Private medical care and patient safety
Fit for purpose?
With NHS resources stretched to breaking point, more and more patients are seeking care in the private medical sector. Some have the benefit of workplace medical insurance, pay individual premiums to insurers or can afford to fund the care themselves. There has long been concern that this leads to inequality in healthcare provision but private medicine is now also coming under scrutiny from a patient safety perspective.
The Ian Paterson case
In April 2017 Breast surgeon, Ian Paterson stood trial and was convicted of 17 counts of wounding with intent in connection with the care that he provided to patients, some of whom were private patients at the Spire Parkway Hospital in Solihull. In all, patients alleged to have been harmed were estimated to exceed 750 and many of these came forward once the case was publicised.
Shortly afterwards Philip Dunne, Minister of State for Health said:
‘The Government is appalled by the actions of Ian Paterson and the harm that has affected a significant number of patients. The disclosures about the seriousness and extent of his malpractice are deeply and profoundly shocking.’
What was the harm patients suffered?
Many patients underwent unnecessary operations, were told they had cancer, when they did not, or conversely had inadequate cancer surgery which was insufficient to treat their disease and suffered recurrences which were avoidable. Some patients died as a result of negligent care.
Why could Mr Paterson act with impunity for so long?
Mr Paterson was permitted to continue to practise in this way for a long time, both in the NHS but also in private practice causing serious lasting harm to a vast number of patients. There are issues of scrutiny with his NHS practice and it is understood that some concerns were raised internally at his NHS trust – Heart of England NHS Foundation Trust but this information was not shared with managers and those responsible for his private medical practice at the Spire Parkway. Had it been, and had the NHS, private hospitals, and medical insurers collaborated, it is likely that the inadequate care he was providing would have come to light much sooner and far fewer patients would have come to harm.
A further complication is that private doctors are independent contractors and are not employed by the private hospital but have ‘practising privileges’ and so often, in the past, if there has been concern regarding a private consultant the hospital steps away from the problem, leaving it to be resolved between the patient and consultant.
What could private medical insurers have done?
There is a fundamental conflict of interest at the heart of private medicine between the best interests of the patient and the financial interest of the surgeon in recommending a particular treatment. The more treatment the doctor undertakes, the greater the private doctor’s income. Patients are vulnerable and will often agree to care due to anxiety about their health and a trust in the person advising them.
A specialist doctor has to recommend treatment to a patient and often their health insurers. If it is complex medical treatment, it may not always be easy to question whether that recommendation for treatment is appropriate. Where an insurer is paying, there may be a sense that it will simply be approved if recommended. Insurers have data that they can scrutinise to examine whether particular doctors are undertaking excessive procedures and ask whether that is reasonable.
These and other problems with accountability and sharing of information between different healthcare providers in the Paterson case have now been subject to detailed review. In December 2017 a non-statutory independent Inquiry was set up into the circumstances and practices surrounding him.
Some of the key terms of reference are as follows:
- Comparison of the accountability and responsibility for the safety and quality of care received between the independent sector and in the NHS; including the roles of hospital providers and others in appraising, reporting, considering concerns and monitoring as regards healthcare professionals activity levels, conduct and actual performance;
- How and when information is shared between the NHS, independent sector and others, including concerns raised about performance and patient safety;
- The role of independent sector insurers, medical indemnifiers and medical defence organisations including sharing of data
The Inquiry is due to report on 4 February 2020. It will hopefully examine each of the above, and more, in detail and ensure that in the future, patients are no longer vulnerable to harm due to a lack of scrutiny on the part of the organisations responsible for medical care.
Contact our medical negligence team
If you or a member of your family has been affected by the issues in this article and want advice about bringing a claim against a private doctor or private medical provider, call a member of our Medical Negligence team on 0800 316 8892 or e-mail marguarita.tyne@clarkewillmott.com
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