There is a movement in all health fields, whether public sector or independent sector, for patients to take a more active role in decisions about their treatment. The internet is playing a central role in this by giving ordinary people access to information about medical issues which previously was available only to professionals.
CareHealth aims to provide guidance to assist individuals who need hospital treatment and have opted for the independent sector in playing an informed part in the choice of hospital where they will be treated. The advice of the medical professionals treating a particular condition will naturally have great weight but responsible individuals increasingly wish to assess for themselves the quality of the care they, or their relatives, are likely to receive.
CareHealth has asked the Health Quality Service to produce a short guide for this website covering the key issues to consider when choosing treatment in an independent sector hospital. The HQS is a charity, associated with the highly respected King's Fund, which specialises in setting quality standards for hospitals and assessing whether individual hospitals meet those standards.
The following guide, What you need to ask about treatment in an independent sector hospital, has been written by Helen Crisp, Standards Development Coordinator of the Health Quality Service. Copyright in this guide belongs to CareHealth Limited, while the remaining intellectual property rights belong to HQS.
It is divided into the following sections.
You can read the guide straight through, or click on the links above to find an individual section.
CareHealth has asked hospitals to complete a simple questionnaire covering the key questions to ask about hospital services and facilities, including the ones outlined in the guide below. The results for each hospital are given, where available, in the CareHealth directory of private hospitals.
If you are considering opting for independent healthcare, this is likely to be one of your major purchases. As with every other service you buy, either privately or through statutory services, improvements are only likely to be made when consumers are well informed and have the confidence to demand high standards.
It is likely that your choice will be motivated by some factors around lack of choice and suitability of services in what is available from the NHS. However, it is very important to ensure that you are really going to get the quality and services that you want from the independent sector and for this you will need to be armed with the facts and a checklist of questions.
There has been a major drive over the past few years for independent hospitals to demonstrate that they are providing services of a consistently high quality. The trade body, the Independent Healthcare Association (IHA), requires that all its member organisations in the hospital sector demonstrate the quality of their services by achieving a recognised quality award. The schemes which are recognised are ISO 9000 (formerly BS5750); Health Quality Service accreditation; an award from the Hospital Accreditation Programme; or an externally validated assessment for the Business Excellence Model with a specified minimum score. Check whether the hospitals you are considering are members of the IHA and which quality scheme they have achieved.
The Health Quality Service (HQS) is an independent charity that promotes quality improvement in healthcare services. The HQS quality programme works by setting organisational standards for hospitals and other healthcare organisations, and assessing whether the standards have been met. The standards are testing and rigorous, covering all the facets of the organisation from management, staff training, health and safety, facilities and equipment to suitability of care for children, the relationship between the organisation and its patients and the completeness and accuracy of health records. Assessments are carried out by team of experienced healthcare professionals, who review documentation, interview staff about their work and observe work practices in action.
Those organisations which can demonstrate compliance with all the essential standards are awarded HQS accreditation, which is valid for three years.
Independent sector hospitals fall into three main categories:
There are certain advantages generally applying to each of these categories:
Depending on the type of treatment that you need, you may need a referral from your GP. Where this is the case, your choice of hospital is likely to be largely led by the consultant to whom you have been referred by your GP. Consultants have to apply for "practice privileges" with the hospitals. While some consultants work with more than one independent hospital, others will centre all their work with one only. The consultant will expect to choose the hospital at which you will have treatment as this will be dependent on where the consultant has practice privileges. That is, they have agreed professional links with certain hospitals and not with others.
It is important to understand that in the independent sector the consultant doctor who is in charge of your medical treatment is not employed by the hospital but is an independent practitioner who is in effect a client of the hospital, using their facilities to pursue his or her business.
This means that as a user of independent healthcare, you will need to make decisions about purchasing care and treatment on at least two levels: the hospital and the consultant.
If you are purchasing your care through a self-pay arrangement, this will normally be arranged directly through the hospital. The hospital is likely to have a customer services or patient services manager who will be available on the phone to talk about treatments, operations, costs, and methods of payment. The hospital will then refer you to one of their consultants with practice privileges, in the area of care and treatment you require. Your GP will normally be informed of this referral process as well.
