wisdom teeth. The case was settled with a £330,000 out of court payment. In both cases there was no admission of liability.. He told a local paper that he had taken all the necessary precautions. "Sir James was a very unwell man and the hazards of anaesthetic with this type of operation, including vomiting, are well known".'
[Some two years later, the
reported that the Sterling family had accepted an out of court settlement in respect of the death].
[Stirling designed, among many buildings, Selwyn College, Cambridge (UK), the Clore Gallery at the Tate, and museums for Harvard and Columbia].
6 Adèle Hillman:
Mail on Sunday
14th July 1996 appears to quote for her:- .. the Princess Grace Hospital.. The house doctor inserted a drip into her right hand; when it failed to work he tugged the needle sharply 'causing me absolute agony.' Mrs Hillman begged for the needle to be removed, 'but I was told I was making a fuss'. After thirteen hours of excruciating pain a doctor removed the drip and discovered her main radial nerve had been damaged. She has lost the use of her right hand and armpermanently. She cannot drive, write or eat without help, and is in constant pain.. Mrs Hillman has found the private hospital, owned by the BMI group, coldly unsympathetic. They paid her a paltry £1,800 to be reviewed but they have since denied liability. So now this crippled widow in her 50s is having to take the hospital to court for compensation.. [The newspaper does not attempt a comparison with NHS treatment].
7 - 10 Four male patients.
article of 1995, eleven years after the Registered Homes Act, The deaths followed a confidential audit which found that nursing standards at Kneesworth House Hospital in Hertfordshire were not of the same quality or type as in NHS psychiatric units. .. its authors, two senior nursing academics, were threatened with a libel action if it was published. Compiled with the hospital's co-operation, the audit was carried out by the City and Hackney Health Authority.. The audit found that Kneesworth House, Stockton Hall.. and Llanarth Court.., all run by the company Partnerships in Care, adopted a 'factory' approach.. The audit said the hospitals used large numbers of lowly qualified nurses, fewer doctors and wards of up to 30 patients to limit running costs. The Royal College of Psychiatrists is also concerned about the increasing reliance on drugs to manage difficult patients and published a consensus document last year  linking excessive use of neuroleptics.. with sudden deaths from heart attacks. .. Dr John Taylor, medical director at Kneesworth: I am not really aware of what the health authority said in its report. I see so many of them that I can't actually recall that one offhand.
Labour MP Margaret Beckett [now President of the Council and Leader of the Commons]: What makes this particularly alarming is indicators that, in some psychiatric units run for profit, cost margins may be so squeezed that staff levels are inadequate.
[Back to Start]
There have been several TV programmes on this issue; the best was by
World in Action,
('Private Grief', 4 July 1992, research Kate Middleton, producer Sarah Manwaring-White, Granada for ITV). It has to be said [by RW] that TV hasn't yet mastered the art of presenting issues clearly; the programme probably had little effect. The four cases described were:
11 Sidney Cable,
who, after a minor investigation for ulcers [at Fawkham Manor private hospital, now with new owners], became progressively more ill, until three weeks later he was taken to an NHS hospital in critical condition, where he died. A report, by an anonymous 'top surgeon', said the consultant, Peter Bates, should have realised the case was beyond the scope of a small hospital. "It was more likely than not that Mr Cable could have been saved." He "failed to order sufficient tests to monitor Mr Cable's condition." Mr Cable's daughter stated that some nurses had been worried about Mr Cable; but "if they went against [what he said] they'd never work again. ... We were under the impression he would get the best care, but it didn't turn out like that.. I think my father would have been a lot better off if he had crawled into an NHS hospital and got his treatment there." The case was settled out of court.
12 George Ryb,
who died after an angioplasty (i.e. attempt to increase inner diameter of arteries). Edgar Sowton was the surgeon; the family paid £300 for a cardiac surgeon and backup team to 'stand by'. However, the procedure caused one artery to block, causing a heart attack. The supposed backup surgeon was later visited by the dead man's daughter; he told her he'd been operating at Guys, several streets away, and "it was very fortunate that we were able to find an anaesthetist.. by the time I opened the chest there was too much damage.." This was despite the condition of the patient: a 'top cardiac consultant' seeing the X-ray movie film of Mr Ryb's heart wrote: ".. wouldn't recommend angioplasty.. the standby cardiac surgeon would have to be in immediate proximity and ready for instant action.." London Bridge Hospital's own records showed Philip Deverill, the standby cardiac surgeon, listed as covering both for Mr Ryb and the previous patient's angioplasty at the London Bridge. Daughter Samantha Ryb said "One of the things that upset me greatly is the way the doctors treated us.. with such callous disregard." She said in the
, 3 Mar 1999: .. they didn't have the back-up team. If he had been treated in the NHS, if the hospital had been properly equipped, we think the chances are he would have survived.
A report by an expert anaesthetist sates: 'The quality of care provided by the consultant anaesthetist fell below the standard that she was entitled to expect and I also had reservations about the quality of nursing care provided.'
There's an interesting inconsistency between the London Bridge's statement to
World in Action
(TV) in 1992: The hospital told us they'd not felt it necessary to have a special inquiry into Mr Ryb's death and its statement to the
in 1999: The incident was investigated thoroughly.
13 Roy Gray,
who died in an NHS intensive care unit after being ill for some time in a private hospital [BUPA Chalybeate]; the point here was that PPP's policy failed to state what would happen if the cash limit on the policy was reached. In this case, the NHS charged for treatment, which Department of Health guidelines allow, or allowed, if treatment was started in a private hospital.
14 Sue Heap:
after the removal of a small stone from a salivary gland, her tongue swelled to such an extent that she couldn't breathe. Unfortunately this was after she'd been observed 'several times' in the recovery room, then put into her private room. By the time her breathing difficulty had been noticed, and neither the young resident doctor nor the anaesthetist had been able to open an airway, the anaesthetist called for an instrument to perform a tracheotomy [cutting a hole in the throat]. But there was no instrument to hand. 'By the time a scalpel was found it was too late.' She was severely brain damaged and lay for 2½ years in an NHS ward until she died. A medical expert found that 'had her post-operative management been more thorough, obstruction would not have occurred and she would not have suffered respiratory arrest.' Husband Kim Heap: You're paying a lot of money for someone to go into a hospital like that; you expect her to be looked after properly.
(A sign outside the hospital [Holly House private hospital] said: 'NO EMERGENCY DEPARTMENT. NEAREST CASUALTY WHIPPS CROSS HOSPITAL.')
The programme ended with the voiceover: The Independent Healthcare Association (a charity) refused to be interviewed. ... The majority of private hospitals would not tell us how they dealt with complaints. ... The Department of Health have no plans to review the private healthcare system. Arnold Simanowitz of AVMA said: I think the DoH is opting out of the problem.
Further publicised cases:
15 Tony Charalambides:
Windsor and Maidenhead Observer
13 Oct 95, entitled Crippled boy wins £200,000 settlement reports that his father Andreas claims that a consultant at Thames Valley Nuffield Hospital failed to promptly diagnose his son's spinal tumour in 1990, when his son was 13. He states that the stomach pains for which his son was admitted were treated as constipation; his appendix was removed, and he became progressively worse, suffering excruciating pains, immobility, and pressure sores. The analgesics prescribed by the consultant and by the hospital's RMOs had little effect, and only after a second opinion from a neurologist, and an MRI scan at Great Ormond Street hospital, was his tumour diagnosed and treated, but too late to save him from being crippled.
2 Aug 1998No-one knew what was wrong with me until I got into the NHS.. When I was in the private hospital, I was in terrible pain and couldn't move properly. The hospital staff said I was hysterical and even removed the buzzer from my room.
Mr Charalambides said (
Don't Stay the Night
): What was not explained to us when we were paying our money for private health is that, as you become a private patient, the consultant is the person who's ultimately responsible. The nursing staff .. all rely on the consultant, so, if the consultant is not around, you have a complete, total breakdown in communication, potentially, and that is exactly what happened in his case. They should come up front and state in their brochures:- If you go into private health, this is the risk you've got to take. Beware of it! And
11 Aug 1998: People should be aware of the risks as well as the benefits of jumping the NHS queue.. I think that, for the hospitals, it's a matter of mitigating losses, whether financial or in terms on reputation. Those at fault want to preserve face with little consideration for the effects of their actions on the lives of the patients and their loved ones. They rarely say sorry.
14 Aug 1998: I was in severe pain.. I couldn't move my legs once they'd operated on me. I got prescribed paracetamol to take away the pain.. in terms of medical care it was certainly substandard. Meridian: The consultant at the NHS hospital said that although tumours can be difficult to detect, the signs were definitely there.. Tony, now 21, and permanently disabled: My situation is so unnecessary. If I had been diagnosed early enough then I wouldn't be in this situation, I'd be fine. The Thames Valley Nuffield Hospital in a statement to Meridian: In the case of Tony Charalambides we do not believe our care for him was ever less than appropriate and committed.. Nuffield Hospitals treat more than 700,000 patients every year and from our regular surveys we know that we deliver a very high level of patient satisfaction.
16 Ruth Silverman
15 Dec 92): .. A London inquest heard that Mrs Ruth Silverman had died from a massive brain haemorrhage brought on by blood poisoning, caused when surgeons punctured her bowel while clearing a blockage. Her death highlights a major difference between team management in private and NHS hospitals. The St Pancras inquest heard that on June 12th, two surgeons found themselves scrubbing up at the same time to perform different operations on 49-year old Mrs Silverman at the private Portland Hospital on June 14th. As her condition worsened, there was confusion as to who among four consultants was in charge of her. She was transferred to the Harley Street Clinic. On June 15th, two further consultants became involved. Dr Rodney Armstrong, head of Intensive Care at the NHS University College Hospital, took charge of her case. She was transferred to UCH on June 20 after two operations had stabilised her condition, but died on June 22. While praising the quality of the Harley Street Clinic, from whose Intensive Care Unit Mrs Silverman was transferred, Armstrong said he felt she would have been better off in an NHS hospital when she became critical. Greater depth of management expertise would have been available.
1st Feb 98), 27 years old, died after treatment in a private hospital. Problems began following surgery to remove his colon (described as a complex but not life-threatening procedure). According to his parents, nurses failed to realise his circulation was failing him, failed to aspirate him properly, following a build-up of fluid in his gutthe hospital only ever had one other patient with a similar conditionand soon after he went into cardiac arrest. Transferred to an NHS ICU, he died a few days later. The parents 'Rose' and 'Jack' are instructing solicitors but do not identify themselves partly for fear of being sued by the hospital.
18 Emma Pelta:
Channel 4 News
6 Feb 98. A routine keyhole surgery for an ovarian cyst at BUPA's Roding hospital, according to this report, went badly wrong. She had to be rushed over for emergency care to an NHS hospital. Father, Jeffrey Pelta, said: "She could have lost her right leg, she could have lost her life. The laparoscopy went drastically wrong and her artery was punctured." And
2nd Aug 1998: It's a disgrace that you are not told that private hospitals don't have all the facilities and staff on hand to cope with emergencies. When they cut the artery, they had to clamp it and then start phoning round to find the cardio-vascular surgeon to repair it.
