Paying for an operation privately but performed in an NHS hospital - has anyone had any experience of this??

[BorntoDillyDally]

Quick background - FIL has been experiencing some health issues over the last few years. He had an exploratory procedure (via the NHS) in May. An issue was discovered. He is still yet to hear back from the department.

The issue worsened very much over the summer and resulted in a hospital stay so FIL decided he wanted it resolved and went down the private route. We had a consultation with a private consultant (who also works at our local NHS hospital) and was told he could perform the op privately, no issue. FIL has decided to go ahead with this. The operation is booked for the end of this month.

We assumed it would all go ahead at the local private hospital but have discovered that due to a number of potential complications (FIL being 85 and medically obese), the op will be performed at our local NHS hospital but still under the private hospital. It will cost him £25k.

We had the final consultation yesterday and had naturally assumed FIL would be transfered back to the private hospital after the op, when he was settled (the private hospital is just over a mile away from the NHS one) but have been told it is safer for him to spend his complete stay at the NHS hospital. The op will be about 5 hours long and if all goes well it should be a 2 day recovery stay.
Of course the safest place for him is the best place for him and if this is the NHS hospital then so be it.

In all honesty I didn't even know private paying patients were having operations within NHS settings but I suppose it all helps go towards the NHS purse?

Has anyone done this? How did it go?

Hi op I hope all goes well for him, I don’t have personal experience of this but wonder if it’s so that they have access to hdu/itu if needed?

My DH had a private op in an NHS hospital. It went fine. To be honest, your relative is far better off in an NHS hospital. Private hospitals have the very minimum of facilities and limited trained staff, especially overnight.

I think it may be. I have been googling and it looks as though there have been a few tragic cases over the last few years of people having operations in private settings and dying because of complications and not being able to get to the ITC in time. I imagine they are covering themselves as FIL is classed as high risk.

That's good to know. We were hoping he would have been transfered back to the private hospital after the op so he could have his own room but of course, if he needs to in the most safest place and if that is on an NHS ward then that is how it should be.

Paying privately for the op just basically means he cuts the waiting times or doesn’t have to wait to fit the nhs criteria. I would just consider myself lucky that the nhs will cover his recovery costs, otherwise he could be paying more above the 25k surgery cost. Hope all goes well and wishing a speedy recovery.

I used to work in theatres at a private hospital, extremely few of them have any kind of high dependency care on site, if something goes wrong then it's an NHS ambulance to hospital. Due to this they generally only take patients up to a certain level of anaesthetic risk.

The staffing levels, equipment and availability of that equipment is generally better in NHS theatres, plus there being back up in case things go awry means it's usually a safer place to be.

I hope things go well for him. It’s the best possible place given his age and they aren’t covering themselves they are making a sensible, informed clinical decision in his best interests.

My Dad had this. He actually got a pretty hefty per night payment from his insurance for every night he spent in the NHS hospital - so look into that and make sure you’re getting your full compensation. It really added up!

In my workplace the private patients get the same care as NHS patients (ie staff might not realise that you are paying). This sometimes surprises patients who expect prioritisation/ better food etc.

You are paying to essentially queue jump and this is facilitated by the surgeon providing additional non-NHS time and the hospital facilitating this with capacity.

The hospital charges a “facility fee” to cover medications, supplies, nursing, ancillary staff etc. My institution relies of these fees to make the numbers work for the NHS patients. We built a new operating theatre and to make it cost effective we have to do a certain amount of private work In that theatre we do entire lists of private patients to provide capacity for the surgeons but other patients may be done mixed into an NHS list.

The anaesthetist may be doing the same as the surgeon and providing additional time for which they receive a specific fee directly or may be working as normal (ie paid by NHS) In which case the hospital is paid an anaesthetic fee to cover their time.

You probably won’t know what arrangement is in place as all fees are collected by the private patient dept and then passed on as required. Most of my colleagues and I work under the latter arrangement because it’s a small volume and we’re not interested in setting up private indemnity, billing or paying an account, or working more hours than we have agreed with our NHS employer. I never discuss how I am paid with patients and I’m pretty sure my colleagues don’t either.

If you are offered care in an NHS hospital you know the staff are all qualified and experienced although patients who equate a high profile private practice with being a “top doc” might be disappointed. I once had a patient reluctant to allow us to look after them as an emergency for an urgent procedure (so the NHS was paying) at 4am and wanted to be transferred to the private hospital (where the staff have virtually no experience of doing the procedure as it is almost always performed in the NHS) in addition organising transfer and finding a private surgeon/anaesthetist (if even possible, at that time of night) would have delayed time critical surgery and an NHS Consultant surgeon, anaesthetist and theatre team were all ready to go.

