AIBU to ask how A&E works in private hospitals?

[ComingUpTrumps]

This is a really simplistic question, so sorry in advance! I'm just interested, and wasn't sure where to ask it.

I was watching the last episode of Trust Me (about a nurse posing as an A&E doctor) last night, and in the episode they had a few patients brought in with chemical and thermal burns after an accident at a factory or something similar. It was really difficult to watch and quite upsetting.

Anyway, this got me thinking about the NHS, and how with different governments, feelings about the NHS can vary. So for example, under the last Labour government, the NHS was seen as fairly important and was prioritised by the government.

However, under the last couple of Conservative governments, there seems to be a feeling that the Conservatives are pushing for people to use private healthcare rather than using the NHS. My question is: AIBU to ask how A and E works in private hospitals? Is it the same sort of thing as in the NHS?

There isn't private a&e. Once admitted, they are often transferred to their preferred private hospital/private ward within the hospital. I struggle with private patients, they often have pretty demanding attitudes and I've known them call their private consultants mid-treatment and demand something else going from their recommendation 🙄

....no A&E departments in private hospitals, even in London
Not entirely true. Princess Grace Hospital in W1 has an "Urgent Care Centre" now - I think it started a couple of years ago. It is open 8.00 am to 10.00 pm so not as useful as NHS A&E. From my experience, you get seen by a doctor there who examines you, does initial investigations and then, if warranted, refers you onto the relevant specialist in the Central London area - for preference, one that already has admitting rights to Princess Grace (I work for various consultants in that area). They call the specialist's practice and ask whether they can see the patient urgently. I suppose they keep ringing around until they find someone who can. Also, the Hospital of St John & St Elizabeth (in St John's Wood, London) has an Urgent Care Centre but it seems to deal only with minor injuries and illnesses and if you are an actual emergency, they think you should dial 999.

Why assume it will be like the US? What do patients in France, Germany and Switzerland do? (Or is this just a ruse for yet another Tory-bash?)

Theres a somewhat complicated system in France of subsidy and assurance arrangements which will cover some costs but there is still sometimes a charge.

(Or is this just a ruse for yet another Tory-bash?)

Mother I apologise if the posts I've written come across that way (if your comment is directed at what I've written).

None of what I've written is aimed at the Tories or Labour or any particular government, and I realise that I shouldn't really have mentioned politics and governments at all in my OP. I was just aiming to give a bit of context, but maybe it wasn't a good idea.

I'm just curious really about the difference between private and NHS healthcare. I've never actually been treated in hospital for anything apart from a one-off trip to A&E out of desperation (not related to physical health), where I was really impressed at the level of care I was given.

We're losing our big main local hospital A and E (always busy, saved bitg mine and my mums life and have taken children for asthma etc....)

Instead were merging with one half an hour away (further for those that would have driven from the other direction to us first). A place with severe traffic issues and parking...

The cuts are real. This scares me already!

However, under the last couple of Conservative governments, there seems to be a feeling that the Conservatives are pushing for people to use private healthcare rather than using the NHS.

Are you very conveniently forgetting that Labour introduced PFI?

Where does the 'seems to be a feeling' come from, regarding private health?

As a PP said this is just another Tory bash thread.

I'm no Conservative but it astounds me how so many in here seem to think Labour can do no wrong, and have done how erased decades of political history from their tiny minds.

If the NHS goes then I think there will need to be a big reorganisation of private hospitals and they way the work.

At present they can't provide safe acute care - they are mostly geared to lucrative elective planned work (for which they cherry pick off the well patients leaving the NHS to deal with the unwell ones even if they have private health insurance).

However if the NHS goes a lot of us will have more time on our hands to work in the private sector so I think a service would evolve.

I was speaking to an american colleague she was really surpised that in the NHS I have ready access to IV Paracetamol for patients. This is a safe drug which has a good evidence base to suggest it is much more effective than oral. We use it to reduce the amount of stronger painkillers which carry risks of side effects. She doesn't have access to it in the States because of cost.

Therefore she has to choose that her patients either get oral Paracetamol only and have higher pain scores. Or oral paracetamol and opiates and a higher risk of morbidity.

