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?

One of the worst things was the Labour government pushing hospitals (and schools) to use PFI to reconstruct or build new buildings. The contracts were so badly drafted to benefit the lenders (a fault of govt, civil servants and hospital boards) that interest rates are costing the NHs £2bn a year. Some hospitals now even have charities fundraising to keep new buildings or wards open. Some of the wards can't be staffed because allegedly the interest payments means there's no money to pay staff. It wasn't a Labour idea, but they certainly ran with it.

Haven't read the full thread, but I have been to the A&E at the Princess Grace Hospital in London twice (broken bones) and I also was seen as an emergency patient at the London Chest Clinic by a private cardiologist when I thought I'd had a heart attack (it was pericarditis).

Private hospitals do not have A&E

they also do not admit any patients with infections such as noro, or MRSA

hence when there is an emergency on one of the liners in port here and the patient wants private not NHS
then the private hospital hire NHS staff to go to the boat so as not to risk infecting their own patients

Nutty, I'm interpreting your post as "private hospitals in London have free A&E and free aftercare"....which obviously can't be right?!

Replying to previous poster (WallOps?) about why do people immediately leap to the assumption that 'not NHS' = 'US system' - yes, there are lots of other healthcare models around the world, some of which work pretty well. Many of them involve hospitals run as non-profit organisations or charitable foundations.

Unfortunately, British governments (and I include both Tory and Labour ones in this) have a tendency to see state v private as a choice between state-owned and funded, or selling things off/contracting them out to companies which are run very much for-profit, and the services then changing or being cut to suit the demands of shareholders, rather than the public or the service users.

If this happened to the NHS, the consequence could very well be a healthcare system closer to the US system rather than the much more benign models on offer elsewhere. Large American healthcare companies are already sniffing round the UK market with interest...

I agree that the current NHS model is not necessarily sustainable, and debate on healthcare funding in the UK does tend to get shut down by absolute resistance to any suggestion of insurance/co-payments/privatisation, but I have absolutely no confidence that the current government in particular would take a long-term view and look at more European/Canadian/East Asian models rather than rushing to a quick, botched solution involving profit-making companies.

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

This is one of the things Obamacare tackled. Pre-Obamacare you were charged more for going to an out-of-network hospital even if it was an emergency.

Now if it's an emergency then any ER will accept you, and can only bill you on an in-network basis. I've been through this recently (was rushed by ambulance to the nearest hospital which is not in-network for me).

"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."

How much health care poorer people got for prevention or support in managing chronic conditions would then go down. Right now, many people in A&E have chronic conditions that aren't managed well but flared up badly. The people who manage least well are probably the same ones who couldn't afford a good private package.

More people would end up using A&E even more often as a result.

Christ I have enough problem getting DP to go to the GP for things which invariably do need treated. If he had to pay, DP would just wait. DP only goes when really necessary. As well as those who go to the GP for any sniffle, are those who will not go until it is serious. Knowing several people like that, they would just leave it until A&E, which would cost the NHS far more.

Attendances at A&E have already skyrocketed because so many people struggle to get GP appointments. If it was the only free part of the service, things would get much much worse. GP visits are way cheaper for the NHS than an A&E visit.

Came on to thread to make point exexpat makes about about the interest from US providers. NHS is regularly judged the most efficient healthcare system based on the level of funding it receives.

New private hospitals like to be near NHS hospitals so it's a quick journey if they need them. Also can make life easier for doctors who do private and NHS work. My DC had day surgery in a local private hospital, it shut at 6pm with no overnight patients. Presumably if any complications required an overnight stay they would have either transported her to another of their facilities or to the nearby NHS hospital.

Having recently received treatment for a latent form of a very infectious disease which would have been a major issue for me (and others) had my latent version become active, I'm very nervous about the potential impact that charging to see GPs would have on the motivation for people to get symptoms checked out. I worry there would be an increase in contagious diseases going untreated.

Setting simple broken bones is the kind of thing a Minor Injuries private unit can do. Once it has been x rayed and the x ray interpreted, treatment is easy. Unless of course it is a complex break and may involve an in patient stay or specialists such as maxo facial surgeons.

Pericarditis is not a serious condition and does not usually involve hospital admission. I suspect the cardiologist strongly suspected it was this, and so saw you.

The kind of things A and E is really needed for are things like my elderly gran going there by ambulance immediately after having a stroke. She survived and slowly recovered. But as a very elderly person, her care was expensive. Even getting there she needed an ambulance.