Your private treatment usually starts with a consultation with the Consultant to whom either your GP or the hospital has referred you. The consultation will consist of carrying out an assessment of your needs and confirming the diagnosis and treatment to be undertaken.
After the consultation, the hospital will usually be able to give you a quotation for the treatment needed. This does not usually include the initial consultation with the doctor, which you will need to pay for separately. The quotation should make it clear what is and is not included and is usually valid for a stated number of weeks or months, so that you have time to make up your mind, or pursue other options.
The point at which you can best decide about your consultant is after the initial consultation. If for any reason you do not feel comfortable with the consultant's approach it may well be worth asking either the hospital, or your GP, to refer you to another consultant so that you can gain a second opinion. Although you will have to pay again for a second, or third, initial consultation meeting it is worth doing so to ensure that you are satisfied that you are receiving the care that you want. Other than meeting with the consultant in person it is very difficult to gain information on which to base your decision.
In order to get the most out of the consultation meeting it can be helpful to write down all the questions that you have and issues that you wish to cover during the consultation session. It is all too easy to forget them once the consultant sets off on his or her agenda.
Things to consider when deciding whether to go ahead after the consultation may be:
There are many things to consider when choosing where you want to go for your independent healthcare treatment. These will include how close the hospital is to your home and whether there are choices within easy travelling distance. Not surprisingly, independent hospitals are unevenly distributed around the UK and there will more choice for people living in certain areas, notably the South East.
The questions listed below may give you some pointers - grouped under four headings to assist you in drawing up your own checklist of the things that may concern you.
*All questions asterisked relate to issues included in the HQS standards
1. What is provided for patients and for visitors, or for parents coming with children?
All independent hospitals offer single rooms, usually furnished to a high standard with en-suite bathroom or shower, TV and radio. Some hospitals also have a limited number of beds in shared rooms You can have visitors at any time, although you may need to check with nursing staff.
In most hospitals facilities are available for parents to stay overnight with children.
High quality food is the norm with choices available at every meal. Meals for visitors can usually be ordered for an additional charge.
2. What time will your operation take place? Is it after the consultant has worked a full day in the NHS?
Most independent hospitals have morning or afternoon lists for surgery on weekdays. Sometimes there is the option for a Saturday operation. Some operating theatres do work into the evening when there is a very busy list. For people with a busy schedule an evening list may be very convenient, cutting down the amount of time they are out of action.
3. What are the charges for the treatment, what exactly do they cover, what would the usual additional charges be for someone having this procedure?
Most hospitals should be able to set out this information for you in advance in the quotation prepared after your initial consultation. If there is anything ambiguous on the quotation about exactly what is covered ring the patient services/customer services department for clarification before treatment starts.
4. What charges exactly does my insurance cover - what are the extra charges likely to be?
If you are having your treatment through a health insurance scheme, or part-funded by an insurer, you will need to take these issues up with the insurance company. Health insurers have detailed schedules in place for all common procedures and will be able to tell you what is covered by your scheme. If the information from your insurer is different from what the hospital has set out for you ensure that this is clarified between the hospital and insurer before your treatment commences.
*5. Is there a medical officer available at all times?
Nearly all hospitals in the independent sector will have a resident medical officer (RMO) on-call 24 hours a day. It is important to know to what level they are trained, and their experience for dealing with the type of cases that the hospital is taking. Check that the RMO has training in advanced life support.
*6. Do the staff - and consultants - have up-to-date hepatitis immunisation?
All healthcare staff who are involved in direct clinical work which involves the risk of exposure to hepatitis should be immunised and the hospital should have a list of all staff with the dates of their last immunisation.
*7. Are children nursed by registered sick children's nurses (RSCNs)?
Most independent sector hospitals treat small numbers of children in relation to their overall workload. These hospitals therefore find it very difficult to recruit and retain specialist children's nurses. There is a national shortage of nurses with the appropriate qualifications and for the most part they want to work in dedicated children's units, where they will have the opportunity to be working with children all the time.
A few independent hospitals that do not have the appropriate staff have therefore taken the decision not to treat children, but many continue to do so, with just a telephone link for specialist children's nursing advice.
*8. Are all staff trained in basic resuscitation (CPR)?
This training is generally standard for all staff that are involved in direct patient care.
9. Are there staff with advanced life support training?
Not all the clinical staff are likely to have this training but there should be a core team of staff with advanced training, usually including the resident medical officer.
