Dodgy implants - just a taste of what's to come under the NHS 'reforms'

[medicalmum]

Horrified but not surprised by this story (as a breast radiologist I have some idea of what the women involved will be going through). But the private sector's first duty is to make a profit and that comes before any other consideration, so naturally they made a profit by using cheap materials and never mind the patient. Or they gave an all-in price for surgery and made money by buying cheap implants

Now the argument starts as to who is responsible. The original manufacturer has left the scene of the crime. Some of the private health companies are showing signs of not wanting to take responsibility

www.guardian.co.uk/world/2012/jan/07/breast-implant-lansley-private-treatment?CMP=twt_fd

and some are even charging women for access to their own medical records.

The really worrying thing about this is that the government is pushing through 'reforms' which will mean much more NHS care delivered by this lot. Will the shrinking NHS rump be left to pick up the pieces? Will the private company even exist by the time problems are identified? Will we even know about the problems as they retreat behind the curtain of 'commercial confidentiality'? Do you want to trust your children to their care?

We have been subjected to so many media scare stories about the NHS that we have forgotten about its benefits. People abroad can't believe that we are going to let this happen. Are we?

A lot of the women affected by these shoddy implants had the operations done on the NHS. Which must mean people within the NHS responsible for procurement and quality control made a balls-up and used - as you put it "cheap materials and never mind the patient".

Agree, but at least the NHS is still there (which is more than can be said for the firm that made them) and willing to make good (unlike some of the private sector who put them in).

The story also underlines the fact that the NHS can't control the quality of what's going on at the moment and doesn't have an earthly chance of doing so once the flood gates are open to all and sundry

think you have a somewhat warped and politically biased argument here. yes private sector has to make a profit but most people know they won't do this by supplying a shoddy service that no-one wants to use. competition means that if they do this they will go out of business quickly because no-one will use them. the NHS on the other hand can get away with more as there's less competition.

When NHS "contracts out" NHS patients, then the private providers have to meet NHS specifications.

That's unconnected to the standards which might be encountered when someone buys direct as an individual.

This isn't a relevant example for the current NHS proposals.

The 'dodgy implants' were manufactured by PIP - a company that gas nothing to do with NHS or bupa, spire, or any other private medical group. The hospitals buy from the manufacturer and had no idea that the implants were substandard. The issue is how this happened at PIP - absolutely nothing to do with NHS, bupa, spire, transform, whoever.

Why does it always have to be a big conspiracy theory? PIP have made a huge error somewhere, but that doesn't mean that private medical groups have anything to do with it. I'm fed up of reading absolute rubbish on how all health-related companies are out to kill people on here lately.

don't think pip made an error did they? more like deliberate decision

The point is not just that a substandard product was used, it's about who carries the can. At the moment, it seems to be the women with implants (apart from those treated under the NHS).

If the bill is passed, no-one in future will be treated under the NHS. The taxpayer may continue to pay all or some of the cost (and we could say it was 'NHS money', but the work will be undertaken by indepdendent organisations which are free to go bust, charge the earth when they have a monopoly (anywhere geographically remote, anything highly specialised etc.)

Be careful what you wish for.

Permalice - When NHS "contracts out" NHS patients, then the private providers have to meet NHS specifications.

Nobody knows what their outcomes are. Even the Health Select Committee couldn't find out when they investigated ISTCs, because of 'commercial confidentiality'. So we won't know whether they are doing a good job or not. The CQC can't even keep track at the moment when they've been told there's a problem (see Southern Cross), they haven't a chance of monitoring all the diverse companies who will be invovled in delivering health care in future

This isn't a relevant example for the current NHS proposals

I disagree - if NHS care is delivered by the private sector as currently proposed we will see more of these problems ie the original supplier of care has moved on (has already happened in London where private sector took over GP surgeries and then left as more money to be made from commissioning) and no-on is responsible for the mess left behind. Many of these companies have paid millions of dollars of fines in US for fraud, they don't even bother to go to court contest the accusations

At the moment the Secretary of State is powerless to make the private sector take responsibility and is reduced to appealing to their sense of 'moral obligation'. If this is a measure of how much control the govt will have in the new privatised NHS, then it is not at all clear who is going be responsible for picking up the pieces in future if a) there is no 'publicly provided' health services as all providers will essentially be private providers and b) the secretary of state will no longer be accountable for the provision of a comprehensive health service."

