Proper Gander – Going public about going private

There are several connotations with the word ‘private’, in relation to ‘private hospitals’ or ‘private healthcare’. The description means that they are privately owned companies with the purpose of generating profits for their shareholders, with medical treatment as the product they sell. The word ‘private’ also suggests that these hospitals are select, and separate from the NHS and the majority who use it. This isn’t always the case, as shown in Panorama’s investigation NHS Patients Going Private: What Are The Risks? (BBC One). The word ‘private’ also implies being reluctant to reveal too much, so the documentary was of some use in highlighting issues which private hospitals would sooner be made less public.

One of the symptoms of the ailing NHS has been increasing delays for treatment, with more than six million people in England in the worrying position of coping with a worsening condition while they wait their turn. In an effort to reduce the length of waiting lists, some of these patients have been referred to private hospitals for surgery, with the costs paid from NHS funds. In 2023 around 800,000 NHS patients were handled by private hospitals in this way. Many of these went to one of the 39 hospitals run by Spire Healthcare Group plc, the second-largest private provider in the UK. Since 2021, Spire has treated more than half a million NHS patients, contracts for which have made up around 30 percent of its revenue. Reporter Monika Plaha looks at two aspects of how Spire runs which have had a devastating effect on some of its patients: staffing and arrangements for dealing with emergencies.

Spire’s management of its staff was questioned after two surgeons they employed were separately exposed as dangerously incompetent. Since then, concerns have focused on low staffing levels, especially at nights and weekends, and how alert people can be during back-to-back shifts. Resident doctors have been contracted by Spire for up to 168 hours a week including nights on call, whereas doctors’ working hours in the NHS are capped at 48 a week. Almost all the ex-Spire doctors interviewed for Panorama were worried about the consequences of their high workloads and protracted shifts. Hiring insufficient numbers of staff is one of the most obvious ways of minimising costs to maximise profits, regardless of the more obvious risks to patient safety. For the documentary, Spire provides a bland statement that it now has ‘robust safeguards’ and resident doctors only work ‘when adequately rested’.

The programme also describes failings in how private hospitals have dealt with complications during surgery, whether suffered by referred-in NHS patients or those paying directly. Most private hospitals don’t have intensive care or high-dependency units, so when a patient’s condition deteriorates or a procedure fails, they have to be transferred to an NHS hospital for emergency treatment. Moving a patient during a crisis carries risks, made worse by having to rely on an ambulance which could take hours to arrive, even when the hospitals are close to each other. The programme features interviews with people who have tragically lost loved ones due to complications which Spire hospitals couldn’t cope with and which weren’t dealt with by an NHS hospital in time.

Private hospitals don’t have facilities to deal with crises because they tend to treat medical issues less likely to have serious complications which require care in a high-dependency unit. And they tend not to deal with high-risk operations because these come with additional costs for specialist surgeons or equipment, and would therefore be less profitable. In other words, patients with complex conditions aren’t financially attractive. As Sally Gainsbury of the Nuffield Trust points out, around a third of NHS patients have health issues too complicated to be managed in private hospitals, so they must wait longer for NHS treatment. This is exacerbating a two-tier system where healthier people can be treated quicker privately. One way of reducing this disparity would be for private hospitals to have adequate intensive care facilities, avoiding the risks with transferring patients back to NHS hospitals in emergencies. But this requires investment, raising costs which will mean that fewer people will be able to afford private treatment, whether funded through the NHS or not. So far, private healthcare organisations like Spire have been reluctant to invest in facilities for crises, or sufficient numbers of staff. Despite this, and the criticisms made of it, Spire is aspiring to carry out more complex procedures and have longer-term contracts with the NHS. This isn’t with the aim of helping out the beleaguered ‘public’ sector, but to extend its market share. Last year, Spire’s profits increased by over 30 percent to £126 million, and any expansion will be guided by what’s likely to generate further profits rather than by meeting need.

Reformists call for the NHS to have more funding so it doesn’t need to refer patients to private hospitals, but there will never be enough money for the utopian NHS they want. Even if a government wanted to adequately fund the NHS, other economic imperatives would prevent this, especially the need for profit which guides the system overall. The ‘public’ ownership of the NHS means that it isn’t directly profit-driven, but it still has to survive in the profit-driven system, alongside and inter-dependent with private healthcare.

Every day, skilled and dedicated staff in NHS and private hospitals perform life-saving operations which would have looked like miracles just a few years ago. Somehow, they carry on despite the obstacles put in their way by the system they work in, such as the routine of long shifts in understaffed wards because this minimises costs, or having to gamble on surgery being straightforward because other hospitals with facilities for dealing with crises are overstretched. Trying to overcome these obstacles with reforms or revised contracts or reallocated funding is a never-ending struggle because this approach can’t change the system which creates the problems. It only addresses the symptoms without curing the cause.

MIKE FOSTER

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