19 Eileen Lambie:
11th Aug 1998: .. had a cancerous bladder removed at a private hospital in Surrey. Immediately after the operation, her care was transferred from her consultant to a locum surgeon in the same hospital. Though she was becoming progressively more ill, the hospital claimed there was nothing organically wrong, and the locum saw her only six times during his 25 days in charge of her case. Nothing could have saved my wife, but she could have been spared weeks of pain and suffering, said [husband] Mr Lambie. When I asked for her medical records, I was very angry to see how she had been neglected. Later, a local paper,
Walton and Weybridge Informer
24 Sept 98, wrote: '"She.. became ill and could not eat or drink and had hallucinations. The surgeon failed to carry out a routine blood test and subsequently failed to diagnose a serious calcium deficiency. .." the symptoms were later diagnosed and treated at a different hospital. Mr Lambie said the glossy magazines promoting private health care were attractive but did not give the full picture. "I never realised that taking private health care would cause so many problems. People must be made aware of the risks."'
20 John Corless
Here and Now,
14 Sept 1998: .. John Corless's life was at risk despite paying £20,000 to a top London hospital. He had successful heart surgery three years ago at the Wellington only to end up fighting for his life.. The serious bowel condition he was developing wasn't spotted. He was treated instead for constipation and eight days later he was discharged. His family had to push him out of hospital in a wheelchair. Within hours he was having life-saving surgery in the NHShis bowel had perforated. ['.. he spent 12 days on an NHS life-support machine.. "The private hospital had made a complete mess and the NHS had to pick up the bill to put it right," he said.' (
11 April 1999).] The physician who reviewed the medical notes said that the private hospital should never have discharged him in that state.. Dr Graham Neale, Consultant Gastroenterologist: That decision nearly cost Mr Corless his life. Mr Corless was being treated for his heart.. by a heart surgeon and a heart specialist [who] weren't expecting anything to go wrong with his tummy [sic]... they are not tummy doctors.. BBC: The responsibility for not spotting Mr Corless's condition was less with any individual and more with the private hospital system itself where the consultant works pretty much on his own.
John Corless: The fact that I'd left what I considered to be a hospital of excellence with six hours to live quite frankly is disgraceful.. Certainly, I experienced a terrible experience in respect of private hospitals.. and paid for it in many ways, not only with my wallet, but also almost with my life.
21 Bill Moore
19 Dec 1994: .. went to a private hospital [Holly House] for a routine operation to remove gallstones. .. The consultant made a surgical slip, the error was never properly corrected, and Bill died, eight operations later. Widow Valerie said that the surgeon cut too deep, resulting in a fistula, which went unnoticed. A second operation to investigate his poor circulation also failed to spot the fistula, no second opinion was sought, and no contrast X-ray carried out. Put on solid food soon after, septicaemia and peritonitis set in, and five days after the operation he was rushed to Whipps Cross NHS hospital. After several unsuccessful operations he died. Experts were highly critical of his treatment following the initial operation.
22 Helen Edwards
17 Nov 98) awarded record £3.9M compensation for brain damage, aged 5, during routine surgery at the Hope private clinic, Cambridge, to remove a birthmark. Left blind and unable to crawl, feed, or talk, her parents claim the damage was caused by incorrect intubation by the anaesthetist. The case took twelve years to settle in court.
23 James Williams
, 38, who accepted £800,000 in damages from the surgeon's insurers after a failed 'reverse circumcision' at the 'Lister' private hospital in London.
24 Nov 98: His penis turned gangrenous.. he should not have been discharged.. Surgeons at an NHS hospital believed he was in grave danger of losing his penis and an emergency operation was carried out; and in fact
25 Nov 98: '.. he needed.. six further operations over two years after being discharged.. When he questioned Mr. Pryor after surgery he was told: "If you are worried about it you ought to see a psychiatrist".'
Mr. Williams's case was that Mr. Pryor [consultant uroandrologist at the Lister] used an operative technique that was "doomed to failure".. Mr. Pryor had failed to warn of the real risk associated with the procedure, and had varied the technique, which he had written up in the British Journal of Urology in an article which Mr. Williams had seen. In the operating theatre further things went wrong, but Mr. Pryor did not recognise this early enough or re-operate soon enough.. He administered Voltarol, a drug which should not have been given, and the antibiotic cover was inadequate. Finally, Mr. Williams was sent home from hospital "when it ought to have been superabundantly obvious to anyone that he was not fit to be discharged" ..'
24. 'Patient 3'
, one of several patients of gynaecologist Nicholas Siddle, subsequently struck off by the GMC.
11 July 1995: 'Mr. Siddle, who now works at a private Harley Street clinic, was allegedly responsible for damaging the bowel tissue, bladders and wombs of eight patients over 15 months to December 1992.. The [GMC] hearing, chaired by Sir Herbert Duthie, was told that Mr. Siddle tore a two-centimetre hole in the bladder of a private patient admitted to the Portland Hospital in January 1992. The woman, known as Patient 3 to protect her anonymity, underwent keyhole surgery for a vaginal hysterectomy. Mr. Siddle also damaged both her ureters during the surgery, the hearing was told. "The extent of the damage indicates a lack of experience enabling him to tackle such a procedure safely, and a lack of ability to recognise basic anatomy," Ms. Foster [counsel for the GMC] said.'
25 Owen Ennals
my late father. Some details were reported in the
1 Feb 1998,
The Last Place You Want To Be
based on the medical and nursing notes, correspondence and statements relating to this case supplied to
and four highly critical experts and Health Authoritys reports based on same. The
quotes the findings and conclusions of the second Health Authority report on the death by the Director of Public Health: The care given, in this instance, fell below adequate standards; the documentation was not properly complete and accurate; Mr Richard Ennals complaints do not appear to have been handled in an entirely satisfactory manner (Point 3.5.3 of this report: This letter [the hospital's response to the complaint].. gives the impression that Mr Ennals did in fact only have indigestion on the morning of November 16, when subsequent events make it highly likely that his myocardial infarction started in the early morning on the day of his death). The Authority's report concludes: .. appropriate changes have been and are being made which the Health Authority expects should prevent any recurrence of these unfortunate events. [In this and in an earlier interim Authority report, the Authority made a total of five pages of recommendations for improvements]. The Health Authority Chief Executive in a covering letter: I am sorry that the death of your father has caused you so many concerns. Fuller details to come - RE
26 Hadassa Carmon
, 59. Channel 4 TV News, 29 Apr 99: Israeli state medicine is treating a distressed former patient of Britain's private system. Hadassa Carmon has advanced breast cancer.. BUPA Gatwick Park had told her she was healthy: three radiologists failed to identify her disease, despite three separate mammograms over two and a half years. Her cancer was found by her Tel Aviv GP within five minutes.. In newspaper advertising BUPA claims its radiologists are mammogram experts "who probably know more about the subtle differences between healthy and unhealthy breasts than anyone else." .. expert radiologists said Mrs Carmon's disease should have been obvious from the very first mammogram..
4 March 1999: 'Ian Fentiman, of Guy's [NHS] Hospital's breast clinic, said if a woman with a lump was referred to an NHS clinic, it "will take a history, examine her, do a mammogram and do everything necessary. Too many people just go along [privately] and have a mammogram and if the mammogram is all right they assume they haven't got cancer." .. Mrs.Carmon, 59, received £143,000 from Janet Page, the radiologist responsible for her second screening, in an out-of-court settlement. The patient.. had to withdraw her writ against BUPA after learning, to her distress, that [the BUPA hospital] had no responsibility for doctors' actions.' [Mrs.Carmon subsequently died, 14th.December 1999, in Tel Aviv -RE]
27 Charles Flodin-Tamm.
Newsroom South East
25 March 99: Charles, now 18, became gravely ill as a child when a tonsil and adenoid operation went wrong. Complications emerged which were the responsibility of the consultant who rented facilities at the Sloane Hospital [who was absent] Mother, Anne: At that time I was so distressed because my son was [in a bad state] and there was no other person around who really could take him to theatre again.
28 Jenny Goodman
, 4 Nov 98: .. In July, 1992.. her womb became perforated during a private gynaecological operation at London's [private] Portland Hospital. Jenny says: When I awoke I felt dreadful, my stomach was burning, I was in agony. I said: "I'm dying, please do something." They kept saying it was wind. I knew it was blood poisoning. Three days later she transferred to the [NHS] University College Hospital and doctors discovered she had a huge pelvic abscess and candidal septicaemia. The drugs used to treat it were like chemotherapy and Jenny developed adult respiratory syndrome. Doctors put her into a coma to fight the terrible infection.. Jenny left hospital after a total of 45 days.. [previously] a successful businesswoman.. Jenny in now living on invalidity benefit.. she has been paid a £15,000 "nuisance" payment by solicitors for Professor Stuart Stanton who carried out the surgery. But they have not admitted liability. She describes the payment as an "insult".
11 Dec 98, said she had an unnecessary operation in a BUPA hospital which went radically wrong; a nerve was trapped in her leg, she was a semi-invalid for the next two years and she lost her job. The doctor ignored her complaints and there was no course of action but litigation. Kathleen's husband: I complained about the treatment of my wife and the doctor said "There's nothing I can do for her here". He rang the NHS to look after her. I had to get an ambulance to take her to the NHS hospital.
30 Sir Michael Caine
, Director and Chairman of food company Booker-McConnell, who died at the King Edward VII private hospital in February 1999.
Independent on Sunday
, 18 July 1999: .. the decision to go private, according to his wife, Emma Nicholson, cost him his life, for she is convinced that he would still be alive if he had been treated in an NHS hospital. Sir Michael suffered a heart attack on the evening of 15th February. It lasted at least fifteen minutes, during which time a tube, used to help him breathe, malfunctioned. He suffered massive brain damage and never regained consciousness. The only doctor on site was a GP drafted in for the weekend, who had one week's experience in intensive care duties. The dying patient, the guiding spirit of the Booker Prize for fiction for nearly 25 years, was later moved to the NHS St Thomas's Hospital, where he died on 20th March. Baroness Nicholson claims that nurses at the King Edward VII repeatedly refused to call consultants and doctors, even though she believed her husband was in distress and pain. She believed that, shortly after his operation, a tube inserted into his throat to help him breathe had been removed and wrongly re-inserted, leading to the 15-minute cardiac arrest and brain damage. She claims that after his surgery he was moved to an NHS hospital because the King Edward VII "could not cope" with such a complex condition. After the transfer, she said, King Edward VII staff repeatedly sought his return. "I wonder whether the King Edward VII was seeking Michael's return for financial reasons," she added.
