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    We are so used to the attacks on the NHS from the Daily Mail that we forget that it can be merciless to private medicine too. A critical article by Lois Rogers for the Mail’s on-line edition on June 12th provoked a defensive response from the Association of Independent Healthcare Organisations (AIHO).

    Rogers’ attack begins with the story of a man (a Director of a high-end car company) who underwent surgical removal of the prostate (no small procedure) in a private hospital, only to be told years later that the surgery had not been necessary. According to the Mail’s journalist he is just one of at least 66 people, who believe they were misdiagnosed or underwent unnecessary surgery at the hands of a particular surgeon. For the full story go to http://www.healthmatters.org.uk/blog/nhs/daily-mail-attacks-private-medicine/ .

    Daily Mail

    EXPOSED: How the NHS is paying millions to private surgeons for operations that we may not need – and could even HARM us

    • The quality of care received by NHS patients in private hospitals is under review 
    • Insiders fear countless people are paying for needless, expensive operations   
    • There’s also been a sharp rise in complaints from unhappy or worried patients
    • Those treated in private hospitals are often not compensated  if things go wrong

    By Lois Rogers for The Daily Mail Published: 22:06, 12 June 2017 | Updated: 13:57, 14 June 2017

     This story is the tip of a much bigger iceberg in private hospital care, Rogers asserts, because the private sector has particular problems with lack of scrutiny of what surgeons are doing. Doctors working in private hospitals have a financial incentive to be interventionist about operations. They are not subject to the same monitoring and scrutiny as in the NHS, and private hospitals don’t have to monitor outcome trends to detect substandard surgeons either. Medical insurance cover is also a problem. Rogers believes that many private patients who have undergone unnecessary surgery may never be compensated.

    The Mail article argued that NHS patients should be made aware of these risks before being treated in private hospitals. The article then goes on to mention by name NHS consultants who have been accused of over-treating patients in the private sector.  Unsurprisingly the AIHO was not pleased by these claims and responded sharply, pointing out that surgeons in the private sector are all responsible to the General Medical Council, mostly work for the NHS (where they are scrutinised), and work privately in hospitals that are inspected by the Care Quality Commission. The AIHO says “failings of a handful of rogue surgeons does not represent the high quality and compassionate care delivered day in and day out by the independent sector as a whole”.

    The AIHO insists that the ‘independent’ (private) sector is actively working with NHS England to bring the level of reporting of surgery in line with the NHS’s own. Independent hospitals are already required to provide detailed data on every private episode of care, and they are beginning to publish performance measures for 149 common procedures at over 250 hospitals. More will soon follow, according to the AIHO, including measures of consultant performance in 2018.

    This spat matters. Treating NHS patients is big business for private hospitals. 530,000 surgical procedures were carried out on NHS patients in the private sector in 2016. A third of all NHS-funded hip and knee replacements are now being carried out in private hospitals. The NHS paid the private sector £8.7 billion for services last year, amounting to 28 per cent of private hospitals’ income. The private hospital sector constitutes a source of spare surgical capacity for the NHS, and are in effect in the NHS’s public domain (as distinct from the state-run public sector) when they do NHS work. They are, then, like GPs, dentists, pharmacists and other contractees to the NHS, and they have to perform according to NHS rules. That is why the Mail – always ready to occupy the moral high ground – sees them as fair game for the critical journalist.

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    Wales is the only part of the UK where “deemed consent” to organ donation applies. The means that any deceased who is over 18 years, is mentally competent and who had lived in Wales for  12 months is deemed to have given consent to organ donation unless they have formally registered their objection.

    About a decade ago, the UK had a low organ donation rates (13 / million population) compared to countries such countries as Spain, USA and France. As well it had a much lower rate of next of kin refusal. In Wales around three people per month died while waiting for an organ donation with about 300 people on a transplantation list.

    The issue was considered by the National Assembly for Wales Health and Well-being Committee in 2008. Though its report did not recommend  “presumed consent”, the Welsh Government felt there was sufficient public support for the proposal and indicated its intention to legislate on the matter. A commitment to do so was included in the Welsh Labour, Plaid Cymru and Liberal Democrat’s manifestos for the 2011 National Assembly election.

    The Bill was introduced into the National Assembly in December 2012. Over the next year an extensive debate and consultation took place. There was broad support for its purposes though concern was expressed, by Christian and Islamic faith groups in particular, that “deemed consent” was not real consent and that it undermined the altruistic virtue of the gift of donation.

    A key feature of the legislation was its “soft opt-out” option whereby close relatives are involved in the donation decision with particular attention being paid to any evidence that the deceased may not have wished to have their organs donated.

    In the run up to the beginning of the legislation in December 2015 there was an major campaign to both explain the new legislation and to raise awareness on the wider organ donation need in Wales. The legislation will require the Welsh Government to maintain a programme of promoting public awareness and to report on progress.

    At the end of the first year of the legislation the Welsh Government reported “… the latest figures show that 39 organs from patients whose consent was deemed have been transplanted into people who are in need of replacement organs.

    In the two years prior to the introduction of the new system of deemed consent, .. (we) made significant efforts to inform the public of the exact nature of the upcoming changes in respect of transplantation activities. During this period the number of organs transplanted increased each year, from 120 between the 1 December 2013 and 31 October 2014, to 160 between 1 December 2015 and 2016.

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