When Private Care Goes Wrong

Patients with grievances against the National Health Service are, in some senses, lucky. However inadequate, inefficient or apparently biased against the patient, statutory complaints procedures do exist.

If you do not like the way your GP has treated you, the local family practitioner committee is obliged to hear your case. If you object to hospital treatment or the way it was given the health authority must investigate. Details of administrative bungles can be sent via your MP for the ombudsman to investigate. And in all these cases the community health council is there to advise you.

The five million or so people with private care insurance and the further two million who consult privately without such cover, are not so fortunate. No system for hearing complaints exists for them. Often the only course is to take the hospital or specialist to court. But while families may be happy to find a couple of hundred pounds a year for health insurance, few can afford major legal costs, and applications for legal aid are likely to fail.

Complaints against doctors can cause the most despair. Quite legitimately, BUPA (and other organizations which provide insurance) and hospitals or nursing, homes can wash their collective hands of any accusations of negligence or medical incompetence against a surgeon.

The reason is simple. When you opt to consult a particular specialist, often on your GP’s recommendation, your contractual obligations are with him or her alone. Organizations like BUPA, and the hospital you attend, do not employ any of the specialists directly and are not liable if things go medically wrong.

A spokesman for BUPA says: ‘We just pay the bills. We cannot interfere with the doctor/patient relationship.’ Hospitals, on the other hand, merely rent out the facilities and provide nursing cover. If anything goes wrong it is up to you and your specialist to sort it out.

Dr Peter Ford, of the Medical Protection Society (one of the medical profession’s defense organizations), admits that there is a gap in the system. ‘Patients can raise the matter directly with the doctor, but because there is no statutory mechanism I doubt they will get far.

‘They can grizzle to their MP and they can complain to the General Medical Council – but the latter route will only be satisfactory if there is a prima facie case to answer’, he says. As a spokesman for the GMC put it: ‘An error of diagnosis or treatment will not necessarily be regarded as an indication of professional misconduct’.

Dr Ford has another couple of suggestions: ‘Patients are more likely to make progress if they go to a solicitor or send their cases to Esther Rantzen’.

He adds: ‘The vast majority of specialists who treat patients privately do it brilliantly. There are circumstances where things are less than satisfactory. I do think that the GMC and other responsible medical bodies should look at the quality of service in private medicine more closely.’

Although some private patients may feel vindicated only if they see their surgeon struck off the register when there are problems, many more would be satisfied if they knew a few more medical details and why the problems might have arisen. But for this, patients need to have access to their medical notes. In theory these belong to the surgeon and can be forced from his hand only by a court order.

This is an area of considerable concern. One woman who had a problem with the private sector at the end of December is still waiting for acknowledgement of her letter requesting access to her notes. There is a school of medical thought that patients will be confused by their notes and will gain nothing from seeing them.

Dr Ford believes that these anxieties could be allayed more readily if the notes were released to a third party – nominated by the patient – who could interpret them. If the patient does not know another consultant, solicitors should approach one of the royal colleges or the British Medical Association for a name.

The flaw in the system is whether the third party will be trusted. Patients with complaints tend to develop jaundiced views of the medical profession and believe other doctors cannot be fully independent: the shutters come down and they protect each other.

Some people with private health insurance might be interested in extending their house insurance and have a legal protection policy. For less than pounds 10 a year, a whole family can be protected against legal costs in the region of pounds 5,000; if you opt for an unlinked policy, the premium will range from between pounds 30 and pounds 60.

Patients who object to the quality of services provided by hospitals – from food and laundry to nursing care (or even medical care, if the complaint is against a resident doctor directly employed by the hospital) – will probably be more content at the end of proceedings.

Mary Anne Hodson, administrator of the Garden Hospital, Harrow, says that justifiable complaints would lead to a reduction in the bill. ‘We prefer patients to complain while they are in hospital so that we can put matters right immediately’.

Further assistance, but of a limited kind, should be available for patients early next year with the launch of a Private Health Consumers Association, the brain-child of Hugh Elwell, consultant to the private health care industry. The focus of the association – which will have a membership fee of about pounds 15 a year – will be a quarterly newsletter.

Mr Elwell hopes that it will ‘help individual patients negotiate their way through the Byzantine system of private care, to understand how it works and to unravel what level of cover their policy provides.’