, 13 July 1999: "I decided to move him because I now had no confidence in the quality of their care," the Liberal Democrat MEP told Southwark Coroner's Court. "I felt staff at the King Edward wished him to die in situ. As soon as he arrived at St Thomas's, the consultant got to work. He had tests undertaken, they started feeding him again and they started treatment. The staff at St Thomas's told us they were just too late."
13 July 99: "Everything possible under the circumstances was done. The highest level of care and medical expertise available in emergency conditions attended him at the time. We have complete confidence in our staff and we wholly refute the serious allegations against the hospital." [NB The
's promotion of private medicine was a contributing factor in Nicholson's presumption of NHS inferiority - RW]
Independent on Sunday
: [King Edward VII's Chief Executive] "Whether Emma Nicholson decides to sue the hospital is a matter for her.. If she does decide to sue us it will be resisted most vigorously and comprehensively."
19 Sept 99: '.. the couple believed, along with many others, that 'private' equalled 'quality'. "Had I the knowledge then that I have so painfully and unwillingly acquired now, we would never have gone there,' said Nicholson. 'We would have gone straight to the NHS. Whether Michael would have have had three months or three years more is not the issue. The point is that he would not have died because there were ill-trained staff and inadequate equipment."
20 Sept 99 (
Private Hospitals and Private Risks
): The hospital in a statement: "The majority [of our nurses in the ICU] are not ITU trained.. because intensive care courses are very expensive and they are very oversubscribed" (none of the nurses had received formal ICU training). Dr. Carl Waldman, ICU Director of the NHS Royal Berkshire Hospital, and Council Member of the Intensive Care Society: "We would expect 40 or 50% of the nurses in an ICU to have that training and for there always to be nurses with that training present on all shifts. If the King Edward VII was unable to meet the requirements of a baseline ICU it should have made other arrangements... With the right number of trained staff present, the chances of Sir Michael's death would have been minimal."
31 Brendan Woolhead
, 34, who died following detoxification treatment at the London Wellbeck private hospital in October 1996.
: 'The Westminster inquest was told how Woolhead.. When the anaesthetic wore off.. was taken from intensive care to his room. Later he complained of headache, had a seizure and died of a heart attack, despite the efforts of medical crews. The inquest had earlier been adjourned and the case file referred to the Crown Prosecution Service after two leading medical experts said they believed Woolhead's death had been caused by "reckless" and "grossly negligent" behaviour by the hospital.. his family said they would be taking action against the hospital.'
3 April 1997 added: '.. Griffith Edwards, of the Maudsley Hospital, an expert in addiction behaviour, said the Wellbeck Hospital had made "manifestly false" claims about Mr. Woolhead's treatment.'
32 Ivy Brimble
. BBC2 TV
, 20 July 1999: "When the surgeons at the centre of the Bristol heart scandal operated privately here three years ago on adults, there was less attention to audit. BUPA Hospitals say only one patient died under the care of disgraced surgeon James Wisheart. But at least one case has been overlooked. In 1996 Ivy Brimble had a triple bypass at the BUPA Bristol Hospital [The Glen] performed by the other surgeon implicated in the scandal, Janardan Dhasmana. Her niece stated that she suffered a stroke before she came round. She died shortly afterwards in intensive care at a nearby NHS hospital.. She is shocked that BUPA deny any fatal complications. "There definitely was [sic] with my aunt. She suffered a stroke whilst having the operation and she never regained
consciousness.. she was totally paralysed."
33-51 Nineteen elderly NHS patients, under contract, at BUPA Gatwick Park private hospital.
Channel 4 TV News, 29 Apr 99: Nineteen NHS cataract patients had surgery over a two week period. No one realised that the surgeon was injecting the wrong eyedrop form of the methyl cellulose [the injected substance was intended for external use only], a mistake with the potential to destroy their vision.. a leading eye surgeon says those patients were injected with a toxin. All suffered visual impairment, some seriously, and don't yet know if it is permanent.
Local newspaper earlier had said (
, 24 Mar 99):- .. the patients must wait an agonising six months [sic] to discover if the sight in their eyes will be impaired forever.. it was not until two and a half weeks after the operation that the blunder was detected.. But the medical team has not been suspended from its work.. John Lambie.. said that ironically, as the cataract patients were referred by the NHS, they would have rights to a statutory complaints procedure unlike private patients in the hospital.
of the same date: An independent inquiry has been launched into the bodged operations. Chief Executive of the trust [Brighton Health Care NHS Trust who referred the patients] Stuart Welling said "The operation was only carried out on one eye so they still have reasonable vision in their second eye." David Spalton, director of clinical opthalmology at St. Thomas's Hospital, London, said the same mistake had been made before elsewhere. "These things need to be checked and double checked".'
(The Health Authority Inquiry, as reported in the
18 Dec 99, found
that the operations had been 'hastily' arranged, that the mistakes were due to a 'misunderstanding' between nurses and the surgeon, and that it was because of 'inadequate post-operative care' that the cause of the problem wasn't discovered until after the third batch of surgery. Of the patients recalled, one third had inflammation and corneal damage, another third had swelling and clouded vision, and two had had to have corneal grafts. Eleven recommendations were passed to the Department of Health to prevent similar errors. A BUPA spokesman said compensation 'would be considered' - RE)
52-53 two NHS patients in an NHS hospital
, in a feature on BBC Radio 4, 31 Mar 1999,
You and Yours
on the dangers to patients of consultants dividing their time between NHS and private hospitals.
"In an operating theatre at a London hospital a patient is cut open at the chest. The anaesthetist has the patient's heart in his hands, trying to massage life back into it. There's no one else to do it because the surgeon has left to see his Harley Street patients. This is a true story contained in evidence given by NHS staff to a coroner's court. The patient, an elderly woman, died on the operating table."
The coroner also heard about the death of a second heart patient, again after the same surgeon had left for Harley Street. The patient's daughter: "The main surgeon left a junior doctor who'd only been three months in surgery to carry out the operation on my father, which he found difficult. The surgeon phoned from Harley Street, carried on the operation by telephone via a third person, as the other surgeon was scrubbed up and could not leave the theatre, and then when it was said that this junior surgeon could not help my father any more, he was told by the main surgeon to just try once more, and if it doesn't succeed, just stitch him up and pronounce him dead." BBC: "The incident is now being investigated by the GMC.. some doctors may be treating their NHS patients to a second-class health service.." Daughter: "Don't, when you're being paid to be somewhere else, go and do private work. In any other profession.. You'd be sacked."
54-250? Patients of Rodney Ledward.
Ledward was struck off the Medical Register by the GMC for serious professional misconduct in October 1998, after 33 years as a doctor; it was subsequently acknowledged that one in three of gynaecologist Rodney Ledward's operations resulted in serious complications. Early estimates are that nearly half of the 200 women who have complained about their treatment since the verdict were patients in private hospitals. Many were left infertile, crippled, or needing follow-up repair operations. He was only suspended from the private hospitals he used after he had been suspended in the NHS.
A particularly important point highlighted by the scale of the Ledward case, probably characteristic of all private hospitals, is the degree to which private hospital staff will stay silent and thus help cover up even this level of incompetence. Although many hundreds of nurses and doctors over the years will have been aware of his incompetencehe was known as 'Rodney the Ripper' as long ago as 1985not one spoke out. Another concern is why the Medical Advisory Committees (MACs) of these hospitals did not take action years before. The principal functions of a private hospital's MAC include advising the hospital management on the standards of performance of admitting consultants. St. Saviour's Medical Advisory Committee, composed of admitting doctors who are supposed to monitor performance, only acted after Ledward was suspended by the NHS. BUPA's stance towards its customers may well be illustrated by its conduct at the angry meeting held in Folkestone attended by over 200 victims and relatives, over half of whom were private: unlike the NHS hospital where Ledward operated, BUPA didn't even bother to send a representative, only a curt leaflet advising of a telephone number for 'counselling'.
An inquiry has been instigated, but not an open one, so it is unlikely the truth will ever be known. And the 'Ritchie Report' into Ledward did not investigate his private hospital victims.
At least eight victims contacted APROP. Here are just a few publicised cases:
54 Brenda Johnson
, who was admitted to St Saviour's private hospital as long ago as Sept 1984 for a routine hysterectomy, carried out by Dr Ledward. In the following hours she lost six pints of blood, and had to have a second operation, requiring 76 stitches, to repair the damage. She could not walk for two years and will suffer pain for the rest of her life. BBC
11 Dec 98: You think you're getting the best of treatment but there's nobody on standby.. I was left bleeding all night. There was not proper nursing staffing in this private hospital, there were no intensive care facilities, you were left to suffer. The consultant couldn't be contacted, and eventually when he was brought back the following morning I was dying. I had less than ten minutes left to live. My husband was called and I was not going to make it. Fourteen years later I am still in pain. I had to take it to court because there was no redress anywhere. I got in touch with the hospital authoritiesthey didn't want to know. They said they're not responsible for the doctors working there, it's up to the doctor. You're paying a fortune for private care, thinking you're getting something. I got in touch with the GMC; they didn't want to knowthis was private. You've got no redress anywhere. I was desperately ill and couldn't get help.
17 Nov 98: "If somebody had listened to me and he had been stopped earlier, a lot of women would have been spared an awful lot of pain. If I had been tortured by the Nazis I think it would have been less painful. Marriages have ended over him because the women he operated on are just so beaten up inside that they still can't have a proper relationship..."
16 Nov 99: "It was a massive strain on the family. I have never held a full-time job since because I never felt well enough. I have spent most of the time going to see doctors. It has cost the NHS a fortune to sort out my case." ... She was originally treated for a bladder problem but has been told since that it could have been dealt with by a minor operation or physiotherapy.. She said: "He made such a mess of women in operation after operation. What they want to know is why it took 18 years to come out. They want the whole thing out in the open."
55 Anita Hill
who, following seven operations over six years by Ledward, mostly at St Saviour's private hospital, has been left permanently maimed. Her injuries included a perforated bowel resulting in an emergency colostomy.
14 Jan 99: The series of operations has left her with a weakened stomach wall and a misshapen abdomen. She suffers pain, is prone to vomiting and has been told she needs a further hernia repair and plastic surgery on her stomach to remove scar tissue. .. She said: "If it wasn't for the NHS I wouldn't have anyone to help me. They have told me who to turn to and what to do. The private sector have not been to any of our [victim] support meetings. The message is: 'If you still have got health insurance we can see you, but if not, tough'. .. I thought there would be someone in the private sector to go to if you had problems but I learnt to my cost that there wasn't. My whole life has been ruined and I have had nobody to turn to." ... The South East Kent community health council accused BUPA [owners of St Saviour's] of "dragging its heels" over the issue and lawyers for the victims said its refusal to accept a share of the responsibility was "reprehensible".
22 July 1999 added: 'She said in her own case she had tried to get help but had been blocked by the BUPA hospital's refusal to let her see her notes. In the end she had been forced to appeal for help to the NHS.'