If NHS had referred the patients for these implants, then there would be no question about NHS liability for onwards care. The continued existence or otherwise of the providers simply wouldn't be relevant. It is totally different to and unrelated to the standards offered by private clinics taking patients directly (and those are the patients for whom the SofS is appealing for private clinics to step up to the mark, not those for whom NHS has responsibility as referring body).

Clinical governance for standards of care in the future model are laid out in detail. The BMA does have concerns in this area, but they are not connected to the situation that non-NHS PIPs patients find themselves in. Especially as the success (or otherwise) of a patient referred to a private provider will be totally visible to the NHS GP, the hospital firm which makes a referral, or both.

BTW, I completely agree that CQC has not done its job terribly well to date. The recent NAO report on its shortcomings makes it very clear that it needs to be doing a far better and this will be a critical role.

Thank you for posting this, Medicalmum.

Just checking that I have it right: A person needs an op. They are referred by the NHS to a private company. The company botches the op. The NHS has to repair the damage.

And there's no Freedom of Information Act to find out what happened, and the patient has no right to apply for Legal Aid to fight a court case. In any case, the company can just disappear up its own orifice, whenever it wants.

Tell me this isn't so.

Then, Medicalmum, you made the point that by the time the NHS has finished contracting out all the services, there will be no NHS to speak of. So who will do the contracting out? Company A will contract out to Company B (the CEOs of which just happen to be best friends/married/cousins). Very soon, the smaller companies will go out of business, and your hip replacement will be performed by someone employed by a company based in Palm Springs with a call centre in Narnia.

What I don't understand is how this will actually end up cheaper for the NHS/taxpayer, as when the NHS has actually lost the facilities to perform any operations, they will be forced to pay whatever the companies demand.

It seems to me that the only winners will be the business people at the top. And the health insurance companies, of course.

Dear Solopower - I fear it is so, and has been for a while. When ISTCs were introduced to bring down waiting lists they firstly severely cherry picked who they would see (no pre exisiting conditions, they even refused patients with a history of non severe mental illness) and then when there were complications the patients were turfed back to the NHS. They did operations under conditions that would not be tolerated in the NHS - one patient died during a gall bladder op because the private facility didn't stock blood - 'well, they didn't tell us we had to'

They also have a history of here today gone tomorrow, I forget the figure for private health care companies that don't last more than 10 years but it is significant.

As for who is commissioning, we already know the GPs aren't going to be doing it but KPMG, PwC etc, they already are in some places. And yes, buying care from the private sector, undoubtedly registered under some different name offshore. The thieves in charge of the jewellery shop.

The losers are the patients. the winners are the private sector. Money will be saved only by reducing services (it's happening already) and then - would you like to buy some insurance/pay for a top up etc.

This isn't a fevered imagination, a lot of it is in train, and the train will pick up speed when the bill goes through

Permalice -

If NHS had referred the patients for these implants, then there would be no question about NHS liability for onwards care. The continued existence or otherwise of the providers simply wouldn't be relevant.

Are you saying that when the private sector contracts to deliver NHS care then the NHS is financially responsible for the disasters committed by the private sector? Then the private sector takes the profit and the NHS takes the pain? And when there is only a small rump of the true NHS left then who will pick up the pieces?

Clinical governance for standards of care in the future model are laid out in detail.

There is no way the CQC can cope with what's on its plate now, and I don't see that changing in a hurry. And I don't know why you think patient outcomes will be totally visible when cloaked in commercial confidentiality. Some things need to be exposed by collecting data nationally, I don't see how that will happen as the service fragments and is taken over by private commissioners

Why on earth isn't it a legal requirement for every operation performed by a private provider to have to be insured against potential problems? If the responsibility lay with a device provider, the insurance co could go after them.

There are lots of NHS referrals into the private sector already.

I thought they were covered by agreed clinical governance standards, and that if anything went amiss then there would be no question that NHS was responsible for onwards care of the patient The initial treatment referred out would be free to the patient, as would any subsequent work (and as now that could in NHS, same private provider or another approved private provider).

CQC certainly needs vast and rapid improvement.