Private Health Care
Now
there are a lot more people witching to the private
health care. The independent hospitals and clinics made
£2.26bn in 2001, which is only 11 per cent up
from the last year. Despite the fact that we have care
under the NHS universally, but still they turn to the
private sector, some because the treatment they need
is not necessarily on the health service or they May
have to wait a long wait.
So
that the NHS can deal with the long waiting lists
the NHS is going to the private sectors, mainly for
the operations, like the cataracts and operations.
Now the Government has proposed some diagnostic and
treatment centres, these are designed to cut down
the waits for surgery, in which they will firstly
be set up and run by the private companies.
However,
if go private you may not always necessarily be getting
better or safer care, which has been highlighted over
the years by the Consumers’ Association (CA).
So theoretically all the private sector is, is just
an extra to the NHS, due to it not having all the
full range of health services that the people need,
like the emergency treatment.
It
has been discovered that the CA has petitioned hard
so that a body can be set up, for the quality standards
and regulations to protect the private patients. For
it is difficult for lay people to see if the care
that they are receiving is up to scratch clinically.
So the new National Care Standards Commission (NCSC),
launched by the Government, which has been highly
welcomed, the NCSC will then control the private and
regulatory health care in 2002. Now only after a year,
have they made a difference? And what else still needs
to be done to improve the protection for the patients
that use the private medicine.
Problems
with the Private Health Care
There
is now a major concern over the private health care,
as to whether it is the profit motive of the providers
that occasionally takes over the clinical judgement
or advice. For an example, on the laser eye surgery
and the cosmetic operations have been discovered that
the clinics have given bad advice and the underplaying
the risks of the surgery.
The
peoples' and the patients perception, of the standards
that they expect from the private sector, is to be
ranked up their with the NHS hospitals if not higher.
And the people that has the cosmetic surgery said
that they thought that the market pressure would make
sure that the commercial operators would be trustworthy.
However
the care that you get from the private sector can
be very difficult from the NHS. But the independent
hospitals hardly had any specialist overnight medical
cover; usually the 24 hour cover is from the GPs or
the registrars instead of the consultants.
Another
section, in which, the private and the NHS are different.
For it has been said by the health care analyst William
Laing of Laing and Buisson has said that the intensive
care provision was lower in the independent sector
due to the ‘private hospitals don’t do
emergency work’ but also said that ‘they
will have sufficient (cover) for the requirement’.
Also
any surgery that is done under the general anaesthetic
can lead to unforeseeable complications, like blood
clots for example. But even the intensive care units,
intensive therapy or the high dependency units, of
which are available through the private hospitals,
could be staffed by the specialist nurses than in
the NHS. Likewise lots of the private maternity units
don’t have the back-up of the special care baby
units.
So,
if there is an emergency or a problem that arises
in the private sector, then normally the patient will
be transferred to a NHS hospital. For one surgeon
has said that ‘You go to the private hospital
to be looked after and the NHS hospital to get better.’
Looking
after the patients
As
the NCSC controls the private and voluntary health
an social care in England, like with the similar bodies
in Scotland and Wales, the NCSC has got together some
services that had never been looked after before,
this includes the doctors that work only in the private
sector, along with the private and voluntary hospitals
and clinics and the nursing agencies.
The
NSCS is Newcastle based and it goes through five regions,
of which is closely guarded to the NHS Strategic private
health care that is concentrated in the capital and
in the South East.
As
usual after only a few days of the NSCS operating,
the Government has decided that in April of next year
it will be got rid of, in which it will be replaced
with two new ‘super-regulators’. The Commission
for Health Audit and Inspection (CHAI) will look after
the NHS, private and the voluntary sectors. The Commission
for Social Care Inspection will regulate the nursing
homes for the elderly people.
Already the NSCS has had to use it powers under the
regulations, that range from the refusing of an application
to prosecution and cancelling of registration, as
it shut down two Lifeline clinics that sell the single
measles, mumps and rubella vaccines in Elstree, Sheffield
and Hertfordshire. The Lifeline was breaking the law,
by which it was failing to register the clinics, and
the NCSC also put an allegation to a company of providing
‘faulty immunisations’ of which left the
children unprotected. The Lifeline has since applied
to register the Elstree clinic.
