BRITAIN'S biggest independent hospital group, Nuffield Hospitals, called this weekend for the government to lay down national standards of private care and new complaints procedures after an investigation by The Sunday Times into incidents in which private patients have died or been seriously injured.
Our inquiries have revealed flaws in the organisation of many private hospitals, which the present legislation on the supervision of nursing homes has failed to correct. These include the frequent absence of doctors, shortages of essential equipment and operations hurried to save doctors' time.
* A fatal accident inquiry in Glasgow heard last month that a boy, seven, died after an operation went wrong at Ross Hall hospital, run by American Medical International. The hospital's intensive care unit was shut, and when the boy was eventually transferred to an NHS hospital Ross Hall staff had difficulty starting its ambulance.
* In March, two doctors working at AMI's Harley Street Clinic in London agreed to pay £280,000 to a Saudi Arabian boy who suffered severe brain damage a few hours after non-urgent surgery. The doctors pressed ahead with the operation though the boy, aged four, had a high temperature.
* Last month, the independent St Theresa's hospital in Wimbledon, south London, was, with one of its doctors, ordered to pay £36,000 to a woman whose newborn baby died after being taken to Charing Cross NHS hospital. A court heard that St Theresa's was ill-equipped for complications which arose in this birth, and the anaesthetist was an hour late.
Each of these cases involves particular circumstances from which it would be dangerous to generalise. But they have prompted investigations which reveal gaps in private provision only now coming to the fore because of the recent rapid growth of the £1bn independent private health sector.
More than half of the 190 private hospitals have no doctors on the premises at night and almost none have resident anaesthetists. NHS hospitals generally have "crash teams" of a senior doctor, an anaesthetist and two junior doctors on 24-hour emergency call.
Even private hospitals with heart units and doing major surgery, such as the Princess Grace in London, manage emergency cover with only one doctor and nursing support. But providing for resuscitation with this number is condemned because an anaesthetist is needed to put up drips, insert tubes and administer drugs in the few minutes available to save life.
"It is very hard to handle a patient single-handed," said Dr Peter Nixon, a consultant heart specialist at Charing Cross hospital. "You could dispense with one of the people, just as you could dispense with a wheel on a four-wheeled car."
Although big London private hospitals have some of the most sophisticated medical equipment in the world, many others lack the technical backup regarded as standard in a district general hospital. Mobile X-ray units and fully-stocked 24-hour pharmacies, for example, are often lacking.
These facilities can be crucial in emergencies, such as a cardiac arrest, but there is additional anxiety about the heavy workload of consultants, who are often also employed by the NHS on full-time contracts. This can lead to operations being hurried by what one senior private medical manager called "a new generation of wallet-motivated doctors".
Such difficulties are caused less by the manner of financing private hospitals than by the economics of their small scale. Although about 65 private establishments have opened in the past five years, they will commonly have only 20 or 30 occupied beds, compared with 10 times that number in a typical district general hospital.
The difficulties imposed by size were admitted this weekend by Nuffield Hospitals, which said that it would sometimes recommend that patients use NHS facilities if the case was complex. The group's general manager, Oliver Rowell, called for the government to safeguard standards in the private sector.
At present, there are no specific controls on private hospitals, but Rowell said that the market was big enough for regulation. "I accept that the private sector is small, but it is larger and more mature than it was 10 years ago. It should now move into an arena where we should accept some broad standards.
Nuffield is also to press the government for a consumer watchdog to be set up to handle patients' complaints. Under present arrangements, if internal mechanisms fail to resolve a dispute, patients outside the NHS have recourse only to lengthy and often impracticably expensive action in the courts.
The sensitivity of anything that might add to the cost of private medicine, however, prompted cautious reactions to our inquiries from doctors. Although Dr Nixon of the Charing Cross Hospital backed the general medical opinion that full crash teams were essential, he hung up the telephone when the emergency provisions in private hospitals were broached.
Dr Brian Lewis, an anaesthetist and deputy chairman of the British Medical Association's consultants' committee, said doctors could drive to private hospitals in a few minutes. "Your readers don't want to know about this," he added. "They want to know about the problems in the NHS."
AMI said this weekend that the standards of its medical care and technical backup were completely adequate for the cases it handled. "AMI hospitals are fully equipped to do the operations that we advise our doctors we are capable of doing," said John Cassell, an AMI director. "We provide the best and most appropriate level of care."