The NHS was supposed to be state insurance when it was set up. You paid National Insurance to meet the cost of benefits and the NHS. The issue is that the link between funding and NI was long ago broken. We did have an insurance scheme when it was first set up.

Also whenever some services are offered free to the very poor, those who are most vulnerable are unable to complete the paperwork to access them. So homeless people, adults with learning difficulties and no supportive family, people with mental health issues and no supportive family, would all be left unable to access the NHS. Homeless people accessing the NHS is already an issue.

I have family who live in the US, who do not take all their medication, as they can't afford it.

The real solution is to give the NHS more money.

To give you a perspective from another country setting, I grew up in the U.S. Obviously our private hospitals are there to make money. If you come in to A&E with a non-life threatening emergency, like you sprained your ankle or something less serious than a trauma case due to car accident, stabbing, heart attack, etc., they will ask to see your insurance card before they will treat you. Then it is billed like any other service via your insurance (your insurance then can turn around and say it won't pay as many non-emergency services have to be pre-approved through your insurance). Sometimes insurance will pay it if it's minor and you can make the case that they should for some reason. Other times you will be billed after the fact for the cost of the care. That could be like $200 or it could be $2000 (or more), depending on what services have been provided. You can also privately negotiate with the hospital over the cost of the bill and they will often give you better rates if you are pushy. Or if you say you can't pay, many hospitals also have charitable funds they can access in cases where there is a clear inability to pay and they see this as part of their community work to improve access, etc., etc. They can also refuse to see you at all if you can't provide proof of insurance and they suspect you can't pay. For life threatening emergencies, like you have been brought in unconscious after as serious road traffic accident or whatever, they can't refuse you care, but there is no guarantee you won't receive a massive bill for it either. If you have insurance, most emergencies (like a heart attack, accident, whatever) don't need insurance pre-approval, but there have been some famous cases when insurance companies have refused to pay because the unconscious person did not get their A&E care pre-approved before they had the heart attack. Sounds ridiculous, but they'll do anything to make a profit unfortunately. In these case, again you can often negotiate a better rate with the hospital to pay privately and you may get the bill written off if you are truly unable to pay and can advocate for yourself.

I suspect it would be a system similar to the U.S. system if (god forbid!) the NHS ever did get completely privatised, but there would need to be A&E departments even in a public/private system funded in some way through some means. But that is not a system anyone will want. Having lived in it for 20+ years, it was a nightmare and I am so grateful I never have to do it again. A friend of mine (in the U.S.) just recently had a cancer scare and needed to have a tumour removed. 1 day stay in hospital and the operation, not including the doctor's fees for his own services (yet to be billed), the bill was $63,000!! He is insured and is incredibly thankful he is, so he will only pay a fraction of that. But medical bankruptcy is such a common thing and you can see exactly why.

While there are various private 'walk in' and 'urgent care' facilities across the country, if you have an RTC, have been shot or stabbed, in cardiac arrest, have got meningococcal septicaemia or a whole host of other trauma or medical emergencies you will want an NHS ED. If you have surgery in a private hospital and it goes tits up, you will be taken by NHS ambulance to an NHS ED, if you give birth in a private hospital and again something goes horribly wrong and either you or your baby require specialist emergency care, you will be sent to an NHS hospital. Private do not do 'emergency' well. There is no profit in it so there is no reason for them to develop those skills or invest in them because the NHS will deal with the problem and pick up the tab. Having worked in a number of London hospitals I can assure you that the rich and famous use NHS ED's when the chips are down because their Harley St set up doesn't have a clue. I find it inconceivable that we will stop having NHS ED's because the alternative is horrific. People being made bankrupt because their insurance didn't cover them for stroke, people self discharging prematurely because they can't afford the care, people dying unnecessarily because they can't get insurance or can't afford it. I have the benefit of spending time in the US health system as part of my speciality and I can tell you, the hospitals looked amazing but you are well and truly fucked if you can't pay for those facilities.

Private hospitals usually don't do A & E. Generally you go to an NHS A&E and get moved to a private hospital when it is safe.

The reason people talk about the US system is because this is where what we're sleepwalking towards. There is no national debate about healthcare funding that can lead us to a French-style system. We even have fledgling Accountable Care Otganisations in our STP proposals.

And a PP asked about what have we stopped doing? Well, cataract operations and hip & knee replacements are harder to get funding for, for a start. A Manchester CCG was looking for a reduction in referrals for colonoscopies...