56 Natasza Lambert
, a patient at the Chaucer private hospital, Canterbury, Kent.
17 Nov 98: .. went in for a routine hysterectomy a fit 40-year-old.. But she had to leave in a wheelchair. She said: I discovered that, thanks to his incompetence, my stomach muscles were ripped. .. [thirteen years] pure hell.. I'm still in pain. I was told by my doctor that he was a good surgeon. But I've since discovered that even then he was known as Butcher Ledward. He had no idea how to treat patients. When he told me I had to have the hysterectomy, he said "Never mind, dear. We'll get rid of the cradle and leave you with the playpen." When Natasza complained, she was seen by a psychiatrist at the Chaucer [private] Hospital who said she felt pain because she could not have more babies.
57 Sarah Lees
17 Nov 98: .. suffered a bungled hysterectomy at the hands of Ledward.. she said: "It was like medical rape and he didn't care.. I was not told it had gone wrong.. I spent seven years going to the doctor in pain but no-one could tell me what the problem was.. It was only recently that I discovered it was the op that had been wrong.. I am.. angry at the system that allowed Ledward to continue. I have been told by a friend who is a senior hospital staff member that Ledward's nickname was Rodney the Ripper." .. Sarah.. is now trying to sue St Saviour's Hospital over Ledward's botched operation..
58 Christine Laverty
Sunday 4 Oct 98: .. was due to have a routine hysterectomy at the private St Saviour's hospital run by BUPA in Hythe, Kent. The operation almost cost her her life. Mr Ledward perforated her bladder and damaged one of her ureters (the tubes linking the kidneys to the bladder) but despite clear evidence of the injuries he had causedblood in the urinehe stitched her up and left the hospital.. [following] an emergency transfer to the William Harvey [NHS] hospital, surgeons spent three hours repairing the damage.
59 Anne Dowling.
, 17 Nov 1998: '.. was left disabled after a "routine" op by Ledward in 1985 left her with a punctured bladder. Anne, 58, was given a hysterectomy in a second op that left her so debilitated that she had to quit her job as a stewardess on Channel Ferries. She said "I had to give up the job because I just couldn'tand still can'tlift heavy objects. I was single, had two daughters and a son and it caused me a great deal of distress. I got very depressed about it. I am now registered disabled because of that operation. After that, I needed three further operations, including a major one to repair my bladder."
, 21 July 1999: "Those [victims of Ledward] who were treated in the private sector found there was little they could do. It's all very well having a nice private room with fitted carpets and televisions, but if you're not getting proper care what good is that?"
60 Anne Rhodes.
(Reported in SE Kent Community Health Council's evidence to the Commons Health Select Committee's Inquiry into private health care). Persuaded by Ledward to have her hysterectomy done privately (at St.Saviour's in 1992), she came round to find that her healthy ovaries had also been removed. Ledward told her: "You won't be needing them any more, will you? And it saves going back in there again if there are problems." It seems she had signed for an oophorectomy as well a hysterectomy but no one at the hospital had explained to her what 'oophorectomy' meant.
61 Eileen Piddick
(as reported by SE Kent CHC). Encouraged by Ledward to go private at St.Saviour's for dilation and curettage, he then advised a hysterectomy as she "had an enlarged uterus". The operation was followed by haemmorrhaging, a wound infection, an ovarian cyst and urine leakage. Ledward explained that "this sometimes happens after a hysterectomy". His subsequent two repair operations on her bladder at St.Saviour's made her incontinence worse. Three further operations by a urologist at an NHS hospital were required and she is still undergoing investigation. The NHS could not find in her medical records any clear reason for the hysterectomy.
62 Ginette Rodesano
(as above). Following earlier operations by Ledward for removal of ovaries, laparotomy and hormone implant, she was admitted by Ledward to St. Saviour's in 1990 for further laparotomy, drainage of a torsion cyst and division of adhesions. The bowel was punctured resulting in leakage of faecal fluid accompanied by severe pain. Another surgeon had to remove part of her bowel and following discharge she was subsequently admitted as an emergency to an NHS hospital as there was an obstruction in the bowel. She is now in pain every day, caused by adhesions from all her surgery, but cannot be operated on again to divide the adhesions as this will exacerbate the problem.
251 James McAlpine
.. seven-year-old.. admitted to the private Ross Hall Hospital in Glasgow for an operation to remove a small blemish from his lower lip. A fatal accident enquiry into the case, which occurred in 1985, heard that the operation would have been better carried out at the Southern General Hospital where proper back-up facilities were available. His parents claimed they were not warned of the risk of the operation and said they had been recommended to go to Ross Hall by a plastic surgeon who had a £27,000 shareholding in the hospital. James died 20 hours after material injected into his face to try to block the blood supply of his lips lodged in the arteries leading to the brain, cutting off the flow of blood. The child came around from the anaesthetic, but had nightmares and became violent. Later he was transferred to the Royal Hospital for Sick Children at Yorkhill but was declared brain dead after being placed on a ventilator. .. (From
, 22 July 99).
252 Ida Honeyman
.. had to be transferred from a private hospital in Dundee to the local acute unit when an operation to correct a sinus problem went wrong. Mrs Honeyman, 58, lost three-quarters of her blood after an operation carried out by a plastic surgeon at Fernbrae Hospital. At the time, her husband, Ian, blamed the hospital for its lack of back-up emergency care. .. (From
, 22 July 99.
253-500? About 250 people who made contact
after recent media coverage of private hospitals. Many of these people had serious injuries or were relatives of people who had died in private hospitals; almost all were dissatisfied with their private hospital's response. We expect many more in future.
501 John Holmes
who in 1996 went for a hip operation. His wife Diane is quoted in
(April 2000): 'When John came round from the second operation things obviously weren't as they should have been. He had low blood pressure and a high temperature. .. I waited at home.. About teatime the nurses admitted he wasn't very well.. By early evening.. the nurses said they'd called the anaesthetist. .. he realised John was seriously ill and had him transferred.. to an NHS hospital. But by that time it was too late. .. I had gone through sheer hell watching him die. .. This was a routine operationhow had it gone so wrong? .. I asked for John's notes, but they were spare and unclear.. in messy bundles.. I wouldn't use the private system for anything now. I feel frustrated with the system and terribly bitter. ..'
502 Anne Kennedy
from south London; hysterectomy went wrongcomplications included viral encephalitis and coma, which was unnoticed. At her husband's insistence she was taken to the NHS Maudsley hospital where in
words 'they picked up the pieces, using a new drug, which cost £4,000.' She said "I'd never go back into a private hospital."
503 Pauline Radford
. Various media sources.
states she bought private insurance in 1992, and, since she'd had 'minor bowel trouble', a clause, to be reviewed in one year, was added, excluding bowel treatment. However, after 'tests showed her liver and kidneys were failing', 'she was asked to sign a form' despite being ill: "I didn't know what was going on." Crohn's disease was diagnosed and her colon removed. After more than four years, she was sued for £14,000presumably the cost of the operation. Someone had decided her treatment wasn't insured. About a year later judgment was made in favour of the hospital, leaving her £20,000 medical bills and £10,000 costs to pay, and liable to lose her home.
504 Margaret Waterhouse
'admitted to the South Cheshire private hospital in Crewe for a routine gynaecological operation. She was subsequently transferred, comatose and irreversibly brain-damaged, into NHS intensive care.' (
, 7th May 2000, Private health blunders take up NHS beds
. The following two cases come from the same article:)
She died in 1998 following treatment at the BMI South Cheshire private hospital near Crewe (BBC TV
20 Sept 99). An epidural for pain relief was administered for a 15-minute minor gynaecological procedure. The resulting fall in blood pressure continued after she had been returned to her private room. Her heart stopped beating after some 20 minutes but it wasn't until ten minutes later that a nurse first checked up on her. She was resuscitated but the damage was such that she stayed in a coma, dying twelve days later in the NHS hospital to which she was transferred. According to expert, Prof Felicity Reynolds, she was in an unstable state following the epidural, her circulation was not stabilised, and steps should have been taken to ensure her condition was stable before placing her in a single room. It was a misjudgement with fatal consequences. BMI private hospitals said they concluded from the inquest evidence that her death was caused by a rare late-onset drug reaction and that she was properly monitored. The anaesthetist said she was attended by an experienced team. Husband Ray Waterhouse: "All hospitals should be centres of medical excellence regardless of whether they are NHS or private. They're dealing with human life and you cannot afford to make mistakes".
505 Richard Yarnell
an amateur athlete from Walsall, who died from an undiagnosed blood clot after knee surgery.
506 Catherine Kearney
died.. after a hysterectomy went wrong at the Rivers hospital near Sawbridgeworth.. Her sister.. claimed staff had no option but to call an ambulance. .. the hospital was told to use its own transport to move her into NHS intensive care, where Kearney subsequently died.
507-532? Private Hospital Patients of Richard Neale.
A consultant gynaecologist and obstetrician, now struck off, Neale returned to Britain in 1985 when his licence was revoked in Canada after a pregnant patient died in his care. A disciplinary hearing was told that Dr.Neale administered a drug banned in the hospital and altered the woman's medical notes after her death. Earlier, in 1979, he was stopped from operating at the Prince George Hospital in British Columbia after the death of a woman. The Chief of Obstetrics and Gynaecology at the Prince George reported that in a long series of cases Dr.Neale 'showed poor judgement and.. poor surgical procedure'. His 1987 appeal for reinstatement was dismissed. Dr. Eldon Lee, a senior gynaecologist at the Prince George stated recently to BBC TV's Panorama: "He was absolutely incompetent. He was incapable of making reasonable decisions as to a patient." Another Canadian former colleague, Dr. Andy Sear, says he warned the GMC in 1985
of his incompetence.
Neale worked as head of the maternity unit at Friarage Hospital, Northallerton, N. Yorks, but was suspended after complaints from colleagues and patients. He was eventually asked to leave in 1995 after complaints from colleagues and patients (the victim support group currently numbers over 100), but was given a reference and a £100,000 payoff. [The calculation presumably being it's cheaper to do this and get rid of him quietly than admit negligence-RW]. He continued to work in other NHS hospitals, in private hospitals (including St John of God (Yorkshire), the York Nuffield, The Cleveland Nuffield, London's Portland Clinic, Lister Hospital, and Harley Strret Clinic), and as an expert witness. Private patients who allege they have been injured make up nearly a quarter of the action/support group that has been formed.
A police inquiry has begun into a number of deaths among his former patients, whilst the broadcast of the BBC
programme in Canada and the northern US resulted in forty further alleged victims coming forward. He is also being investigated for fraudulently claiming he was a fellow of the Royal College of Surgeons. The General Medical Council, however, stated that it allows doctors who have been struck off abroad to practise in Britain (
25 May 99), and in 1998 appointed him as an assessor in medical hit squads aimed at weeding out failing doctors.
, 29 Jan 98: 'The GMC said: "We are not aware of any complaints to the GMC about Dr. Neale's practice in the UK".. Jim Cousins, Labour MP for Newcastle Central, said: "This makes the new [GMC] system a complete laughing stock. He should be dismissed instantly from this post."'
