You were going to explain what the great dream is?
While you're thinking about it, here's something to read.
Robert Baker: Don't use private medicine unless you're feeling fine
I am going to let you in on a trade secret. One that every junior doctor in Britain knows; and then promptly forgets when they get to be a consultant. It is a secret that could just save your life - or, at very least, your savings. That secret is this: If you have anything wrong with you, don't go private. Stick to the bread and butter NHS.
Please note that conditional clause. If you have anything wrong with you. I will explain later why, if you're well, you might also want to steer clear of MammonCare plc.
Let us suppose you require major surgery. You discover that your local hospital has a long waiting list, so you use your savings to bring your date forward. You are admitted to a prestigious private hospital. The operation goes well but afterwards you suffer complications. You need a tube in your throat to help you to breathe. During the night your tube falls out or becomes blocked. The (only available) duty doctor is called. He does not know how to replace the tube or unblock it and nor do the nurses. There is no other doctor available. You die.
This is an extreme - but true - example of one of the problems with private hospitals. What would have happened in the NHS? Even your local bog-standard rackety old district general would have multiple doctors from various specialties on hand for just such emergencies.
About 500 seriously ill patients are transferred to NHS intensive-care beds from private hospitals every year - ICU is not covered by most insurance policies. There are virtually no private intensive care units. Out of hours, private hospitals usually boast a single duty doctor - the RMO, or resident medical officer. They are usually in training, working for an exam and desperate for a quiet life. They may have no experience whatever of your particular condition.
Of course I exempt (from this particular criticism) those few private units that are situated within large NHS hospitals. Nor would I be so bold as to present our final experiment with socialism as perfect. But there are clear, even statutory differences between the two that reflect their relative safety. Some are exempt from regulations by registering as nursing homes or, in one case, by Royal Charter.
The Government's new plan for improving the quality in the NHS in the wake of Bristol, Ledward and the rest is called Clinical Governance. The scheme can best be understood under seven headings, bombastically called the Seven Pillars. Taking each in turn:
Research and Development. The non-pharmaceutical private sector contributes, effectively, no research or development. No marks. Quality Indicators - designed to compare units and hospitals - private sector not included, no marks. Risk Management - designed to reduce accident and error. No statutory obligation to carry this out in private hospitals. No marks. Clinical Efficacy - assessing the best and most effective treatments - exclusively carried out by the state and academic sectors. No marks. Continuing Medical Education - ensuring that consultants are kept up to speed. No obligation for private consultants to comply. No marks. Audit - examining past performance against an agreed standard. No involvement by private sector. No marks Patient Empowerment - self explanatory. I suppose if you want the choice of a leather sofa in the waiting room, and a doctor who uses a Montblanc pen, then that's a sort of power. One mark. Total for private hospitals: one mark out of seven.
Harley Street is, of course, utterly unregulated. Any quack can set up shop on the Street of Shamen (sic) and any quack does. Like Elsie in Cabaret, rental may be arranged by the hour. One lucrative pastime comprises employment health screening. If you work in the City you may have had to undergo this yourself - a round of blood tests and a trot on the treadmill to check out your ticker. Such patients - and the worried well - are known as the "dairy herd", to be regularly milked.
There is a simple mathematical theory to explain why screening the healthy is so bent. Bayes' theorem of conditional probability refers to the interpretation of any given test with reference to the prior conditions of the studied population. Consider two weather forecasters, one living in Addis Ababa and one in Fort William. Both use the same tests, including monitoring changes in atmospheric pressure on a barometer. Suppose the barometer needle says "rain likely". Which meteorologist is going to be correct in his prediction?
Similarly, if you apply medical tests to the wrong population, then your results will not be reliable, and the consequences unpredictable. No test is perfect and there will inevitably be both false positives and false negatives, with potentially serious results. For these reasons there is almost no point - with certain exceptions, like HIV tests - in screening healthy people.
What can be done about it? The Commission for Health Improvement has announced that it is going to be "breathing down the neck" of private hospitals. Quite right too. The chief difference between accepting money for iffy medical practice and pick-pocketing is that the Artful Dodger never expected his victims to hold their wallets deferentially open and say, "Do you take Visa?"
The writer is a registrar at a London teaching hospital