The great man himself

And again

I had to go to an amercian a and e once. It was exactly like an english one in terms of lots of waiting between tests and seeing doctors, the smell and the uncomfy chairs. The only difference was before i could even see the booking in desk i had to spend 30 minutes with the money people, and then literally ever other person i saw asked me how i was paying for it 😳😰

There are no private A & E's in the UK
Also if you do go private and have say a cardiac arrest in the evening post surgery when all the consultants and surgeons have left for the day for example in a private hospital there will only be one resident doctor on call along with a few very experienced nurses.
If they couldn't resuscitate you using the crash trolley then you would have to go to A & E anyway via an NHS ambulance wasting valuable time.
Also at a private hospital after your surgery you will pushed out the door far quicker than in the NHS because it is a business, so just hope you have no underlying health problems.
You have exactly the same consultants and surgeons you might have on the NHS only you have to wait a bit longer, but not always.
Also a few surgeons who have been struck off at the NHS end up working as surgeons in the private sector.
You will be treated like a queen whilst you're there with lovely food and tea and cake etc but if anything dramatic happens then off to A&E you go.

Those who were saying that in the private system abroad one can choose the BEST paediatrician or other specialist without the GP gatekeeper I
In my opinion you are justifying our system.
The benefit of the uk system is that the small child with feckless parent gets the same treatment as the pfb of the well educated time rich parent with google skills.we should be very proud of free at the point of contact.
Most attendees at GP surgery or A&E are small children or elderly. I.e. Vulnerable. Systems that put these groups second are not what we in uk have traditionally wanted... have we changed?

One of our private hospitals has an A&E - well a minor injuries unit - its £69 for a stand by consultation. Presumably you go there if you cant be bothered waiting 3 weeks to see the GP.

@MotherofSausage in Switzerland everything is paid for. If you go to A&E you are asked for your insurance details before they will treat you. The same applies to any medical treatment. It's all very quick and efficient though - just a form to fill in then on to the triage nurse. I imagine (hope) the insurance step would be sorted later if you came in as a serious emergency.

It is a two-tier system of public and private hospitals; you pay extra for the private hospitals which are generally smaller and posher. I do know people who have been turned away from the local private hospital and sent into the nearest big town to the public one because their insurance didn't cover the private hospital. (One had acute appendicitis and was ambulanced, the other a broken arm and made her own way by car - husband drove.). I'm not sure whether the so-called public hospitals would treat people without insurance.

Generally the system works well - they will see anyone at A&E, no one is sent away because they are not ill enough. The system isn't abused because healthcare is generally available (so you don't have to wait weeks to see GP. ) The wait at A&E is usually 2-4 hours. The cost is no more than an ordinary doctor appointment, about 80-120 pounds, plus x-rays etc extra.

Personally I am glad not to have to depend on the NHS. I fear that eventually it will all be privatised and the private (in reality ex-NHS) hospitals will have to accept emergencies. We pay a lot in insurance (about 500 pounds a month each for DH and me) but we have got our money's worth in recent years as I have had a lot of surgery, and am on a lot of meds... we pay upfront for these at cost (so for e.g., blood pressure meds are cheap, some antidepressants and opiates are expensive), but claim back from insurance, up to a limit. I always go over the limit so have to self fund some medicine.

The NHS is currently focusing on providing fewer but more specialised major trauma centres. So in London there are a couple of places that specialise in cardiac emergencies. Outside London? Who knows? If you're in Scotland or Wales it may be one.
Privatisation will chase the money. Right now there may be a routine A&E in London. If you're outside London or dying, you'll be taken to NHS.
People argue that the model is not necessarily US or NHS but the current government has courted only the U.S. model. Nobody is talking socialized care because that doesn't fit with free market policies.

I'd like a specific rate of deduction from wages dedicated to the NHS rather than the vague awareness I have at the moment that it's partly from national insurance but also from general taxation. On this thread, where people are paying for other systems and know exactly what the deduction is, it always seems to be more but there is an acceptance because they are clear about what it is.

It's not just A&E the private sector can't deal with. My friend's husband had abdominal surgery in the local private hospital. When he developed post-op complications that required further (acute) surgery overnight, the private called an ambulance and sent him the local NHS hospital (major trauma centre, proper A&E, theatres staffed 24hrs) to sort it out. Private hospitals exist to make money - providing major trauma facilities, acute care and staffing theatres round the clock is expensive.