, 22 July 1999, reports the case of Sheila Wright-Hogeland, who 'suffered from endometriosis, which causes thickening of the womb lining. As a private patient, she was checked regularly by Dr Neale, but he failed to notice the worsening of her condition and she needed a hysterectomy, which left her unable to have children. Mr Neale operated on her at the St John of God hospital.. but the wound became infected and she had emergency surgery in the NHS Friarage hospital six weeks later..'
6 April 1999 reported "he told me I was fit and well, despite my increasing pain.. after six years I was in agony and bleeding. He said it was the worst case he had seen. After the operation the wound became badly infected. ..'
533-600? About 20 Private Hospital Patients of Dr Ingoldby. (And about 80 NHS). Including:
Kathryn Glover, 38
, private hospital patient of Christopher Ingoldby. Gastro-intestinal surgeon Ingoldby is facing sixty [NHS and private] lawsuits following operations. Two families are suing after relatives died because of alleged botched stomach and bowel operations. Suspended from Pindersfield NHS hospital in Wakefield, West Yorkshire in January 1998, he continued to look after his private patients at BUPA's Methley Park Hospital outside Leeds for several months after his suspension.
14 Nov 1999: 'A routine operation by Ingoldby allegedly failed to remove the diseased section of [Ms. Glover's] bowel and cut several blood vessels. She has since had seven operations to correct the problem. "It is highly irresponsible that he is deemed not fit to practise on the NHS but could still practise on private patients. I have been in agony for years. I am suing him but I am more interested that he is struck off so he cannot treat patients any more," she said.'
600-700? Patients of ENT specialist Julian Upton.
(Probably about 20 private hospital patients and 80 NHS).
29 Mar 2000: '.. whose incompetence left more than 100 patients needing further treatment.. a highly critical independent inquiry into his 21-year career at Musgrove Park NHS hospital in Taunton Somerset made a series of recommendations.. six patients are now to have specialised care for tumours which spread after he failed to remove them properly. Others have suffered total or partial hearing loss as a result of his outdated remedies.. he is already facing 29 compensation claims'. [According to a local journalist he was also treating patients in private hospitals in Taunton and on the south coast -RE]. The GMC let him escape censure by allowing him to voluntarily resign from the medical register.
701 Lorraine Batt, 36
, who died two days after a routine cosmetic 'tummy tuck' operation at the Highgate private hospital in January 1999. Recording a verdict of death by misadventure, the coroner described the operation, on a patient of normal weight and size, as unnecessary. The patient's vomiting, and complaints of nausea and sickness were treated by an anti-emetic and morphine, but blood samples were not analysed nor does it seem that her fluid balance was being monitored. She died soon after transfer to the nearby NHS hospital. The cause of death was attributed to swelling from waterlogging of the brain, which went unnoticed (from the
25 Jan 00)
702 Raquel Siganporia
magazine 28 Feb 2000): at age 11 had rod inserted to cure curvature of the spine in an operation at the private
. The small risk of damage to the spinal cord means that post-operative monitoring of movement of legs and toes is essential. The night nurse repeatedly failed to report the patient's absence of feeling, the one doctor on duty (typical of private hospitals at night) did not visit, and the surgeon, who lived nearby, was not contacted. Expert opinion is that had she been properly monitored, and had there been an operation to remove the rod immediately after her absence of feeling was noticed, much of the damage would have been reversed. She is now permanently paralysed from the waist down. The London Clinic took three years to admit liability and settle the case.
They said in a statement to
: "Each year over 16,000 in-patient procedures take place at the London Clinic. The hospital implements a strict protocol for the care of patients in the post-operative period."
703 Quentin Grant, 45
. Policyholder of Cornhill Insurance. They used an exemption clause to withdraw funding for his £12,000 heart operationfor a life-threatening conditionjust two days before it was due. He died after the operation, in October 1999, and the widow claims the severe anxiety caused by the insurer's decisionhe was unable to afford this sumlessened his chances of survival. She is suing Cornhill, who had told her husband that their reassessment of his condition meant that they now regarded it as 'chronic' and therefore not covered as there was no cure. Specialists told Cornhill the operation would have cured him.
16 Mar 2000: 'Their assessment contradicted that of leading medical specialists, including world famous heart surgeon Sir Magdi Jacoub. The case highlights growing concern..that insurers are employing an array of tactics to avoid paying claims for private health care.. Sir Magdi: "Often insurance companies put commercial interests before the patient. It's morally questionable. ".. President of the Hospital Consultants Specialists Association, surgeon Winston Peters, said: "People believe they'll be covered when they're not. It's a growing problem. Companies try to bypass payment on technicalities."' (The article goes on to cite several other cases including cancer patients facing bills of £40,000 and £20,000, one of whom must also now sell her house following unsuccessful legal action against Norwich Union).
704 David Williams, 55
, disabled actor who has starred in TV's 'The Bill' and 'Eastenders'. Has paid insurance premiums for private medical treatment for over twenty years.
, 22 July 99: 'Two years ago, an operation on Mr. Williams' thigh carried out in a private hospital went wrong. It was left to the NHS to put it right... this week he was told by his insurers, Sigma, that a sore on his leg [requiring a further operation] was a 'chronic' condition and could not be treated.. he will have to wait four or five weeks for an NHS bed. In the meantime his condition will get worse and when he does get treatment he will have to spend longer in hospital. The case highlights concerns that the NHS is being forced to pick up patients which [sic] private hospitals refuse to treat.. Mr. Williams: "It is disgusting.. I have paid my dues for 22 years.. The consultant says five to six weeks of treatment and the sore will be gone, so it is not a chronic condition. They have never turned me down before and have always been happy to take my money."
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IN DIFFICULTIES? THIS IS WHAT MAY HAPPEN TO YOU
Sawdust Saviours, Toothless Watchdogs, Inert Institutions...
...Organisations that don't do what they're supposed to do.
Theoretically, many organisations exist to help patients. In practice, victims have a difficult time of it.
With luck, you may find there's been a misunderstanding, if you're fortunate enough to find someone willing and able to discuss the issue. (There is no organisation for people who fear something may have gone wrong, but aren't sure.)
With less luck, a typical sequence might be:
a patient (or surviving relative) wonders what happened, and tries to find out. The first problem may be to get any sort of reply. A standard technique (in politics, too, of course) is simply not to answer. Then there may be contemptuous or evasive replies. These may escalate to legal threats. And there may be simple lies, a tempting technique where there are complicated technical issues, with obstructions making them hard to check:'Independent Healthcare providers are demonstrably committed to delivering the highest quality of care' (IHA written evidence).
Actors in these dramas may include:
If you are dragged in further, you'll become aware of organisations you probably never heard of before.
GPs (General Practitioners)
, who are often complainants' first port of call after an untoward incident or unexpected death, especially
if there is complete silence from the hospital or consultant. Conflicts of interest include:
GPs may regularly refer other patients, NHS as well as private, to a consultant. He/she may be reluctant to help with medical questions if this may lead to criticism of an associate.
It's possible also that some GPs may refer insured private patients to a consultant inappropriate for their needs in return for financial kickbacks. (This interesting area is completely unexplored, despite the millions of private referrals every year). GPs may be reluctant to offer assistance for fear of laying themselves open to scrutiny.
If there is a subsequent legal investigation, the GP's medical records of the patient will also be required, in addition to those of the hospital and the consultant; the complainant's solicitors' letter seeking these will be referred to the GP's own medical defence organisation [i.e. his insurer] who will pass it on to its solicitors, and this can lead to further delay and confusion.
Citizens Advice Bureaux. (CABs)
. Another frequent first contact, but until recently with little or no knowledge of complaints procedures in private hospitals and health authority investigations. Again, it was an APROP member who had to advise their National Association about this, and later tell them of the Medical Accidents Handbook. However, CABs are sometimes useful for quickly supplying details of specialist medical negligence lawyers, more quickly than AVMA.
Whistleblowersor rather their absence
in the private sector. Where there has been a serious untoward incident resulting in severe injury or death, a frequent cause of puzzlement amongst APROP members, usually bereaved relatives, is the consistent failure of private hospital staff, or consultants, or especially Medical Advisory Committees
who are supposed to monitor such mattersto speak out. Whereas even in the NHS doctors and nurses such as Stephen Bolsin (Bristol babies heart deaths) or Graham Pink (abuse) will occasionally blow the whistle, the private sector maintains a consistent silence in this area, even in the 'charitable' or 'religious' private hospitals. This may be because of a gagging clause in staff contractsthere is no public information about this. Or perhaps because private sector practice is more attractive to clinical staff with a less 'caring' and more mercenary approach to illness.
Holders of Medical Records.
In theory, patient notes are available on request. In practice, these may be tampered with or 'lost'. (Tampering tends to be tailored to the competence of the person expected to examine the notes; if they're careless, important information may slip through; if they're hyper-careful, the notes are filled with non-standard medical expressions and abbreviations).
Following the belated introduction of the Access to Health Records Act, complainants have the right to ask for copies of their or their relatives' medical records, in private as well as NHS settings, whether a complaint has been made or not. The experience of a number of APROP members, however, is that records are tampered with, key documents go 'missing', or that they are drip-fed slowly to complainants or their solicitors to lessen the time available for issuing writs. A written or verbal complaint prior to their request may also alert the hospital or doctor to which documents need doctoring. To date, there has never been a criminal prosecution for falsifying medical records, possibly because there is no specific law for this.
Executives of Private Hospitals.
Neither the hospital nor its staff nor the consultant are under any legal obligation to approach the family if there have been failures in a patient's care, and it is the experience of some APROP members that, if no complaint has been made, i.e. if the family haven't realised mistakes may have been made, all parties will stay silent, especially if death has resulted.
In theory, however, once the family has approached the hospital, the complaints procedure should come into play which the registering authority expects all private hospitals to have in place. This should be along the lines of the IHA's 1988 (revised 1991) 'Code of Practice for Patient Complaints' (available free from the IHA, 22 Little Russell St, London WC1A 2HT) with a thorough investigation by a designated complaints officer, the interviewing of all staff involved, the participation of the hospital's Medical Advisory Committee if necessary, and resulting in 'as full an explanation as possible', with an acknowledgement of mistakes, apology, compensation and rectification proposal where appropriate.
In practice, almost all APROP members have not even been advised of the existence of any complaints procedures, and complainants are sometimes simply responded to with an untrue statement of events, the detail and plausibility proportionate to the scale of the blunders, and the suggestion that they can go to lawyers if they're not satisfied.
