As the Government’s roadmap out of lockdown begins, for many people the most pressing priority is accessing desperately needed hospital treatment or surgery, postponed due to the pressures of COVID-19. 

With 4.7 million people on waiting lists for routine surgical procedures some may considering private treatment to resolve their health problem and looking at funding options.

A binary perception of NHS or private services is too simplistic. 

Health and care are an interdependent 'eco-system' and the majority of the population use both privately funded and publicly funded services. 

It is people’s right to choose how they are treated.  

However, it can be confusing for people with some services 'branded' NHS but offering some privately funded healthcare services, for example flu vaccines for patients not eligible to NHS flu vaccinations. 

Other mixed provision occurs, for example with NHS Hospital private beds. 

Also, private, voluntary, charitable or social enterprise organisations may provide services that are publicly funded, on behalf of the NHS.  

There is a potential to create an unconscious blindness to the differences between publicly and privately funded healthcare. 

Reassuringly for patients the quality of care is measured in the same way by system regulators.

However, the rights and 'safety nets' provided with publicly funded treatment are not the same for private patients.  

The 'consumer' who opts for a private pathway needs to be aware of the differences so they can assess all the benefits and risks as part of the decision-making process.

As new legislation on integration and innovation is developed, and the regulation related to health and care professionals is reviewed, PIF calls on all providers to supply health literate information to patients to support their decision making on the use of publicly funded or privately services.

The Perfect Patient Information Journey (PPIJ)

The PIF Perfect Patient Information Journey process is flexible to a range of uses and can be used to ensure stakeholders consider the differences between publicly and privately funded healthcare, for example:  

  1. Leadership – NHSE, private providers and leadership bodies, such as those within the Academy of Medical Royal Colleges (AoMRC), should run public and patient engagement on information to support integrated service models where pathways may include both publicly funded and privately funded elements of care and treatment. It is essential that privately funded services, such as cancer or elective surgery in NHS private patient units (NHS PPU), are included in this.
  2. Patient input – clarify what information needs are not already met by providers of publicly or privately funded services, as well as provided by other organisations such as the Private Healthcare Information Network (PHIN).  
  3. Healthcare professional input – find out what staff know/think about information on publicly and privately funded services. Learn from other experiences across the UK, for example, The Patients’ Guide, set out in the Independent Health Care (Wales) Regulations 2011.
  4. Mapping – use the insights to co-create information on how the 'safety nets' embedded in the NHS Constitution vary in privately funded pathways. This should cover when things go wrong and how complaints are escalated, issues that have previously been identified by patient groups.  
  5. Identify and make improvements – to support informed decision making on the benefits of access to privately funded services, against the general risks (to supplement separate procedure specific information). Ensure access to information is timely and in accessible formats.
  6. Evaluate impact of change – use quality improvement (QI) methodology, such as the ‘plan, do, study, act’ (PDSA) to make the changes to information on publicly/privately funded services. Evaluate impact and make further improvements where necessary.
  7. Benchmark – monitor effectiveness over time and review with the input of patient groups, professionals and other stakeholders.  

Real life experiences of integrated healthcare

Patient information must embrace the design principles set out by the NHS, and must consider the public’s real-life experiences of integrated healthcare.  

  • Put the ‘whole’ person at the centre (respect people’s needs/design with compassion).
  • Outcome focused (improved quality of life/need to return to work).
  • Inclusive (respect and meet different needs).
  • Understand context (consider people’s entire experience of plural pathways).
  • Design for trust and transparency (in professionals and system).
  • Test your design (using people who choose from a range of service providers).  
  • Make, learn, iterate (test and refine).
  • Keep it simple (do not push complexity onto patient in small print, for example, in a private healthcare Terms and Conditions).
  • Make things open (make sure information is accessible and transparent).

These principles are embedded in the criteria for the PIF TICK scheme for trustworthy health information. 

As people varyingly seek access to both publicly and privately funded healthcare, it is essential they have trustworthy and transparent information to support health literacy and decision making – 'consent with candour'.

About the author

Karen Harrowing is an independent adviser in healthcare governance, quality systems and medication safety.

She has provided expert opinion and independent advice on private healthcare, including in relation the issues concerning Ian Paterson. 

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