This tragic case (See Shaun Lintern’s report in HSJ 5/6/19 and coroner’s report https://www.judiciary.uk/publications/simon-healey/ ) throws into sharp relief the debate about the risk thresholds of independent hospitals that are remote from 24/7 critical care back up.
Where the private providers in a catchment do not have such facilities (and few do, particularly outside London) then patients requiring high grade complex surgery, and/or have co-morbidities, are going to be at some reduced risk if their treatment and care is provided on an NHS campus. Where there is a Private Patient Unit (PPU) then the Trust benefits and the patient receives the private care their insurance supports, but where there is no PPU (and perhaps half of Trusts outside London still have no dedicated private beds) then the patient ‘defaults’ to the NHS – together with their costs of treatment.
This financial driver – plus of course the Patient Safety imperative – are the main reasons for the ongoing organic growth of NHS PPUs. Perhaps the NHS should go further, and through open engagement with insurers, regulators and the Royal Colleges, adopt policies that encourage a full geographic coverage of PPUs such that every NHS Trust has at least an entry level unit to take the most complex local private cases.
Analysis of the market suggests that gaps in PPU provision is costing the NHS perhaps c.£500M. Achievement of a national network of NHS PPUs would deliver a range of system-wide benefits: Patient Safety raised; individual patient risks down; consultant fee growth; NHS costs down; insurer customer choice up.
This is a rare opportunity for a win-win-win-win-win and so now is a good time for a wider debate between all stakeholders to boost in-house private provision as an integral thread supporting the achievement of NHS strategic priorities.