Recent reports in the national press suggest that private hospitals are not all they are cracked up to be. Criticism centres on a perceived lack of resources and back-up staff which are readily available in the NHS.
Selected cases have been highlighted, shedding an unfavourable light on the level of patient care in the private hospital sector. But can this seemingly incontrovertible evidence be substantiated? And, if ‘ so, should intermediaries be recommending that their PMI clients go into privately-run wards in NHS hospitals?
There will inevitably be incidents where the health service, be it public or private, fails the customer. And private hospitals which fail are bound to hit the headlines.
Individuals paying for peace of mind want to be secure in the knowledge that diagnosis and treatment will be swift and efficient. This is summed up by the promotional literature of many insurers, including BUPA’s LocalCare policy which promises “you can count on prompt medical cover for both in-patient and outpatient care at any one of a network of convenient hospitals.”
But it only takes one piece of adverse publicity to damage the reputation of private care as a whole.
A key criticism levelled at the sector focuses on the training of nurses in private hospitals. Newspaper stories claim nurses are not fully able to deal with a variety of specialist tasks. A lack of facilities, particularly in intensive care units, is stressed. Not to mention the allegation that patients in private rooms are ignored.
Tim Baker, commercial director of Norwich Union Healthcare, hits back at these accusations. “My experience has always been of a high level of service at private hospitals. The nursing staff are well trained and most hospitals have some form of intensive care. And there are medical officers on call. I don’t see any need to be alarmist.”
Baker goes on to detail the systems in place. A chief advantage of PMI is the access to the consultant. Patients are more likely to see a top specialist rather than the registrar, and this presumably reduces the risk of anything going wrong.
He adds that the consultants are highly qualified professionals who put their reputation on the line if any mistakes occur.
Furthermore, it is widely recognised that not all hospitals can offer all services. Most have arrangements in place with the local NHS trust for emergency procedures. And this happens across both sectors. Baker describes it as “relatively commonplace.”
He emphasises the huge amounts of money that many private hospitals have invested in technology to ensure excellent levels of practice.
It is these high standards that are under constant scrutiny, despite what certain members of the press might say. The Registered Homes Act 1984 is the only piece of legislation that brings private hospitals to account but it is indispensable.
Basically, this law means that the local health authority is empowered to inspect the hospital twice a year. Barry Hassell, chief executive of the Independent Healthcare Association, which represents private healthcare providers, says that private hospitals are the only hospitals which are vetted. He remarks that if the health authority wants to close an institution down, it can.
It is also safe to say that an insurer would be very reluctant to be affiliated with a private hospital which had been investigated for medical malpractice.
The crux of the issue is the Government’s policy on healthcare and its attitude to private hospitals. It would appear that the Labour party has performed a U-turn on its view of the private sector and its commitment to the NHS. Previously it was thought the party would come down hard on private medicine.
Sources close to Frank Dobson, the Health Secretary, said only recently: “They [Department of Health] don’t care about the private sector. If you want to go private, that’s your affair.”
Quite how Dobson and his colleagues can distance themselves from the private sector is a cause for concern.
The NHS is under no obligation to publish an audited account of its expenditure on private units within its hospitals. As the table below demonstrates, the amount of revenue is no secret. But without the corresponding figures there is no comprehensive analysis of the impact of private business.
Hassell says that the NHS could even be subsidising the work of private insurers. Who knows how much money is being spent on private wards? And the fact that NHS hospitals are committed to maintaining private wards is at odds with the government’s promise that the NHS will be non-commercial.
The IHA’s report on Independent Perspectives on Health and Social Care, published in 1996, calls for public accountability for the actions of health and social services provides: “The next government should enforce the existing treasury rules on commercial activity by public bodies. Further, NHS Trusts and Local Authorities should be obliged to publish separate audited accounts of their commercial activities so that the public is aware of what is being done with taxpayers’ money.”
The issue of pay-beds in NHS trusts cannot help but be contentious. But are they a preferable alternative for someone seeking to buy PMI? As the table confirms, the number of private units and beds have increased dramatically in recent years. This cannot be solely attributable to dissatisfaction with privately-run hospitals. A primary factor is the conscience of the patient. Although the adage of `queue-jumping’ is fairly old hat, vestiges still remain. Paying for a bed in a NHS hospital is a way of assuaging the guilt for buying PMI. The thought is paramount that the NHS benefits intrinsically and financially from `leasing out’ beds.
David Potter, director of private health insurer OHRA, relates how his GP praised him for choosing to go private. Once Potter was paying for his treatment, his NHS bed could go to someone without similar personal means.
And of course, private patients continue to contribute to the welfare state through National Insurance, even though they are not taking advantage of its facilities.
But while private units may not necessarily be a strain on NHS resources, Hassell has an important point to make.
Hassell believes the burgeoning number of pay beds has led to increased waiting times for NHS patients and adversely affected the service the public receives. He cites two statements by the British Medical Association to underline this: “increased private insurance would create unequal access to health care and turn the NHS into a safety net for the uninsured,” and “greater concentration by trusts on generating pay bed income could lead to a wider public perception of a two tier service.” Hassell belives that private hospitals are a better solution and if these were used entirely, it would give the NHS more resources.
While there are good and bad points to make about the merits of private hospitals and private units with the NHS, it all boils down to patient choice. It is clear that buying PMI does not exclude the customer from using the NHS as well.
PPP is in the process of rolling out a network of hospitals and is asking hospitals in each region to tender for their business. These include BUPA, individual-owned, charitable and NHS private wings. They anticipate over half of their 1.8 million customers will soon have the choice of an extra 25 approved PPP hospitals.
Norwich Union Healthcare has also developed Trust Care Starter which covers the costs of treatment and care within the independent sector of the NHS. They state that “while you benefit from lower premiums, the NHS benefits from valuable additional income.”
The bountiful number of polices available do not provide a solution to the private hospital versus private unit debate. But they illustrate that the central philosophy of PMI is alive and well: the ability to choose your own healthcare.
So perhaps the question for the intermediary should not concern the safety of private hospitals but concentrate on explaining the quality of choice for the consumer. Customer Services Manager Liz Hammond, of Cheshire-based Private Medicine Intermediaries, voices the views of many intermediaries when she calls for a complementary relationship between the NHS and the private sector. She emphasises an intermediary’s role is to give the client the best possible advice which is most relevant. Advice will of course depend on what stance the government decides to take on the private sector.
Whatever happens, those responsible for private hospitals will continue to insist they are well worth the money and offer care which is second to none.