(In the IHA's written evidence to the Commons Health Committee's Inquiry, one member of its 'Inquiry Steering Group' has written (Paragraph 44) regarding private hospitals' complaints procedures: 'Regettably, but rarely, some complaints will not be resolved to the complainant's satisfaction. This may be because the view of the facts that the hospital has formed as a result of its investigation is at odds with the patients [sic], or perhaps the resolution that the complainant is seeking is not in the gift of [sic] the hospital.' This implies that most, if not all, complainants are advised of and use the private hospital's complaints procedure, and that only a rare few are dissatisfied with it. To make such a clearly mendacious claim to MPsnoticeably, no evidence is supplied to support itmay well illustrate the private sector's and medical establishment's sense of being above accountability).
Alternatively, the hospital with or without any bogus statement, may invite complainants to a meeting to discuss their complaints verbally. The obvious danger is that this will be solely to try and ascertain just how much a relative knows and how damaging that information may be to the hospital or doctor, rather than to get at the truth or answer legitimate questions. They may also wish to know whether the complainant can afford lawyers.
Deaths: the Registrar of Deaths, Coroners, and Crematorium Medical Referees.
It is sometimes the case that relatives will not uncover mistakes until after the patient is dead and buried or cremated, especially if the hospital and consultants have elected to engage in a cover-up. Unfortunately the present system here as elsewhere conspires against the complainant. A Coroner's inquest is usually only called if the death occurs within 24 hours after admission and unusually beyond that time. If mistakes have been shown the coroner will almost always conclude that there was 'misadventure' rather than 'lack of care' partly because of the difficulty of showing this in coroner's law, but partly also probably because of pro-doctor prejudicea quarter of all coroners are doctors, the rest lawyers. The coroner is also primarily concerned with the cause of death rather than attributing blame. Where the death has occurred in a hospital, the Registrar of Deaths should, in theory and as good practice, ask relatives registering the death whether they were satisfied with and had and any concerns about the care [meeting with Sutton Registrar and RE]. In practice this does not always happen [call to Registrar-General's Office]. If the body is to be cremated, the crematorium's Medical Referee (a doctor) should satisfy himself as to the details of the death in the two forms filled out by the physician who attended the patient in his final hours and a second corroborating doctor. It is a criminal offence under Section 8 of the Cremation Act 1902 to make a false statement in these forms. In practice, he can only go by what is written, and if what is written seems plausible, he is not liable if false statements have been made [conversation between RE and medical referee]. Relatives are not allowed to view these forms, only the Home Office and police, and it is likely that many 'dodgy' deaths slip by. ....
Complainants may ask for help from their medical insurers, perhaps believing promotional claims, e.g. Allied Dunbar Healthcare: 'Patients [sic] comments on all aspects of their treatment are always welcome and are used to help improve standards of care and treatment.' In fact, insurers, whose advertising may suggest high clinical standards in private hospitals, show very little concern over injuries or deaths caused by iatrogenic neglect. Responses are unsympathetic, dismissive or evasive, e.g. BUPA, to the relative of a former BUPA insuree who had successfully sued: 'Thank you for your letter.. I was sorry to read about your concerns about your late father's care at this hospital.. As a third party insurer we cannot comment on the services provided by non BUPA hospitals or consultants. Thank you for again [sic] bringing your concerns to our attention. I regret, however, that BUPA cannot take this matter further.'
This applies unless the insurers, if there is serious injury, are obliged to pay for their customer's continuing care; then, they often deem the condition 'chronic', to free themselves from liability. Evidence suggests insurers are much more concerned with not rocking the boat, even when there may have been very many adverse incidents at a hospital or involving a consultant. Annual private medical insurance revenues amount to approximately £2 billion....
(Action for the Victims of Medical Accidents. No connection with American Veterinarians) founded 1982. Says it 'offers independent specialist advice and information to people who feel they have been victims of a medical accident'. In fact it is mainly interested in law, and has made a successful attempt to establish a sort of monopoly. Its legal interests include directing cases to specialists in the medical negligence industry, and investigating complaints about solicitors. Most communication is by letter; for meetings and sympathetic talk, you'll need to go to their regional group support meetings. Valuable weeks may be lost before there is a response. Much of its funding comes from legal conferences and publications. It has plans to rename itself, dropping the word 'victims' which the medical establishment does not like. ('Medical' negligence has been renamed 'clinical' negligence in legal circles for the same reason). AVMA gets government money for assessing legal aid cases, and gets fees from insurance companies for estimating the chances of success of legal actions. Complaints include: unreturned phone calls, an unsympathetic response at an often very distressing time, and the sense of AVMA being too involved with looking after lawyers' rather than victims' interests.
Lack of Statutory Complaints Procedures
for a long account of problems, and percentages of cases which proceed through the courts. To summarise:
Precious time may be wasted by inexperienced high-street solicitors who can't deal with the insurance solicitors defending the hospital or consultant, usually from large City commercial firms. Specialist firms' fees are higher. Typical complaints include: work delegated to inexperienced juniors (charged at partner fee rates); correspondence unanswered for months; unanswered telephone calls; overcharging (e.g. a special 'care and consideration' clause); and missing the three year deadline for issuing writs. Solicitors will not forward records to a new firm until all their fees have been paid, no matter how shoddy their work may have been. Clients who complain to the Office for Supervision of Solicitors may wait for up to a year.
Even if a complainant's case appears to have a high chance of success in court (i.e. if he is lucky enough to find an impartial expert), his solicitor may prefer to lose, and pressure him into an unsatisfactory settlement, because that solicitor's costs may be larger, and eassier to obtain (Michael Joseph,
Lawyers can Seriously Damage your Health
, 1985, pp. 260-1, who also says (p. 118) that some solicitors are bribed by the other side's insurance company). Insurance solicitors' prime concern, for their clients, is to settle claims deemed meritorious for the minimum figure possible, by exploiting the procedural processes to the fullignoring letters, delaying, threatening with defamationto increase the strain on the complainant.
Medical negligence (or 'medneg') is an industry, largely unaccountable and unregulated, whose principal aim is to derive maximum profit from the effects of medical blunders. Lawyers' fees often exceed compensation payments.
Lack of Statutory Complaints Procedures
has details. To summarise:
Experts (who are consultants who do reports as a side-line) are biased in favour of fellow-doctors.
Even if they are have untampered notes, important aspects of a case can be overlooked, blame may be unwarrantedly placed on nursing staff, and there may be little knowledge of the legal test for negligence (Bolam).
This may be unconscious bias, or perhaps the result of the medical authorities' selection and appointment process, tacitly ensuring that those appointed consultants are the sort who can be relied upon to find only rarely against other doctors. The Woolf reforms do not appear to address this problem. Indeed the proposal that the experts of both parties should meet alone behind closed doors to examine a case, may make it worse.
Legal Expenses Insurance.
Claimants seeking funding for their legal costs may have legal expenses cover on insurance policies. However, such policies have limits and are unlikely to cover the very high costs of medical negligence cases. Insurance companies keep tight control on how the money is spent, the solicitors that can be used and how far a claim can proceed. There are also narrow time limits for claims.
And you'll become aware of such possibilities as secret collusion, careerism preventing frank criticism, strings-attached funding, legal devices to conceal truth. And of course plain laziness and incompetence:-
If you decide governmental organisations aren't helping, you might try professional bodies:-
The Patients Association
(8 Guildford Street, London, WC1N 1DT) is partly government-funded, and claims to be the 'voice of the patient', existing 'to help patients [including private patients] and their interests.' APROP members found their letters were unanswered, and that the association had little knowledge of private hospital problems and no awareness of private patients' right of access to the health authority. However, it does supply spokespersons for chat shows.
Rita Pal writes: "... This is .. run by Clair Rayner [midwifery/nursing background, moved to novels/broadcasting-RW]. ... [It] is government funded and .. will not do anything to contradict the government. Furthermore it is a charity and by law charities cannot involve themselves in anything that is politically challenging. I have not come across any patient to date who has been supportive of the Patients Association."
Community Health Councils (CHCs)
are often complainants' first contact. They will find they assist only with NHS complaints. (However, S.E. Kent CHC chairman's exceptional taking up the case against Rodney Ledward may have contributed to the Health Committee's decision to investigate private healthcare). APROP members who have contacted CHCs have generally found them uninterested and unhelpful, and invariably unaware of the registering health authority's scope for investigation. APROP founder members had to advise the CHCs' National Association of this.
Evidence shows one purpose of these government-funded organisations is to provide career paths and to prevent disturbing information from being made known. Examples include a Chief Officer of a
CHC who ignored letters on this subject, but joined the Consumer Association and became a Senior Health Researcher; she also gave evidence to the Commons Health Select Committee. A former chief executive is now a 'New Labour' lord.
should be approached after the hospital, if there is dissatisfaction with the hospital's response (as is almost always the case). Few private hospitals or health authorities will tell you about the authority's regulatory role and theoretical scope for investigations. In principle, thorough
could have positive benefits. In practice, health authorities may bend over backwards to avoid thisoften hiring lawyers, with public money, to do so. (
for an account by Richard Ennals of the Merton, Sutton and Wandsworth Health Authority. Other examples include the report into Owen Ennals deathwhich needed a plea to the Chief Executive after two years of non-activity, and the investigation into Christine Maloneywhich took letters from two MPs). No doubt health authorities are concerned with not upsetting the local medical establishment, contrary to the NHS Executive Guidelines HGS(95)41: 'The primary objectives of the registration and inspection system are to protect patients and maintain standards'.
Health Authority Registration and Inspection Officers
. The experience of all complainants has been that these people always find reasons not to investigate, being happier with small private nursing homes than huge private hospitals and chains. They may not be clinically qualified. Their publications seem to show that NAIRO, the National Association of Inspection and Registration Officers, and the Royal College of Nursing's 'Forum', are largely talking-shops.
Twice yearly inspections: see above for their absurd limitations. Only one APROP member succeeded in obtaining inspection reports of the private hospital at the time of his wife's untoward death, and found them cursory and superficial. Other requests were refused, contrary to the Health Ombudsman's recommendations. The suspicion is that health authorities do not want their potential inadequacies scrutinised, even when this may help prevent injury or death.
Department of health/ NHS Executive.
There were no plans to legislate until mounting publicity forced a U-turn. Experience shows the DoH and the responsible minister do little, leaving the complainant to go to the GMC or sue. There is careerist interchange with the private sectorfor example with BUPAso that conditions have coasted along for many years. (
, 24 Apr 2000, 'Private sector 'secures favours' in Whitehall')
NHS Confederation (formerly 'NAHAT').
This is funded by the NHS. Its objectives include 'how to disseminate good practice.' But its important guidelines on investigating incidents in private hospitals don't appear to be well disseminated. Many APROP members have found health authorities are unaware of these guidelines.
