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Private vs public healthcare: Who is accountable when it goes wrong?

  • ITV News Health Correspondent Emily Morgan explains reason behind the inquiry

Going "private" is better right?

Paying for healthcare means you get top dollar service, better clinicians and good food in hospital.

That’s what we all really think isn’t it? It’s like flying first class. Come on, admit it, private treatment is better than the public service.

Or is it?

The belief that private healthcare will always offer better, quicker treatment is of course a misnomer.

Yes, we pay; yes, we get a private room; yes, the waiting times are shorter and, yes, the food is arguably better but why is that?

Because the private sector is a business.

It wants you to come back, to taste that luxury again and feel like you’re getting better care. The thing is the treatment, the clinicians and the care are the same and some would argue not nearly so good.

The hospital at the centre of the surgery scandal. Credit: PA

Why do I say this?

Not out of some sort of hatred for profit-driven business models but because many people argue there is undeniable evidence that private care is allowed to operate differently to public care and not always in the best interests of the patients.

I’ll give you an example. The Centre for Health and the Public Interest claims that post-operative care is carried out by a junior doctor, and one who is working 168 hours a week without supervision.

It says the consultants, who carry out the surgery, do not hang around to look after the patients afterwards but disappear home, some might live 45 minutes away.

The Royal College of Surgeons recommends no consultant should be more than 30 minutes away. It also argues the lack of intensive care facilities means patients who become very ill end up having to be transferred to an NHS hospital, the travel can make the patient even worse.

Victims Tracey Smith (left) and Debbie Douglas were instrumental in getting the public inquiry established. Credit: PA

Indeed private hospitals are businesses but like the NHS they too are regulated by the Care Quality Commission.

In 2018, though, a report by the CQC into the independent sector was scathing.

It found two in five private hospitals were failing to meet safety standards.

In particular it raised a major concern into the lack of effective oversight of consultants "working" for the hospital but not formally employed by them.

It also said there was not enough reporting of serious incidents or transparency when something went wrong.

This led to the Health Secretary writing to all private hospitals demanding changes. But very little has changed.

And this brings me to Ian Paterson.

  • Watch the inquiry findings into the disgraced breast surgeon:

This horrific case simply highlights the lack of transparency and accountability in the healthcare system. Mr Patterson worked independently, the private hospital he worked at did not employ him (clinicians are effectively freelance) and he had his own insurance.

So, when something went wrong, as it so cruelly did, the hospital was able to claim it was not liable (though Spire healthcare has paid out some damages to some patients as has Mr Paterson’s insurance company, but the victims had to fight tooth and nail to get it).

Private hospitals allow doctors to work under "practising privileges", they do their own thing, unsupervised.

The Independent Healthcare Providers Network, which talks for the private sector, concedes that changes need to be made.

It says there needs to be better information sharing between the NHS and the private sector. And indeed it does.

  • David Hare, Chief Executive of the Independent Healthcare Providers Network, says the NHS and private providers need to work to "improve the joins" between the two.

But will it happen?

On Tuesday, the inquiry into how Ian Paterson was allowed to practise the way he did for so long, unchecked is pretty damning.

It says the healthcare system was dysfunctional at every level when it came to keeping patients safe. It goes on to say patients were let down by both the NHS and independent providers. The NHS then is not off the hook.

The report states some staff at the NHS Trust that employed him must have known about his practices and didn’t report him, others may have suspected but also didn’t report him.

  • Ian Paterson was asked about his motivations before he was jailed in 2017

The fact is, there was no transfer of information and the inquiry has called for the creation of a central list of consultants key performance data for patients to check.

It also, importantly, calls for better regulation of insurance protection for patients as a nationwide safety net.

Essentially that means there needs to be parity in liability in both the public and private sector.

Rt Rev James said there has 'not been a single change to regulations which would prevent another Paterson'. Credit: PA

What matters now is that the recommendations are acted on. The Government must insure both the NHS and the private sector change.

It has said it will act quickly on the lessons learned and that to me seems elementary given the report author warned on Tuesday that based on evidence from clinicians something similar could happen again.