You can only assume that Wes Streeting’s recent embrace of the private hospital sector as a solution to the current health crisis stems from naivety about how UK private healthcare works, or is part of the Labour leadership’s attempts to turn it into a party of the centre right.
It is certainly not based on evidence.
Famously described by the late Julian Tudor Hart as the “red-light district of medicine”, the evidence about the parasitic and risky nature of private healthcare in the UK has been mounting for decades.
As anyone in the health service knows, private hospitals do not have any additional doctors to assist in reducing the NHS backlog – in all the private hospitals operating in the UK, the doctors are NHS doctors, working in their spare time. In commercial terms, because the private sector contributes nothing to the training of the 17,500 doctors who work in its hospitals, this amounts to a free subsidy to the private sector of about £8bn.
And because these consultants operate on a freelance basis, the hospitals do not pay any associated national insurance costs and they are notoriously able to use this employment arrangement to deny liability if a doctor harms a patient, as they are merely “renting them a room”.
Given that the main constraint on clearing the backlog is not operating theatres but consultants, surgeons and anaesthetists, it makes no sense to suggest that the private sector can come to the rescue of the NHS.
There is only one pool of healthcare professionals in the UK and unless that pool expands significantly and quickly, a policy of pushing NHS patients to be treated in the private sector will not make any significant dent in the number of patients waiting to be treated, working class or otherwise.
What pushing more NHS patients to be treated in private hospitals will undoubtedly do is to expose them to a greater risk of harm. Anyone who has followed with horror the Ian Paterson scandal – a surgeon who, for financial reasons, maimed potentially thousands of women mainly in the private hospital sector by telling them they had cancer when they didn’t and then removing their breasts and other internal organs – will have seen how poorly regulated the UK private hospital sector is.
Even though the inquiry into the Paterson scandal by the bishop of Norwich published a series of recommendations almost three years ago designed to prevent something as awful happening again, neither government nor the private hospital sector has done anything substantial to implement the recommendations or address the systemic patient safety risks that have been raised by coroners, regulators and official inquiries going back more than 20 years.
These safety risks include the fact that the vast majority of private hospitals do not have any ICU facilities to look after patients if something goes wrong after an operation. Even at the height of the pandemic, 6,600 patients were transferred to NHS wards after treatment in a private hospital – a fact that suggests that far from assisting the NHS during the pandemic, the support went the other way. It is also an arrangement that costs the NHS an estimated £80m a year.
Not only does the private hospital sector not have ICU facilities, it places the post-operative care of patients in the hands of a junior doctor (a resident medical officer, or RMO) often working a shift pattern of 168 hours a week – way in excess of the European working time directive. In doing so, they are required to be in the hospital and to be available to provide care 24 hours a day, for a week at a time, with no supervision from a medical consultant and often lacking the necessary experience in how to look after patients in an emergency.
In no fewer than five coroner’s inquests, the RMO model has been cited as a contributing factor to the deaths of patients, including the tragic case of Peter O’Donnell, an NHS patient who died after treatment in a private hospital. O’Donnell’s death and the subsequent coroner’s inquest led the former health secretary Jeremy Hunt to write to the private healthcare sector telling it “to get their house in order and improve safety” – again, to no avail.
Ironically, given that Labour has suggested that the NHS needs to rely less on “foreign doctors”, a recent exposé by BBC File on 4 found that many of the RMOs who staffed private hospitals were brought to work in the UK from countries such as Nigeria by recruitment agencies that require them to operate under employment conditions described by the British Medical Association and Doctors’ Association UK as a “disgrace” and by the doctors themselves as “borderline slavery”.
And it is not just a couple of private hospitals that operate this model – a review by the Centre for Health and the Public Interest of patient safety in the private sector found this reliance on agency-employed junior doctors was common to almost every private hospital company operating in the UK.
Given these known, systemic safety risks, it is unclear why any health minister, Labour or Conservative, would seek to use private hospitals to treat more NHS patients. But it is not the only issue of concern that they should be aware of.
For all the seemingly benevolent offers of support offered by the private hospital sector in clearing the NHS backlog, its track record during the pandemic suggests that the sole (and legitimate) concern is to maximise revenue and profit.
It should never be forgotten that at the darkest point of the Covid pandemic in January 2021, when the NHS in London was being overwhelmed, the medical directors of the main London trusts publicly pleaded with the private sector to stop treating more profitable private patients and turn its attention to treating urgently sick NHS cancer patients. This was even though many of these same hospitals were under contract with the NHS to provide support for the pandemic response at a value to them of more than £2bn a year.
Nor should it ever be forgotten that on top of this £2bn handout – for which they delivered comparatively little healthcare activity – a number of the hospital companies also thought it appropriate to claim a further £72m from the public purse in the form of furlough payments.
Add in the fact that a number of private hospital companies recently operating in the UK have been found liable over price fixing, involvement in US healthcare fraud and connections with alleged accountancy fraud, and it becomes clear that Labour’s decision to go private without introducing a major reform of the for-profit sector is taking a massive risk with the public’s health and taxpayer money.
• This article was amended on 13 and 15 December 2022 to clarify a reference to the shift patterns that can be required of resident medical officers, and correct the name of Doctors’ Association UK.
David Rowland is the director of the Centre for Health and the Public Interest (CHPI)
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