Or you might explore other avenues:
GMC, the General Medical Council
(178 Great Portland St, London W1N 6JE) deals only with 'serious professional misconduct', which is largely undefined. It only recently started to investigate clinical incompetence. Doctors struck off abroad are allowed to practiceeven when patients have died, as with Richard Nealewhilst doctors struck off following convictions for manslaughter, drugs and sex offences are regularly allowed back. (
6 Feb 2000,
18 Mar 2000.
29 Oct 1999: 'Everyone knows the GMC is a joke'). In 1993, only four of 1301 complaints resulted in deregistration.
BMA, British Medical Association
(Tavistock Square, London WC1H 9JP) is a trade union or club for medical people; benefits for the annual subscriptions include copies of the BMJ, and use of their library and other facilities. They offer no help to patients.
The Royal Colleges
specialise in branches of medicine: examples include general practitioners, midwives, physicians, pathologists, radiographers, surgeons. They organise and administer qualifications and examinations for their potential and actual members. They offer no help to patients (and would probably be amazed if patients approached them).
UKCC, UK Central Council for Nursing, Midwifery and Health Visiting
(23 Portland Place, London, W1N 3AF), the nurses' regulatory body, claims to 'protect the public'. Complainants have to have the criminal standard of proofbeyond reasonable doubt. It is concerned largely with conduct rather than clinical incompetence. Most complaints are rejected by the 'Preliminary Proceedings Committee', which is held in secret, and gives no explanation for the Committee's decision, even when a nurse's failures have resulted in injury or death. Richard Ennals' verdict: 'a complete waste of time'. There's a good unflattering description
on Rita Pal's website. The UKCC recently altered their rules just sufficiently to comply with EC regulations on secrecy, due to come into force in October 2000.
Think Tanks, Paper Factories, Research Institutions.
For example the King's Fund
(11-13 Cavendish Square, London W1M 0AN), with an
which allows hospital to imply that their clinical care has been checked. And medico-legal departments in Birmingham, Glasgow, Liverpool, and Oxford's Centre for Socio-Legal Studies. Apart from John Yates's research into the effect of consultants' private work on NHS waiting lists, there has been little or no investigation into private hospital problems. Such important obstacles to redress as falsification of notes and prejudiced experts, though well-known, are completely unexplored.
Professional University Ethics Groups.
Ethics 'researchers' usually prefer to dabble in marginal topics, or topics with a frissonembryo research, suicide, euthanasia. As is the case in much of 'social science', serious issues which conflict with establishment groups are tacitly ignored.
Medical Defence Organisations.
You may come into contact with the Medical Defence Union (MDU)
or Medical Protection Society (MPS)
which specifically deal with doctors' interests.
They are doctors' insurers, each with reserves in the region of £300 million. Any serious complaint to a doctor will be referred to his defence organisation. They may help prepare a response or rebuttal to an initial complaint (e.g. the MDU in the
Hospitals and Health Services Year Book
: 'The benefits which may be granted to a member.. include: .. helping with complaints procedures and responses to complaints.'). Their solicitors will defend the doctor in ensuing litigation. Despite their stated objects, e.g. the MDU in its company memorandum 3(ii): 'To promote high standards of professional practice', complainants may find their stance to be one of obstructiveness. E.g. Prof. Margaret Brazier,
Medicine, Patients and the Law
, (Penguin 1987, repr. 1997): 'The private patient may be less fortunate.. The patient's task is made even harder because of an agreement between hospital authorities and medical protection societies that generally neither will join the other as co-defendant. They will not engage in mutual accusations of blame which might offer evidence which could assist the patient. They will simply remain silent, leaving the patient in the dark.' (Compare this with the MPS's advice to its members in
Pitfalls of Practice
: 'The MPS does not encourage members.. to retreat behind 'walls of silence'.') And: 'The medical profession perceives an action for negligence against a doctor as an attack on his professional integrity and a potential blight on his career. Backed by the medical defence societies, and aided by the skill of expensive lawyers, every opportunity provided by our adversary system of litigation may be invoked to defeat the patient's claim.' (Many individual instances of the defence organisations' 'blocking' tactics are listed in this publication and also in
, Corgi 1985. e.g. 'In 1976 Elizabeth Shewin entered hospital for a gall-bladder operation. In the course of the operation she suffered irreversible brain damage. On the advice of their medical defence union, all ten doctors involved with Mrs. Shewin refused to give evidence to the inquiry'. And: '.. a 26-year-old man, David Woodhouse, entered hospital.. for an appendectomy. He never regained consciousness and ten months later still lay in a coma. Pressure from MPs led the health authority to set up an inquiry. Again, on the advice of their defence union the doctors refused to testify. The inquiry was abandoned.' [Experts in a later investigation exposed a series of disasters in his care resulting in an out of court settlement - RE]).
What's Wrong With Your Rights?
(mid-90s publication): '.. doctors in Britain belong to one of two professional bodies, the MDU and the MPS. According to the pressure group AVMA these organisations habitually impede compensation settlements. 'In almost every case liability is not admitted by the doctor, and their societies act just like insurance companies disputing every claim,' says Derek Kartun, spokesman for AVMA. '..[they] behave callously and without regard for the victim.' Such conduct is the experience of a number of APROP members and the defence organisations' frequent statements to the contrary seem only to show hypocrisy on their part e.g.
, 2 Mar 96, letter, MDU Chief Executive Dr. Michael Saunders: 'Since the mid-Fifties, we have repeatedly advised our members to "say sorry" if something has gone wrong.. A sincere and honest apology should be made.. Doctors should not worry about inadvertently making an admission of legal liability, as this is something completely different.'
, 2 May 97, letter: 'Most patients choose not to pursue a complaint or a claim because the doctor has given them an immediate explanation and apology.'
Dr. Christine Tomkins of the MDU on
Channel 4 News
, 27 Jan 2000, following an item on negligent care of a child: "Well, I think when something tragic of this kind has happened it is crucially important that the patient should get an explanation very early.. explaining what has happened, and an apology. If it's clear that the patient has been negligently damaged, then it's in nobody's interest to drag that out."
Some might also question whether the MDU's use of Asklepios (Latin: Aesculapius) on its logo, as its Patron god, is appropriate. The summer 1986 issue of its journal describes him as 'a god of infinite benevolence who sympathised with the physical miseries of humanity'. The MDU's true attitude to patients is possibly more accurately expressed by the senior partner of its solicitors, Hempsons, who describes the public outcry over recent, sometimes fatal, instances of doctors' incompetence as only "a very unpleasant attack [on doctors] by the
20 June 2000).
The MDU's dismissive response to the solicitors of one of the listed cases (after an expert had confirmed failures), is probably typical: 'Dr. X does not accept that he has been negligent in the treatment of Mr. Y (deceased). If you wish to issue proceedings I will nominate solicitors to service.' The victim's tragedy is completely ignored in the knowledge that the victim's family are unlikely to be able to afford the law courts.
as this website shows are often willing to run short pieces, but don't usually have anything like the expertise to examine the issues in depth. National newspapers
have a poor recordpartly on Chomskyan grounds (they know better what issues are to be censored). But partly because their medical correspondents often know little, and mainly want sensation. The broadcast media
rarely have items. When they do, sensationalism is usually given precedence. Bear in mind there may be conflicts of interest, e.g. in women's magazines with cosmetic surgery ads, TV with BUPA ads, and so on. Civil servants
have proved themselves unwilling to take any action spontaneously, even when such action is required by their own rules; instead they prefer to collude with large organisations. The police:
patients and relatives frustrated by hospitals and medical authorities are turning to the police, as occurred with Ledward and Neale (and Shipman). Consumer Groups
occasionally examine this area. The National Consumer Council (NCC)
, government-funded, was set up in 1975 to 'champion the interests of consumers of all types of goods and services'. It ignored APROP members' letters from 1995; its Health Committee inquiry evidence (4 Mar 99) was superficial, subjective and ill informed, because it had not done any proper research into private healthcare. Consumers Association
, not government funded, was also invited to give evidence to the Health Committee inquiry, without having ever researched problems of clinical care in private hospitals, and will also sit on the DoH consultation group as 'patients' representatives'. Neither the Consumers' Association nor the NCC even have patient helplines. In the case of 'charity hospitals', the Charity Commission
is supposed to have responsibilities, but seem to take these lightly; even the accounting standards aren't enforced, as Richard Ennals' investigation into a nuns' charity proved. You might even try the Advertising Standards Authority
'promoting and enforcing the highest standards'
unless advertisers claim medical expertise which they don't have.
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NEWS UPDATE AND EFFECTS OF THIS SITE
Non-effects of this site:
Richard Ennals' information to
coincided with the establishing of this website.
Printouts of this document were given to Frank Dobson, former Secretary of State for Health, and (indirectly) to Anne Widdecombe, former Shadow Health Secretary, after a broadcast of BBC
(3 July 1998). A letter from Anne Widdecombe's office dated Aug 1998 confirmed that 'the Shadow Health team is aware of these issues. The material you have supplied will act as a valuable resource for our research department..' Many other printouts are in circulation.
Here and Now
accessed the website as part of the preparation for a critical feature on private hospitals. It filmed APROP's first meeting [see Links, below], and even advertised the piece in the
for Mon 6 July 1998, 7.30 pm., and other listings, but cancelled at the last moment.
article 'Higher health risks at private hospitals', 2 August 1998. A few days earlier they visited this site for information before carrying out phonebook checking.
'Perils of jumping the queue', 1000 words criticising private healthcare in the
(if you can stand this publication -RW) Tuesday 11th August.
BBC Radio 4
You and Yours,
11 Aug 1998 also featured problems of private hospital care.
Meridian TV (region SW of London) Fri 14 Aug early evening news 5 minute feature on private hospitals based on the Charalambides case; reporters had a copy.
The Consumers Association has downloaded the site as a resource for a proposed report on private healthcare. Their report is in
dated Aug 1999.
A 30 minute BBC regional TV current affairs programme on private hospitals is being planned. This site was downloaded.
Here and Now
's critical feature was finally broadcast on 14 Sept 98; APROP was mentioned but the filmed meeting wasn't shown. However, the BBC announced: .. the Government's Health Select Committee has now decided to review the regulation of private hospitals.
APROP's first new members' meetingsee phototook place on Sunday 8th November, 1998 in Victoria, London.
We hadn't perceived at first the possible overseas effects of this site. For example, it might provide some information to counter the propaganda in the US in favour of their present system.
Thanks to our many correspondents for their e-mails.
BBC Radio Kent broadcasters on the Ledward case made use of this site.
accessed this site for its 14 Feb 99 piece, 'Private clinics use suspended NHS doctors'.
, 3 March 1999, 'Crackdown demand over private hospital failures'. Journalists used the site.
BBC Radio 4
You and Yours
31 March 1999: feature on patients dying in NHS hospitals when consultants left for private practice, leaving operations to be finished by unsupervised junior doctors.
used this site for 'Botched private surgery patients take NHS beds', 11 April 1999. One of our listed cases was contacted.