Hospitals to Beauty Clinics
The NCSC has even reported a doctor to the General
Medical Council (GMC). The Anaesthetist Dr Kenneth
MacLeod was censured at the inquest over the death
of Tracey Sampson, after she gave birth at the famous
London’s Portland Hospital. In which the Dr
MacLeod denied that he acted inappropriately and the
inquest was recorded an open verdict. Also the NCSC
criticised the Portland for carrying out double the
average number of Caesarean sections and of a lack
of clear policies that referred women in labour to
a consultant in an emergency.
Now all of the private and independent hospitals have
to register with the NCSC. This will cover the establishment
from the little hospitals the offer intricate surgery,
to psychiatric and maternity hospitals, hospices etc
along with the, many ‘beauty’ clinics
that will offer you laser and pulsating light services
for cosmetic treatments.
All this will add up to nearly 2,000 hospitals and
clinics that have to be inspected every year to make
sure that they are following the national standards
and regulations. So, by April of this year, the NCSC
had inspected all of the acute units and 80 per cent
of all the mental health units. In this registration
and inspection system, its aim is to have safe, high
quality services and putting the patient safety and
quality assurance first.
Now that the NCSC ahs got regulations, standards and
policies of which clearly state the basic practises
and procedures that the clinics and the staff must
follow to make certain that their patients have a
safe and get the right care before, during and after
their treatment. The detailed standards covet things
like the employment procedures, infection control
and complaints.
Some of these standards that are being set for the
first time have the aim to take care of the problem
areas. Say, for example that of the doctors now has
to agree a time limit for reaching the hospital if
there is a patient, which is in difficulty, along
with conforming to the organisational policies, like
the complaints procedures.
Now all of the healthcare professionals that are working
in the private sector no have to have indemnity cover
(professional insurance) for the first time. Another
standard requires the doctors, but not the GPs that
are starting to work independently in the private
sector to be on the General Medical Council’s
specialist register.
Gaps to leave you vulnerable
Despite the fact that the new regulations have given
us excellent benefits, there are still some gaps in
the regulations that will leave some consumers vulnerable.
For example, a big ambiguity lets the doctors that
are already working privately before the NCSC was
set up to carry on without joining the specialist
register.
There are some of the services that are totally excluded,
like the complementary therapies and talking therapies,
like the psychotherapy. With some of the professionals
that are working in this type of field will become
the subject to an individual professional regulation,
for example the chiropractors or the osteopaths, but
there others that will not. Which means that not only
being no control over the standards in any of the
clinics that are providing the services, but also
some of the professionals will not be subject to any
of the statutory regulation.
However, there are some more intensive treatments,
like that of the cosmetic treatment that includes
botox, are laso unregulated. But they are still done
without the proper training that is needed, of which
these treatments will carry real risks, by way of
infection and possible disfigurement. And with some
of the more unprincipled manufacturers of the laser
and pulsed light equipment that are not telling the
people that they must be registered with the NCSC
to operate this type of device.
The director of the private and voluntary healthcare,
Ros Gray said ‘Intense pulsed light (IPL) is
a service new to the regulation this year. We have
concerns as to treatment using IPL have the potential
to cause serious harm, and we believe many providers
have failed to apply for registration with NCSC.’
Also, another item to be left out is that of dentistry.
However, in Scotland, these are now plans that include
wholly private dentists in the regulation of private
health care. In truth there are now very few only
private dentists, many of whom have at least a few
NHS patients. But due to more and more dentists earnings
getting bigger a good proportion of their income from
the private treatment, many consumers will still be
unprotected.
Likewise, with the private doctors that also work
in the NHS don’t have to be registered with
the NCSC. Which means that there is no inspection
of the practise are the private consulting rooms.
And there is no guarantee that the private practise
is conducted in the safe surroundings, or if they
are competent to carry out the procedures that they
use on the private patients.