We need to be careful what we wish for...

The idea that if we don't have the NHS exactly as it is (or was in 1948) then we must instead have the American system is a peculiar British terror which inhibits all sensible discussion about how to cope with a really difficult societal challenge: funding healthcare.

Both the American shambles and the NHS are weird outliers - what almost everyone else does is roughly to have some kind of universal Government-backed insurance system which then pays for private provision. This avoids the horrors of a private insurance market and the challenges of the government having to employ millions of people to staff hospitals.

The business about people making some kind of co-payment (as in France for lots of stuff, or as here with prescriptions) is just a minor detail, although personally I think it's a great idea.

The private EDs are not level 1 EDs and will not accept true emergencies. They see a mix of minor illness and injuries and will charge for absolutely everything.
The one in Manchester which opened as a private A&E in 2007 now calls itself an Urgent Care (private walk in centre)
As others have said, there is no money to be made in Emergency Medicine so the state will always provide it. This means true emergencies though and will exclude the majority of patients who currently attend.
DOI Emergency Medicine doctor for 25 yrs

mrsjoyful with all due respect I don't think the Priness Grace's urgent care centre with it's restricted opening hours is in anyway comparable to an NHS ED which has 24 hour opening and is available to London Ambulance Service....

Centralisation is real. The Tories health cuts are haemorrhaging staff - a report in the Daily Record yesterday 8.2% of Consultant posts in Scotland are vacant along with a huge number of nursing posts.

An ED struggling to cover it's roster is probably more dangerous than a well staffed one 30 minutes away. The massive massive success at reducing mortality from major trauma by centralising services (necessitating longer travel times/ use of helicopters etc) is testament to that fact that sometimes bigger is better.

Why assume it will be like the US? What do patients in France, Germany and Switzerland do? (Or is this just a ruse for yet another Tory-bash?)

Patients in France generally go to A&Es in public hospitals, just like you do in the UK.

As a PP said this is just another Tory bash thread

Shelly, as I've said before, I'm sorry for involving any government or particular political party at all in my OP. This absolutely is not a Tory-bashing thread, nor is it Labour/Lib Dem/Green/UKIP/Monster Raving Loony party bashing either.

Also, in terms of Labour introducing PFI, I haven't 'conveniently forgotten' this. I was 5 and had been living abroad for several years when Labour came to power, so politics wasn't on mind for most of the time that they were in power, and certainly wasn't when they introduced PFI.

Again, I don't know any private hospitals in the UK that run A&E services.

In America if you turn up at A&E as a walk in case you have to fill in a form with all your insurance details before you get seen. If you get rushed in via ambulance etc and aren't fit to give details on arrival, my understanding is that they will provide life-saving care and take insurance details once you are better. If you don't have insurance then you will be given a bill when you leave (or your family get given a bill if you die). This can be for many thousands of dollars.

What daisybell said.

These threads and the press always surprise me. Most other European countries have insurance-based systems with some element of co-pay and support for the most vulnerable. And the standards are often superior to those of our NHS.

If the NHS were abolished, I would expect it to be replaced by some form of insurance based system. This would extend to A and E, as it does in other countries.

Also, with regard to NHS patients who transfer to private care - lots of them have private insurance through their jobs and have never used it so don't think to try it initially. We usually get called to see if they can transfer to a private specialist when they are worried they are not receiving quick enough treatment as either an out-patient or an in-patient (which is often the case as poor NHS can't do things for patients as fast as they would like to). Some of their private medical insurance policies state that they are entitled to private care only if the same treatment was not available within six weeks in the NHS - I think this clause might have been extended now because few things are available within six weeks on the NHS, in my (NHS patient) experience. In my (many, many years' private med sec experience) we have only had a handful of patients transferred from NHS in-patient are to private hospital (and I don't mean private wing of NHS hospital, most of them don't have them any more) - one of them had unstable angina and was being told she needed a coronary angiogram to see what was going on but the hospital did not have a resident cardiologist and she would have to wait a couple of days until the one from another hospital in the group did his round and could see her. Her friend called me, described the fact that the poor patient was still having terrible angina whilst lying still in bed (red flag symptom!) so we arranged for her to whiz over to private hospital (with much co-operation from NHS staff, who were relieved she could get sorted out quicker that way) and she turned out to have a critical cardiac lesion which needed angioplasty immediately - her life was saved by going privately as it is very unlikely she'd have lasted another two days without intervention. It's not all bad - all my patients are private patients - they aren't all rich - some, as I've said, have policies via their employment and do low paid jobs otherwise. They come from all walks of life - some are entitled pains but most are just normal people... and pleasant, polite and interesting.

