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NHS’s £250m bill after private surgery gone wrong

Every year around 1.6 million people in this country undergo surgery at a private hospital. 

While many pay for it themselves, it is estimated that around half of the inpatients are funded by the NHS.

This is done to help clear waiting lists and for these patients in particular, it can seem like they’ve hit the jackpot: going private may seem like the health equivalent of flying first class or booking into a top restaurant.

Most private hospitals don’t have emergency care facilities meaning that if something goes wrong, patients need to be rushed to the nearest NHS hospital

But while the experience should be the best that money can buy — and of course many patients are happy with their care — if something goes wrong, private hospital treatment can fall woefully and dangerously short.

The problem is that while NHS hospitals are equipped with expertly staffed intensive care units, most private hospitals have no such emergency care facilities.

So should a patient’s condition suddenly deteriorate or a complication occur, they can end up being rushed to A&E at the nearest NHS hospital.

And the stakes can be very high — a report published last October claims that in the past three years alone, more than 100 patients have died after being transferred from private hospitals to NHS hospitals.

The report, written by Colin Leys, an honorary professor of research at Goldsmiths, University of London, was based on data including Care Quality Commission (CQC) inspections of 177 private hospitals and NHS figures obtained through Freedom of Information requests.

His findings echo those of a British Medical Association report in 2016, which found that up to 6,000 people annually need NHS care after bungled treatment at a private hospital. Around 2,500 of these were classed as emergencies.

This comes at huge personal cost to patients — and at a cost of hundreds of millions of pounds to the already cash-strapped NHS.

One of the most telling findings from the new report is that some private hospitals allow surgeons to leave work after they have carried out an operation and be up to 45 minutes’ distance away from the hospital. This means they’re not on site to deal with any complications, a factor in avoidable deaths.

The report also warns that many private hospitals rely on only a single junior doctor to provide post-operative care for patients.

The potential consequences of this are all too real for Carmel Bloom’s family.

Bupa hospital administrator Carmel Bloom (pictured), 54, died of septicemia in the private hospital she worked at

Bupa hospital administrator Carmel Bloom (pictured), 54, died of septicemia in the private hospital she worked at

Apart from a bothersome kidney stone, Carmel, 54, had been in good health when she went in for surgery to remove thestone at the Bupa-run Roding Hospital in Ilford, Essex.

But within hours of the operation, her condition deteriorated catastrophically. Carmel, a hospital administrator from Woodford Green, Essex, developed sepsis; her blood pressure plummeted and she went into multiple organ failure.

The private hospital’s facilities could not cope with the emergency. Instead it sent her by ambulance to the NHS intensive care unit at Whipps Cross Hospital in East London.

Carmel died there ten days later in September 2002, having never regained consciousness. 

It took 14 long years of campaigning by her brother Bernard, and an unprecedented three coroners’ inquiries, to shed light on what happened. In the last inquest, in late 2016, a coroner heard new evidence about a 999 call from the private hospital, which showed that staff were aware of the seriousness of her condition — that she was unconscious and deteriorating perilously.

The coroner ruled that her death was due in part to ‘the absence of regular monitoring’ after her surgery. She also noted failings in communication between the private hospital nurses, urologist and anaesthetist while Carmel’s condition was worsening.

The private hospital’s consultant urological surgeon did not arrive at her bedside until an hour and 20 minutes after she had been found to have developed life-threatening sepsis and the consultant anaesthetist was not called until two-and-a-half hours after the onset of sepsis. The transfer to the NHS hospital was mismanaged — the coroner ruled that the anaesthetist, ‘did not intubate [insert a tube, typically into the airway] and ventilate Carmel before transferring her, or attach equipment which would have allowed for the monitoring of her vital signs during transfer’.

During the ambulance journey, her blood pressure fell still further, causing the heart attack that fatally starved her brain of oxygen.

Bernard, 68, a luxury car dealer of Chingford, North-East London, told Good Health that the draining legal battle has ruined his own health. He now suffers from debilitatingly high blood pressure.

‘The stress of fighting through the courts, gathering expert evidence from top medics around the world and continually being confronted with setbacks has all taken an awful toll on my health,’ he says.

A British Medical Association report in 2016 found that up to 6,000 people annually need NHS care after bungled treatment at a private hospital

A British Medical Association report in 2016 found that up to 6,000 people annually need NHS care after bungled treatment at a private hospital

A spokeswoman for Bupa, which owned Roding hospital in 2002, said: ‘We sympathise with Carmel Bloom’s family for their loss.

‘As we no longer own the hospital, it’s not appropriate for us to comment any further.’ You might feel that so manyyears after Carmel’s death, the problem of private hospitals failing to cope with post-operative emergencies would have been addressed by now.

But as Professor Leys’ report reveals, it’s a problem that’s far from gone away. 

Take the tragic story of Mary Roddy. Mary, 78, of Kearsley, Greater manchester, was perfectly healthy but suffering with pain in her right knee when she was advised by a consultant surgeon at the Royal Bolton Hospital that she could have a knee-replacement operation, funded by the NHS, at a local private hospital.

She was admitted to the BMI Beaumont Hospital in Bolton in 2010. Doctors noted that she was fit and well before carrying out the procedure.

