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Joachim Stanley considers the advantages and disadvantages of private healthcare and NHS healthcare, including the differences if you are considering bringing a clinical negligence claim.
In comparison to some media reports of the NHS, private healthcare appears to be a panacea: it doesn’t lurch from crisis to crisis (at least, rarely in a newsworthy fashion) and neither is it beset by industrial action. Waiting times are minimal, and you can generally be seen by a consultant. However, private healthcare is not without its own problems, some of which are serious enough to give rise to clinical negligence claims. In this article, I will briefly review some of these.
If you undergo surgery in a private hospital, it is very likely that your operation will be performed by a consultant, and not a trainee. There will be a scrub nurse present and an anaesthetist – probably also a consultant.
With such a quantity of expertise, what could possibly go wrong? If the operation is routine, then the answer could well be “not that much”. The procedure is likely to be very familiar to the surgical team, and one would hope that any points of concern in your presentation would have been addressed by a full diagnostic workup.
However, if complications arise (and particularly if these have not been anticipated), then that assessment could change dramatically. In this respect it is generally NHS hospitals which have the advantage because if unexpected things happen, then appropriate assistance is usually just down the corridor.
Complications of surgery can be complex and may well necessitate a stay on an Intensive Care Unit. For this reason, if and when they occur, many private patients will need to be blue-lighted to the local NHS hospital that they’d decided not to go to.
One perceived benefit of private healthcare is the relative absence of “red tape”. There are not nearly so many forms to fill in, and in theory, that leaves your treating clinicians with more time to care for you. This is true – up to a point.
Since the 1990s, the NHS has increasingly modelled its internal procedures on the airline industry. The frequent and rigorous checks are there primarily in order to avoid “near misses” and mistakes. Because those checks are not always implemented in the private sector, it is proportionately easier for oversights to happen: for example, errors in medication are more likely in clinical situations in which drug charts are not routinely reviewed, and a requirement to keep a clear written record frequently produces hidden benefits, such as providing a clear record of events for colleagues who subsequently give treatment.
As an example, I have acted for a diabetic patient with hypertension in a claim relating to alleged negligence during surgery which was carried out privately. On reviewing my client’s medical records it appeared he had been left without the anaesthetist’s help during his operation. The computerised anaesthetic chart showed that my client had become profoundly hypotensive (his blood pressure dropped to dangerously low levels), and this was not corrected until, belatedly, it became obvious that something was badly wrong. It was very difficult to work out precisely what had happened from the notes, but it was apparent that, for whatever reason, the anaesthetist had left the operating theatre, and had not come back for a significant period of time. In an NHS hospital, where the anaesthetist would have been expected to complete a chart manually, it is very unlikely that this could have happened.
In the same way, omissions such as a failure to do a full diagnostic workup prior to surgery are arguably more likely to happen in an environment where rigorous working practices are not uniformly enforced.
The thought of your own room in which to convalesce is an enticing one. The alternative is a bed on a ward, with other patients, little privacy, and less sleep. Surely you will recover more quickly with minimal disturbance?
Well, yes and no. In NHS wards the patients are typically within eyeshot of the nursing bay, so if a patient unexpectedly deteriorates, then help is to hand rapidly. Generally, the higher risk the patient, the nearer the nursing bay s/he will be put. If you are in a private hospital, it is unlikely you will be left entirely to your own devices, but equally, people will probably only check up on you periodically. .
If something goes wrong with treatment provided in an NHS hospital, then the patient will generally pursue their claim against the NHS Trust responsible for the hospital on the basis that they employ the clinical staff involved in the treatment and therefore are liable for their acts or omissions in providing care.
In private healthcare, Consultants are generally not employed by the particular private hospital. If you wish to pursue allegations of negligence against a private Consultant then you generally have to bring a claim against them directly. In the majority of cases this causes no particular issues as the Consultant will have appropriate insurance. Problems can sometimes arise however if the Consultant has since moved on or retired, and cannot be traced. For this reason if you do have concerns about treatment you have received, it is important to seek advice at an early stage.
If your allegations relate to nursing care provided in a private hospital then your claim will be made to the private hospital, as employers of the nursing staff, in the same way as it would in an NHS hospital.
If your claim includes allegations relating to care by nursing staff and the Consultant, then you would likely need to pursue it against two Defendants, which can sometimes be more complex.
Ultimately, as with most things in life, there are advantages and disadvantages with different types of medical care, whether NHS or private healthcare, and it is important that patients consider these if faced with a decision as to where to seek treatment.