The regulations at Present
Under the present regulations you do not need private
doctors offering GP services to have the same specialist
training that NHS GPs need to have. This, is a certificate
of completion o vocational training or exemption from
the Joint Committee on Postgraduate Training for General
Practise. This will mean that any doctor, will be
able to call themselves a GP. Now this is a very worrying
factor already giving the fact that there are no restrictions
being placed on the type of minor surgery these doctors
can perform.
There is a good gap in the regulations that has only
just come about, which is that of the exclusion of
the private units in the NHS hospitals. Now it is
these that are not inspected by the NCSC or by the
NHS watchdog, the Commission for Health Improvement.
This means that is a big omission, by many of whom
choose these units because they think that they are
getting the best of both worlds, by blending the reliability
of the NHS care to the of the extras of the private
treatment.
By looking outside the regulatory system, this means
that the national standards or regulations don’t
apply, not just the clinical services but also the
clinical governance (the systems aimed at making sure
a good quality care is given) and the type of information
that needs to be given to the patients along with
the compliant handling. This will then leave the patient
vulnerable is and when things go wrong.
Over this the confusion has made by regulations that
let many of the health professionals to operate some
types of lasers without the need of registration with
the NCSC, if they are already registered with a professional
body.
The regulation benefits
Despite the fact, that some clinics and hospitals
don’t have to be registered with the NCSC, but
the regulations are bringing up some good benefits
like:
• Accountability of management being improved
• The emphasis on information for patients is
being increased
• The minimum for standards of complaint handling.
The registered hospitals and clinics must now have
an appointed, registered manager who is accountable
to the NCSC, along with the owner, for the staff practice,
for standards and making sure that the safety and
quality of care. This person must ensure that any
of the staff that are providing care in their establishment
are appropriately skilled, competent and qualified.
Which also includes making the pre- and post- employment
checks on staff, this includes agency nurses and locums.
For all the clinic or hospital that are regulated
by the NCSC must now produce a patient’s guide,
that has information about the services, along with
how to make comments, suggestions or even complaints.
Also the providers must conduct an annual patient
surveys and make the results available to the public
on request for the first time.
However, the CA is now worrying about the patient
guides that can be more like a sales brochure a one
sided patient information. And that there is no requirement
to outline the experience and training of staff, and
the clinical information does not have to be separated
from prices.
The questions to ask when going private
• Ask over your doctor’s qualifications
and experience, and make sure their entry with the
General Medical Council, and if it is a specialist
register for hospital doctors.
• Is the hospital or doctor registered with
eh National Care Standards Commission?
• Whether the emergency medical cover will be
available overnight? And how senior are these doctors?
• Is there any intensive care unit? If it can
look after the patients that need a ventilator of
who support for a single failing organ system (level
2)? Or those that have a multi-organ failure (level
3), or those patients that offer critical care alone,
like the frequent observation or cardiovascular monitoring
(level1)
• If it is staffed by the specially trained
nurses and doctors?
• Due to there being no intensive care unit,
where is the nearest ICU facility?
• The staff that have Advanced Life Support
(ALS) training, what is the minimum number on duty?
If you are having a baby:
• Whether it is staffed by a specialist nurses?
• Is there a specialist care baby unit at the
hospital?
• If no, then where is the nearest unit?
• At all times are there neonatal paediatricians
on duty?
Conclusion
Under the current regulations there is an good improvement
in the protection of patients, however it is not the
whole answer. Due to their being big gaps and omissions
that leave the people unprotected and confused. It
is hard for the consumers to work out what services
are needed to be registered by the NCS and which of
those are not.
For it is these precise problems that add up to the
wide diversity to the providers in the this private
sector, to the individual operators that may not be
qualified health professionals via the high-tech hospitals
that are part of the large health care companies.
It due to the CA that a petition has been started
on these problems. What is needed according to many
people is a Health and Social Care Bill, but at present
before the Parliament, to make sure that there is
a consistent and good basis, for which all the consumers
have the same level of protection and information
wherever they are to be treated.
The patients need to ask those that provide this private
care for any details of their registration with NCSS.
Foe the service will not have to be regulated, but
the provider should be able to prove it. If you are
unsure, you can check with the NCSC.