*10. Are consultants appropriately trained and accredited for all the procedures they undertake?
The consultants should let the hospital know every time they are undertaking new procedures or using new techniques. This should be checked by the Medical Advisory Committee (MAC) on a regular basis. The MAC should be assured that the necessary training and competency checks have been undertaken before new procedures/technique are undertaken. It is worth asking how often the consultants' practice privileges are routinely reviewed by the MAC.
*11. Is the professional registration of all clinical staff checked and up to date?
All hospitals should have systems for this and have all records to hand, with a 'bring-forward' system to ensure that staff have re-registered as appropriate. However, there may be gaps in situations where a hospital is using a large number of agency staff. There need to be clear procedures defining whether it is up to the agency or the hospital to check registration. All agency staff should be asked to bring the appropriate documentation with them when they first report for duty at the hospital.
*12. Are all clinical staff, and consultants, engaged in continuing professional development activities?
This is a requirement of most professional regulatory bodies and Royal Colleges and is a requirement of clinical governance arrangements. It is the hospital's responsibility to ensure that this is in place for their employed staff, nurses, physiotherapists, radiographers etc. but more difficult for the hospital to ascertain with regard to the consultants with practice privileges.
13. Does the hospital have an intensive care facility?
Not all independent hospitals have an intensive care facility. This will depend upon the type cases that they are equipped to deal with. The majority of elective surgery procedures do not require intensive care. Check with your surgeon the probability of the need for intensive care for your condition/treatment and ensure that the hospital you will attend has an appropriate level of cover and facilities.
Many hospitals have one or two patients' rooms that are denoted HDU, or high dependency unit. These facilities would not have all the technical support for intensive care but are equipped for patients requiring additional care post-operatively.
*14. For intensive care facilities – when did the nursing staff last have up-date training? How often is the unit used?
It is important the staff up-date their skills in intensive care at regular intervals. If the intensive care beds are not often required staff may not have sufficient expertise in delivering this highly specialised care.
*15. If intensive care is not available, what are the arrangements for transfer to intensive care at another facility?
Independent hospitals should have documented transfer procedures that identify the facilities to which patients will be transferred should complications arise. In many cases these are already formalised agreements with NHS trusts. It is likely that all independent hospitals will be required to have formalised agreements in the next few years.
*16. If I need to be re-admitted in an emergency will the hospital have retained a full set of medical notes?
Traditionally, consultants have kept their patients' notes - not the hospital. This is considered dangerous practice, as the hospital does not have all the information if a patient is readmitted. The culture is changing and the majority of consultants now leave a copy of their notes with the hospital.
*17. Has the hospital had a full fire safety inspection/fire certificate issued in the last three years?
This is not fully within the control of the hospital as not all fire authorities are willing to undertake routine inspections. Where there has not been an inspection undertaken by the fire authority, it would be expected that the hospital has had an independent inspection undertaken by an appropriately qualified person.
*18 Is the hospital recording, monitoring and evaluating all accidents, clinical incidents and near misses?
This is key to the requirements for clinical governance, ensuring that an organisation is constantly monitoring quality and how it can improve quality of services.
*19. How is infection control monitored? What are the rates for hospital acquired infection in the unit?
All hospitals should carry out basic infection control surveillance. Independent sector hospitals generally have a very low rate of hospital acquired infection.
20. Who provides clinical cover at night? How many nurses are on duty and are they employed staff or agency staff?
Night time staffing may be a problem for some independent hospitals, due to a general shortage of trained nurses throughout the UK. Nurses should have access to advice from a senior nurse - who may be based off-site.
*21. If agency staff are used to cover nursing posts what induction training do they undertake when coming on to the ward?
All clinical staff working in the hospital should have basic induction information. As a minimum for agency or locum staff providing short-term cover this may be in the form of written information/instructions and a walk around of the area in which they will be working.
*22. Does the hospital have care pathways in place for its most common procedures? Are these evidence based?
Care pathways set out in detail how all aspects of care and treatment should be provided for routine operations. Clinicians should only deviate from the care pathway when there is a clinical justification to demonstrate that an alternative approach is more appropriate in a particular case. It is important that care pathways are evidence-based as this means that the treatment given is based on verified evidence of what is most effective in most cases.