22 April 1999: APROP testimony to Parliamentary Select Committee. The website was also submitted.
Channel 4 News, 29 April 1999: six-minute piece on private hospitals described the 19 BUPA-treated NHS patients and the breast cancer case of H. Carmon (see above). Researchers accessed this site.
, 22 July 1999; long article.
Some civil servants in the various health departments may have been stirred a little. After all, the situation hasn't changed for years, and they must bear some responsibility.
of Mon 20 Sept, 1999, producer Sam Bagnall. Of the 21 people listed in the credits, Ingrid Geser actually seems to have made some enquiries. Three cases were examined, but there was no attempt to examine analyse the situation or to apportion blame. Falsification of notes wasn't mentioned; neither was the cost to the public of botched operations; nor were owners and controllers of the hospitals mentioned. Statements by various hospitals seem to have been issued anonymously. The advice that the best policy may be to go to private wings of NHS hospitals wasn't given. And, despite two categorical assurances, Panorama's own website didn't give this site, but preferred to link to trade and advertising outfits. Vallance-Owen was allowed to get away with his statement about everyone being entitled to NHS facilities, omitting the point that botched operations aren't the same thing as normal illnesses. [I thought he was showing some signs of strainhe seemed a bit high-pitched-RW].
Various TV, radio and newspaper items have made use of this site. Their presenters are not always well-informed. For example, a new ploy by Barry Hassell and others of the Independent Healthcare Association (IHA) is to claim they have been campaigning for more than ten years for better regulation. This is probably untrue, but the presenters haven't thought to ask for evidence.
Spreading the word
: Richard Ennals helped advise
, April 2000, on their four-page and generally excellent article.
Concerns raised were: staffing problemsagency nurses without specialist training, RMOs on their ownand intensive care not available for emergencies. (Dr Carl Waldmann, Clinical Director of ICU at Reading's Royal Berks hospital, was quoted as saying 60 to 100 patient-days, about £100,000, each year, are taken up by private patients in this ICU. See above for details, and in Michael Caine's details for more). And insurance difficulties - even if they claim to be 'comprehensive'. Major exclusions are likely to include long-term, incurable, pre-existing and psychiatric conditions, and conditions which become more serious than was thought at first. Other exclusions may be pregnancy, optical and dental treatment, organ transplants, cosmetic surgery, X-rays, ECGs.
Emma Nicholson (see above) was interviewed; she is campaigning for the word "hospital" to be legally defined. The article doesn't mention the point about
private wings in NHS hospitals
at the end of April 2000 ran a three-page article. It outlines limitations of the NHS as well as of private hospitals.
of APROP are quoted. other cases:
says: 'Many patients opt to go private
an NHS hospital, thus being sure of proper back-up... Ask your GP to refer you to a consultant working in the private wing of an NHS hospital...'
article 7th May 2000 based on our information.
Early June 2000: GMC's 2nd hearing on the conduct of Dr Richard Neale. Graham Maloney has hired a coach for victims who wish to attend. Canadian (and other international) media attention is expected, too. The GMC is in Hallam Street.
(Spring 2000) has a short article 'Private Regulation needs Public Pressure', quoting Richard Ennals.
(23rd June) reported at length the case of Mrs Laura Touche, (related to Presidents Jefferson and Coolidge), who died after giving birth in the Portland Clinic. Her blood pressure, which in the NHS is monitored at regular intervals, was left unchecked, leading to pre-eclampsia and death eight days later. She was transferred to an NHS hospital. The article added that the coroner's verdict of death by misadventure was overturned by the efforts of Philip Havers, QC, something which occurs very rarely. Further legal action is planned.
On the 29th June,
printed the following letter from Barry Hassell, 'Chief Executive of the Independent Healthcare Association':-
This dishonesty deserves comment (especially as the Labour Government is including creatures like Hassell in its negotiations over new laws.
The assertion in your report ("Private patients face risks in 'unregulated' medical centres", June 23) that the independent healthcare sector is "largely unregulated" is far from accurate. Indeed, the independent sector is the most regulated service in health. 
Many independent hospitals now have full and appropriately staffed intensive care facilities. Where those are not in place, government regulations require agreements with NHS hospitals to facilitate transfers in the event of unexpected complications. 
We welcome the fact that our ten-year campaign to see better regulations is currently bearing fruit in the shape of the Care Standards Bill. The independent sector is one of the key drivers of this reform and supports the principle of better regulation. 
The independent sector makes a major contribution in delivering high-quality care to patients - both privately funded and on behalf of the NHS, as the Government itself has recently recognised. 
 The total private sector includes psychiatric and nursing homes, cosmetic clinics, private dentists, eye clinics and so on; collectively they have a great deal of miscellaneous regulation. BUT private acute hospitals (which carry out operations), as we have documented, don't.
 Hassell attempts to give the impression that 'intensive care facilities' resemble Intensive Care Units of the NHS type, with one-to-one 24 hours/day nursing. In fact, private hospital IC facilities are mostly only for post-operative supervision. 'HDUs'=high dependency units are not for emergencies. (See for example the Michael Caine case, when no there were no trained nurses). As for 'regulations for transfer', these are
by the Care Standards Bill.
 If the private sector has sent a few letters, they have remained unpublicised. The private sector's public statements make no reference to their supposed desire for reform. Their letters after deaths or accidents, and defensive quotations in the media, of course make no mention of any of this. And they showed no sign of unhappiness with the looseness of the Registered Homes Act. Their statements to the Health Select Committee miss out all references to accidents and deaths. The U-turn probably came about through adverse publicity of the Emma Nicholson type, and perhaps through APROP etc. In short, the 'key drivers' claim is a deliberate lie.
 As we have documented, the care is not 'high quality'. The Government recognise the private sector, but only conditionallyproviding it meets acceptable clinical standards (and value for money) if it can do so. It remains to be seen how and whether high standards might be enforced. Mr Hassell naturally gives no indications on this front.
(Sunday 13th Aug 2000): long (half-page) article by Nick Cohen,
Perils of going private: The rich may do it, but go outside the HNS and you enter a world of corruption and greed
. This website address was included.
BBC collection of about fifty similar emails and letters
. (Total response size not given by BBC).
Date: Mon, 14 Aug 2000
An interesting Web Site. I found it following the article
Perils of going private
in the Observer, 13 Aug 2000.
I read it with particular interest as I am at this present moment the RMO on-call at one of London's Private 'Clinics'.
I see my position in this job as a 'necessary evil'. A number of us are obliged to work in such places to fund our NHS researchsomething as trainee surgeons we are rail-roaded into doing.
One reads the accounts on your site, but as you accept, this is merely the tip of the iceberg. Many 'Customer' slip off home unaware that their treatment is sub-NHS standard, and that their recovery has been more luck than judgment.
When I started this 1 year contract 10 months ago hardly, I could recount a frightening event for almost every 24 hour session I worked. Having said that, discussion with other colleagues doing similar work in other places, show that there are a lot worse places. I initially dreaded coming to work, worried about what dilemma I might be faced with; observing sub-NHS treatment being carried out with no ability to intervene on my part. I am obviously allowed and capable of instituting my own treatment under life threatening situations but otherwise all other treatment must be carried out by the Consultants. These consultants are not necessarily bad doctors, they are making out-dated treatment decisions on areas outside their expertisedecisions which would be made by their junior team in the NHS whom are more in-tune with current treatments for general conditions.
When I say 'frightening events', I do not mean imminently life threatening blunders, I mean omissions that if a junior was to do the same in the NHS they would be reprimanded by the team.
I find it surprising that there is relatively so little adverse publicity concerning the private sector. The public still flock to these places and see them as the 'Gold Standard' of medical care. Perhaps it is not so surprising when you talk to medical students, whom you might think had some insight into the pros and cons of Private Hospitalsso many of them think the level of care must be excellent as it is being paid for. If they see the system through such rose tinted spectacles what hope have the un-initiated public!
For my own part, I hope that I have helped initiate some safer practices in this work place and will hopefully be more aware of the limitations when I too am one of those consultants working in such hospitals. However, I feel, as you suggest, that the way forward is private wings in 'proper' hospitals were the appropriate skill mix is on tap 24 hours a day. Sadly with the 'buying up' tactics of some foreign companies who clearly have profit margins forefront in their minds, such units are likely to disappear rather than proliferate.
RB (MBBS FRCS)
early 2001 UK edition has an article by Judy Jones,
Private Hospitals Can Damage Your Health
, recommended by Richard Ennals.
In our quest for publicity, we have e-mailed a number of serious-seeming health journals and newspapers. No responses received from:
[Back to Start]
'International Journal of Health Care Quality Assurance'
'Health Services Journal'
'European Journal of Public Health'
'Qualitative Health Research'
'Journal of Integrated Care'
Ian Murray, medical correspondent, 'The Times'
LINKS TO OTHER ORGANISATIONS
[Back to Start]
A campaigning group, Action for the Proper Regulation of Private Hospitals (APROP) has been formed. This is not APROP's official website, though one has been discussed. Dissatisfied patients and relatives may e-mail APROP
by clicking here
, or may contact: APROP, PO Box 418, Weybridge, Surrey KT13 0FJ. APROP has had publicity in
Here and Now,
The Sunday Times,
Healthcare Market News,
newspaper group, BBC Radio 4's
You and Yours,
, and other media. Click for
APROP's official memorandum to the Select Committee
. The testimony of
APROP's founder members
including John Lambie, Caroline Buckley, Samantha Ryb, and Graham Maloney is here. Richard Ennals felt unable to testify because of legal threats, unaware at the time that the proceedings are privileged.
Oral Evidence for the Parliamentary Select Committee on Health, which is investigating this subject, is on the
Health Select Committee Website
of the House of Commons. You may well find the arrangement of subjects and dates confusing.
This site has the
; and this is the submission of the
National Consumer Council
Some APROP testimony is listed above. And you may like this
concise summary of NHS/private sector differences
Minutes for 25th March are transcriptions of oral evidence by the heads of the Independent Healthcare Association, BUPA's hospitals, the General Healthcare Group, Nuffield Hospitals, and Community Hospitals Group. (Each also supplied at least one memorandum; these too are on Internet). Their oral evidence strategy was evasion and the infliction of acuteor rather chronicboredom. [-RW]
if you'd like to see. Possibly, however, their approach will not go unnoticed. More recent minutes record the views of medical witnesses.
AVMA, Action for Victims of Medical Accidents (specific to Britainno connection with American Veterinarians) founded 1982, 44 High Street, Croydon, CR0 1YB, submitted an excellent memorandum to the Health Select Committee. Click for
We hope in future to have information on groups involved with cosmetic surgery, and with private psychiatry.
APRON ('Action for the Proper Regulation of Nursing') may be formed, for those who have complained without success to the UKCC. Another critical examination is being considered of medical defence organisations and defendants' law firms. Websites may follow - RE.
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