Steeley If we get a call from an existing patient (currently receiving NHS treatment) who wants to know advice of the private specialist, they are usually told that their doctors are welcome to contact us for information, if they wish. Very often the NHS doctors do want to discuss the case with the specialist as some of the patients have hugely complicated medical histories or are tricky cases. If the patient wants to follow their private specialist's advice contrary to that of their NHS doctors, they should discharge themselves and transfer to private practice. We make clear to them that if they are under an NHS consultant, they must take their advice.

A&E services are expensive. Yes you get people going with minor stuff that they shouldn't. But you also get people going with major serious stuff that is expensive to treat and needs treated asap.
I was taken to A&E in an ambulance, called by a nurse on my behalf, and spent 4 days in hospital having lots of tests and treatment.

On the day of admittance, I had a home visit by a nurse, an ambulance with 2 staff, and a paramedic who attended on a motorbike before the ambulance got there. I was seen by a Dr, who ordered 2 tests immediately. A porter wheeled me down for these as I could not walk far. Then the Dr reviewed the results with another Dr there - they discussed my case, and admitted me. Before I was admitted a HCA brought drinks, offered sandwiches and checked I was okay - I had no one with me. All of that alone, before I actually had any treatment, must have cost a fortune. And I was not nearly as ill as some patients.

Remember private insurance is a business. They are there to make money. There are plenty of chronically ill people who pay an absolute fortune just for 2 weeks of holiday insurance. The biggest users of the NHS are children, and elderly people. And their treatment can be very expensive.

If the NHS is abolished I would expect big NHS hospitals to become private providers.

The existing private providers current model couldn't cope with out an NHS as back up.

Both the American shambles and the NHS are weird outliers - what almost everyone else does is roughly to have some kind of universal Government-backed insurance system which then pays for private provision

Not true of all European systems e.g. France. Most big hospitals in France are publicly owned and staffed by public employees.

The business about people making some kind of co-payment (as in France for lots of stuff

Copayments exist in theory in France but are disappearing in practice as the government is implementing obligatory top-up insurance to reduce health poverty.

There is an interesting discussion to be had re the merits of the European social insurance model, but you have to get your facts straight first.

European countries that have insurance and co pay pay more for their healthcare. If we wanted a better NHS we could have it, but it costs. Britain spends relatively little on health care.

Not entirely relevant but wouldn't the NHS still have to provide free treatment to children?

Why ? You're assuming (1) there will be an NHS indefinitely and (2) it will work the way you think it should.

Plenty of other countries in the world where you pay or die. Why should the UK be such a snowflake ?

Copayments are a very bad idea. They simply stop people who are poor getting the treatment they need. It won't be the very poorest people who suffer as they will get it free. It will be people working, on not great money, and the self employed. I already don't get sick pay. Being ill costs me money. Having to pay copay as well would just add to my financial burden when ill.

When I lived in the USA, my daughter had to be rushed to A & E with a severe allergic reaction. They asked about insurance, and as we were covered by my husbands' company insurance, we were taken to a certain hospital for treatment. If we hadn't have had insurance, we would have been taken to another (more basic state provided ) hospital. I wouldn't like to see the NHS disappear but it is often misused ( cosmetic procedures, binge drinkers, missed appointments etc.) and some people, even those who complain about 'struggling', seem happy to pay monthly for things like nail extensions, cigarettes etc. but would object to paying a similar amount to protect their health.

Surely the obvious solution is for the NHS to become solely A&E and everything else be dealt with privately. Much the same way that NHS dental care seems to be going.