The surgeon involved was actually an international expert (who does work privately), and the rest of the team in theatre/on the ward care for patients having this operation regularly, as do I (although if you put me into Google I don’t have an international reputation or private practice profile!).

The crucial thing for me was that we all worked with the surgeon and each other regularly. It was the kind of operation that requires a lot of team work which I wasn’t at all sure could be replicated in the private sector under these circumstances. If it had been my loved one I would have been really happy with what the NHS was offering but I got the impression all the patient saw was NHS = shit, Private = amazing.

Make sure he will be getting a private room.

Like hell would I be paying £25k and having to be on a bay with people.

Private rooms are allocated on clinical need not want (even if you are paying).

also if you require intensive monitoring post op it’s safer to be clearly visible to the nursing team in a bay.

FIL is self funding.

It's not the actual surgical team that concerns me. We've consulted with both the surgeon and the anaesthetist and are we more than happy with them (and their team).

I have no issue with any surgical team at this hospital. I worked there myself for over a decade and am due my own NHS operation there later this year.

It's the aftercare when back on the ward which concerns me. FIL ended up in this hospital in May, for a week. My elderly mother ended up in the same hospital for a month and has only recently been discharged. The care on the ward was dreadful for both of them. The very reason he chose to use his life savings for this op was in the hope of better aftercare as his recent experience had shaken him.

I just hope his recovery is swift and he's not on a ward as dreadful as the previous one.

Maybe on intensive care wards but from my own experience sitting every day with my elderly mother the care on a standard ward (she ended up on two different wards) was woefully I adequate. I'm fairly relaxed about things and rarely complain but it was not a good experience.

I can only but hope FIL's will be a more positive one.

Some NHS hospitals have private wards or private wings. St Mary's has the Lindo wing.

In any high risk surgery you need ICU / HDU available.

Is there any money left in the pot OP? Your FIL could employ a private nurse. I worked in a Private Hospital and it wasn't uncommon for a patient to employ their own nurse.

We did this with my mum (she has a lot of mobility problems and needed some equipment which they don't normally have in private hospitals).

It was an NHS hospital which had a private department/suite within it. So she had her initial consultation in the private department, booked into a private room on the day of the op, was taken into the main NHS hospital surgery area to have the op done by the private consultant, and then taken back to the private room to stay the night.

This worked out really well for her. I totally agree that a private room and aftercare (getting more attention from nurses and choosing nice food from a menu etc) was better for her than the times she's been on an NHS ward.

My son had a private op in an NHS hospital. Not the same, because he was 1 year old and too young for the op in the private hospital.

It was a day case for foot surgery. He was in a bay with other children who were sick and likely contagious due to all of the coughing, etc.

We were treated worse by the nurses than the NHS patients were. Obviously he had been nil by mouth from the previous day. After his surgery, all of the other children in the bay (and their parents!) were given lunch. There was nothing for my baby. He was 1 and could eat the same type of lunch - sandwich, yoghurt, fruit - but they weren't interested in feeding him despite him being allowed to eat and having had nothing since the previous day.

Thankfully, while my husband went to find the canteen for something for at least the baby, the surgeon came to check on us and expedited the discharge so we could get out of there.

Also, I had to have a cervical scan during my high-risk pregnancy, which my consultant arranged in the NHS next door. (St Mary's and Lindo Wing mentioned above. My other scans were in a private specialist clinic.)

The sonographer/ receptionist kept me waiting for nearly 2 hours despite having an appointment. She saw all of the NHS patients that arrived after I had, before me, seemingly to make a point. I had arrived a little early and was my usual polite self, there was no reason to treat me that way. I hadn't been forgotten as the waiting room was small and I was mostly the only one there as everyone else was ushered through soon after they arrived.

I hope the surgery goes well and that your FIL has a better experience than I had, hopefully with private aftercare. The medical aspect was all good, but we were treated almost with contempt by the NHS staff.

I don't know why, perhaps they saw us as an extra workload that they weren't personally paid extra for, but I'm sure the NHS took a good cut of the money paid by our insurance.

That does sound ideal, sadly that isn't an option within this hospital.

Oh goodness what a horrible set of experiences for you, that's dreadful.

I do hope it goes well with FIL. I had to make quite a fuss in the end when it came to my mum's care.

Are you expecting NHS staff to give your FIL more time and care than they do the NHS patients in an NHS hospital? If so, wouldn't that make the care they have time to give the NHS patients on the NHS ward even more woefully inadequate?

