The London Heart Hospital is the brainchild of eight consultant cardiologists. Although existing heart facilities were adequate at the time of its conception, they believed that drawing all the necessary services under one roof would cut costs, and, more importantly, endow London with a centre of cardiac excellence on a par with heart facilities worldwide.
There was a certain amount of excitement as plans turned into action, and soon the idea gained serious support. Singapore-based Parkway Group Healthcare, already owner of a hospital group and interested in founding a flagship establishment, agreed to fund the project.
Planning began, with the aim of developing a site on Wimpole Street, near Harley Street, the centre of medical excellence in Britain. The hospital was to be furnished with 95 beds, four operating theatres and three catheter laboratories, in addition to an adult and paediatric unit.
But achieving these aims proved to be far more difficult than had been anticipated. Particularly when objections were raised. One such came from Columbia Hospitals, owner of the nearby Harley Street Clinic.
Sir Richard Needham, chairman of the London Heart Hospital, explains: “Columbia tried to use the planning process to delay it, which showed how disturbed Columbia was by the introduction of anew competitor.”
While Needham implies planning objections were intended to hinder the building of the Heart Hospital, Columbia Hospitals disagrees. “When the Heart Hospital was going through planning a number of hospitals, including Columbia, raised objections. This was due to factors such as car parking and road access,” says a spokesman for Columbia. “It was not exclusively Columbia and it is not a long-standing vendetta.”
Halfway into the building of the Heart Hospital, according to Needham, the second obstacle appeared. In January 1997, PPP purchased 49 per cent of Columbia Hospitals. “The consequence of the investment was inevitably designed to try and ensure that PPP patients went to PPP-owned hospitals. Otherwise, why do it?” Needham asks.
Even now, discussing these events leaves Needham irate: “We were left with the position that one half of the partnership had done everything to delay us and the other part of the partnership, now owner of hospitals, made it perfectly clear to me that they were not going to allow us onto their network.”
PPP has stated and restated its reasons for excluding the Heart Hospital from its network list. Adrian Bull, medical director at PPP healthcare, says that the Heart Hospital “does not meet the needs of PPP healthcare customers on the grounds of quality, range of services and value” when compared with the network facilities.
Needham feels that this is an inconsistency. For although Bull states that the Heart Hospital was inadequate in terms of quality for PPP patients, Needham points out that PPP customers have been patients at the hospital.
“Why has PPP accepted quietly that at least 20 of its patients demanded to come to the Heart Hospital, and paid?” Needham asks. “So is it good enough for PPP’s most important patients, but not good enough for the ordinary humdrum person with an ordinary insurance policy?”
Furthermore, Needham asks why the London Heart Hospital is good enough for other insurers, but not for PPP? Surely, says Needham, the issue of not meeting the necessary standards is a spin-immersed excuse.
According to Needham, Bull’s reasons for turning the Heart Hospital down were invalid. “If he turned it down, why didn’t BUPA? Why did every other insurer not turn it down? Why does the NHS use it?”
PPP is quick to disagree with Needham’s allegation. “Customers can benefit from our network proposition and be confident that they will receive high quality care,” says Emma Grainge, public relations officer for PPP. “They are also covered for treatment in hospitals that are not part of the network in those rare and exceptional cases where the care they require is not available from a nearby network hospital. Alternatively, they can choose an insurance option that provides cover for treatment at any hospital.”
Methods of measuring the standards by which a hospital is included on PPP’s network list, are, in Needham’s opinion, the fundamental problem. “PPP has to determine which are the very best hospitals in a transparent, above board way and then say on what grounds it is going to use those hospitals,” he argues.
Needham contends that if there are no clear guidelines issued by PPP, no hospital can ensure its premises fit PPP’s requirements. “Adrian Bull has not published the criteria or the parameters on which he determines which hospital is in or out of his network,” he says. “There is no transparency, there are no Chinese walls between Adrian Bull’s insurance side and PPP’s hospital side. It is a blatant attempt to manipulate the market in favour of PPP and Columbia.”
Yet, according to PPP, its 60 page questionnaire, covering everything from management to medical services, is an extensive means of quality assessment. “We select hospitals for our network by means of competitive tender in each town or local market where more than one private hospital or NHS private wing exists in competition,” says Grainge. “This includes a full assessment of facilities and services by a team of healthcare professionals.”
And Bull argues that the network scheme is an imperative strategy that, ultimately, will save an ailing healthcare insurance market. By channelling its patients into fewer premises, it is able to manage costs and budget more effectively. The network system is therefore a perfect method of cost control.
And, yet again, the recurrent feature of the network debate comes back down to occupancy levels. Many claim that private hospitals in the UK operate with an overspill of vacant beds. This leads to increases in hospital charges which may directly correlate to a reduction of patients. Insurers hope that by limiting the number of accessible private beds, there is a higher probability that maximum occupancy levels can be maintained.
But, despite this, the network method fails to address one issue that has always affected private hospitals: the NHS. Because most consultants and surgeons work for the NHS, their private work has to be carried out in their own time. “Operations in the private sector tend to happen at certain times of the day, on certain days of the week. So how can you get total through-put?” asks Needham. “Our problem with running a hospital like this, as it has always been, is that such facilities run in circuits – doctors can only work at certain times.”
He continues: “Bull is trying to say that some of these hospitals have unacceptable down time which means that costs increase. So does he say that the Harley Street Clinic will be operating 24 hours a day, seven days a week?”
Before the debate arose, however, Needham did not raise any objection to insurers utilising their network systems. So is this all sour grapes? Is he simply annoyed that his hospital has been excluded? Perhaps then, he actually agrees with the ethic essential to networks?
“No I don’t. Where I fundamentally differ is that I do not think you can be judge and jury in your own case.”
And, contrary to public opinion, Needham does have a certain amount of sympathy for the insurer’s position. “The insurer has to make a return. The reason they are losing money is not the cost of the hospitals, you will always have hospitals with empty beds. You need to find ways of attracting patients to pay subscriptions for much longer than they have in the past.”
Perhaps this is why Needham is reluctant to join an official action group against the development of networks. “The problem is,” he says, “if you are not careful you look like a self-interested cartel facing another cartel.” So far, it appears that Needham has gathered a fair amount of support. The press coverage of the affair, which fell strongly in Needham’s favour, was followed by BBC’s Watchdog report, also raising questions about the network system.
And, more recently, while the OFT quietly continued its enquiries into networks, Alan Duncan, the shadow health minister, publicly criticised conduct within these systems, stating that it “is cause for profound concern”.
The future of the Heart Hospital remains to be seen. But even if the series of impending meetings between PPP and Needham’s allies does not deliver a favourable result, Needham has raised questions about the conduct of some of the UK’s health insurers. Questions that could leave many others with raised blood pressure until the issues they relate to are resolved.