Early in the morning after surgery, at around 2am, her blood pressure dropped significantly. Nurses noted that she was drowsy and confused. She was given intravenous fluid to increase her blood pressure. But it was the wrong response, because she had in fact suffered a heart attack that went undetected.

Later that morning at 7am she was seen by a junior doctor who gave her a second dose of intravenous fluid. Mary was finally reviewed by a consultant at 2pm who gave her a third dose of intravenous fluids.

The fluids cumulatively flooded her system and caused heart failure that was only diagnosed at 4pm. She was transferred to the intensive care unit at the Royal Bolton Hospital.

But the heart damage caused by the excess fluid was irreparable and she died eight days later.

Her husband John, 77, a retired charity worker, sued the hospital for negligence. ‘I was adamant to take it all the way because I knew they were at fault,’ he said through his solicitors, Linder Myers.

‘By hook or by crook I wanted to get justice for Mary. She was an amazing person and everybody knew her and loved her.’

In 2015, five years after her death, a court awarded John a five-figure settlement. In a statement at the time The Beaumont Hospital said: ‘Following the conclusion of legal matters we have written to Mr Roddy to apologise for failings in the care of his wife. We always strive to provide the best care to our patients and accept that in the case of Mrs Roddy we fell short of the standards we aspire to.’

However, the compensation was paid not by the hospital, but by the NHS Clinical Commissioning Board: in other words, the taxpayer — who also paid for the operation at the private hospital. 

In the three years between 2013 and 2016 alone, private hospitals have cost the NHS around £250 million by sending them sick patients after treatment has gone wrong, according to Professor Leys’ report (commissioned by the Centre for Health and the Public Interest).

He found that in 82 English private hospitals, the majority of inpatients — and a third of outpatients — are funded by the NHS (figures from the NHS itself show its spending on private operations rose significantly from £241 million in 2015 to £381 million in 2016). ‘This puts the NHS and the Department of Health in a very strong position to require changes to the private hospital business model to ensure the safety of NHS patients,’ he wrote.

The bungled operations that need to be fixed come at huge personal cost to patients and at a cost of hundreds of millions of pounds to the already cash-strapped NHS

The bungled operations that need to be fixed come at huge personal cost to patients and at a cost of hundreds of millions of pounds to the already cash-strapped NHS

But exactly the opposite is happening: even when the NHS has paid a private hospital as a contractor to provide treatment on its behalf, if it goes wrong, it’s NHS that has to fund the compensation, which means there is no financial pressure for the private organisations to do better.

Figures uncovered by Labour MP Roger Godsiff in 2016 show that failures by private contractors had cost taxpayers nearly £33 million in damages in the previous five years.

When court costs are included, this adds up to almost £52 million, he said, adding that: ‘The NHS should, at the very least, have the powers to recoup costs.’

In one case, the NHS has paid tens of thousands of pounds to just two patients in compensation for botched eye surgery carried out by a private company at Musgrove Park Hospital in Taunton, Somerset.

The operations were done in 2014 by Vanguard Healthcare Solutions, which had been appointed by the trust to help clear a backlog of 400 patients. Vanguard then sub-contracted part of the contract to another company, The Practice, which then sub-contracted to Kestrel Ophthalmics.

Half of those operated on, 31 patients, suffered problems — a complication rate ten times the normal figure; NHS staff raised the alarm and the operations at the hospital were terminated after only four days.

In 2016 Health Minister Ben Gummer told Parliament that so far, ten compensation claims for these patients have been received.

Two have been settled, at a total cost of nearly £90,000 — one of those was Michael Newcombe, 84, who was left blind in one eye after the surgery.

The money has come from the NHS, with no indication that it will be able to recoup the damages from the private company.

Ian Gillespie, chief executive of Vanguard Healthcare Solutions, said at the time: ‘Operations were carried out by highly qualified surgeons, approved by the hospital, and with many years’ experience of working in the NHS.’ 

Professor Leys’ report urges that the NHS mopping up after the private sector must come to an end, for there to be any hope of improving private care.

‘If the private hospital business does not have to deal with the consequences of post-operative complications, it has no incentive to prevent things from going wrong in the first place,’ he wrote.‘The refusal by private hospital companies to accept full responsibility for what happens in their facilities means that patients will always be at risk.’

This is allowed to happen, he suggests, because surgeons are not directly employed by the private hospitals, but are instead considered to be independent professionals contracted by the private hospitals. So the hospitals argue they cannot be held legally responsible for the surgeons’ actions.

Professor Leys added: ‘Private hospitals will not be truly safe unless they have adequate facilities to deal with those situations where a patient’s life becomes endangered following an operation and where the hazardous transfer of patients to NHS hospitals ceases.’

The Royal College of Surgeons, backed by the Royal College of Emergency Medicine, is calling for a national review of safety in the private health sector.

Its lay group chair, Derek Prentice, told Good Health: ‘If the private healthcare sector is using the NHS as a safety net then questions must be asked about why that is.

‘NHS emergency departments are already overstretched and private hospitals need to have robust risk management plans to ensure that safeguards are in place with adequate aftercare.

‘Where a patient is admitted to the NHS due to the fault of private healthcare, the private sector should be expected to pay for the costs incurred by NHS emergency departments for that patient’s treatment.

‘Otherwise patients will continue to be perilously dumped back into the NHS — and we the taxpayers will have to pay the costs.’