I have no problem with people paying to avoid the NHS, but that's not what's happening. Doctors' training is subsidised by taxpayers (and they learn using NHS facilities), and as you have discovered many 'private' operations are carried out on NHS premises by staff who are employed by the NHS. The NHS picks up cases where things go wrong, too.

What you have paid for is basically an overtime payment to the surgeon which has allowed you to jump the queue. I'm not sure what more you can reasonably expect. Staff should probably hide any frustrations they might have (particularly where babies and children are concerned), but if they routinely deal with patients whose outcomes may have been better had they not been pushed back in the queue, then perhaps it's understandable that they find it hard to do so.

Of course we are not expecting the NHS staff to pander to his every whim and to give him preferential treatment. That's not what I have said at all.

My FIL has a condition which was detected by the NHS, in May this year following an investigative procedure. We are still yet to hear back following this, he is still on a waiting list. We consulted with the private surgeon to find out what the prognosis was and where to go from there. We discovered that FIL is likely to die within a year if he does not have this operation and therefore he felt he had no choice but to pay for the operation to be performed privately (it goes without saying this prognosis was a shock). At the time of consultation we all naturally assumed the operation and aftercare would be performed at the private hospital but upon discovering FIL's SORT percentage rate it was deemed an unsuitable operation at the private hospital and therefore would need to be performed at the local NHS hospital. This was all the consultants decision, we are simply going along with his decisions and expertise as we have no option but to lay our trust with him. My FIL is a normal working class person with a little bit put away for a rainy day which has now come, he is by no means a finaically comfortable person with money to throw at private healthcare just to simply jump NHS queues. Being told you may only have a year to live without surgery is a tad scary.

It would have been nice to have had a different option with the aftercare and when I say aftercare I am talking about ward care which is often very inadequate within the NHS and as I have mentioned in a previous reply both FIL and my own mother have had very recent experiences of this, at the exact same hospital and theirs have not been positive ones. So yes, we were hoping that paying privately and a lot of money at that would have secured a more comfortable and private post-op experience and only time will tell I suppose but no, we are not expecting the NHS staff to give him special treament, we were not expecting the NHS to be involved at all.

it seems a little unusual that the surgeon hasn't suggested that they could refer back to the NHS in view of the new/progress in his condition. If the untreated prognosis really is that bad it will probably get him bumped some significant way further up the waiting list.

fwiw though it's not at all uncommon to decline to do higher risk customers in the private. Aside from the immediate perioperative risk the ongoing care can be pretty patchy - if the nurses aren't used to looking after more complex customers and the RMO is suboptimal then it's easy for any deterioration to pass by unnoticed. The bog-standard private hospital will only be able to stabilise sickies in theatre/have a small 'hdu' area which is essentially a holding space with a bit more kit until the ambulance arrives - they will do that if someone falls of their perch by surprise, but shouldn't be planning to do cases at risk of needing more intervention than they usually provide. Some private hospitals though do have a more comprehensive high-risk set up so if you're dead set on staying in the private it may be worth exploring where his nearest is though.

none of the risk prediction tools factor in all the known information and SORT only tells you what the predicted 30 day mortality is not what the risk of morbidity (ie. serious complications other than death) - they will also be thinking about the other potential complications when they're advising where's the safest site to be cared for.

Following the initial consultation, I suggested to DH and FIL we try chasing up the NHS to get a second opinion but FIL was adamant he wanted to go with this surgeon and down the private route. I personally would have opted for a second opinion, I wonder if the NHS would have declined to perform the op? We will never know.

FIL is set on the op and the safest option is within an NHS setting so we will just have to hope and pray his after care on the ward isn't as sub-standard as we have so far experienced this summer. Fingers crossed.

What't the mortality prediction for the operation? Sounds like he is pretty high risk with a high risk condition (is it an aortic aneurysm?).

Careful decision making required all round. Do you have faith surgeon has weighed everything and isn't just a "there is a fracture I must fix it" type?

In the NHS the various MDT type processes exist generally to stop this mentality, private patient pathways can bypass them. This type of scenario was the cause of my last major disagreement with a surgical colleague who had booked a private high risk patient, who had only been partially worked up onto a Saturday list and wouldn't consider postponing.

The link may not translate well outside the profession, but you said you'd worked in hospitals.

I had private treatment in an NHS hospital for similar reasons, but it was a dedicated facility within the broader hospital setting - use of the normal theatres but the "ward" was private. I also had another surgery in a private hospital which had the potential to be complicated, and was told if it did I would wake up in the local NHS hospital. Luckily it all went well.