CURRENT BRITISH BARRIERS TO PRIVATE MEDICAL PRACTICE

Bureaucracy gone mad

What's 30 pounds, after all, if it stops another Shipman? That's what I told myself. And there won't be another Harold Shipman. That's what the nice man from the Health Care Commission (HCC) told me. They're making sure of that - with our help of course. The œ30 was what my GP charged me for sending the HCC copies of my personal medical records.

You never can be too sure, can you? I am a doctor so I am under suspicion. Quite right. No one should be above suspicion. I left the NHS last year after 25 years and was hoping to see patients in private rooms two afternoons a week, which means I have to register with the HCC. I downloaded the pack and started on the paper work. I'm happy to comply and pay the œ600 fee. After all, we have to protect the public, don't we?

At least my bank didn't charge me for providing details of my personal finances, which the HCC also needed. The criminal records bureau (CRB) wanted 38 pounds for an enhanced level search. I already had clearance but not at an enhanced level, and not with the HCC name on the form.

What I hadn't realised, until the nice man from the HCC made a visit, was that all the staff also had to have CRB clearance: my secretary, the physiotherapist, the occupational therapist, the nurse, the receptionist, even the cleaner. I was surprised that the women also had to have clearance - after all, how many female paedophiles are there? The helpful man answered my question by mentioning Rosemary West. Good point. No matter how small the risk....

I explained that we see no children under the age of 18, but apparently that doesn't matter. I guess the staff may be up to something at the weekend! It's more complicated getting their clearance because we have to get 'an umbrella agency' to act for us, so the cost goes up a bit to 42 pounds each. It's very straightforward: you just fill in the form, present copies of your birth certificate, passport, utility bills, etc, to the agency, pay the fee, and wait two months. Out of interest, I asked how many people they had found thus far with criminal records? None yet, was the reply. But how can you tell whether the kindly nurse is really a murderous paedophile?

CRB clearance is nothing these days. We all have to do it. Well, that's what I thought, but I was shocked to find that none of my colleagues in NHS hospitals have to do it. New staff yes, but not existing staff. How many people is that? Several hundred thousand, I guess. Now that is scary - think of all the criminals in among that lot pretending to be honest healthcare workers.

What I hadn't appreciated, until the man came to make his inspection, was all the personal data that we needed to keep for our staff (in a locked cabinet, of course). Two references, a recent photo, a copy of their passport, copies of their qualification certificates, a curriculum vitae with explanations for any gaps, a copy of their contract and job description.

Including the cleaner? Yes, including the cleaner. 'It's not me who makes the regulations', said the man from the HCC. 'The onus is on you to comply with the statutory requirements as set out in the standards of care regulations. We are not here to enforce, simply to register. And you must legally register.' We constructed some references for the cleaner and of course enrolled her in the appraisal process, which she didn't seem to mind.

Why the cleaner, I asked? Ah, that's easy - 'Holly Wells and Jessica Chapman might still be alive if these regulations had been in place'. But we don't see or treat children or vulnerable adults - if we did, a further tranch of regulations come into play. Nevertheless, we must do everything we can to prevent frightful murders like that. The cleaner was somewhat grumpy the following week when she couldn't start her work because the electrical testing man was checking her Hoover for safety, another of the HCC requirements, and a bargain at 130 pounds.

Our long-suffering nurse had taken on the role of health and safety officer, and had made a thorough risk assessment of the building. We had a bit of a joke about the kettle, which is a clear risk, but we addressed the problem by putting up a large notice saying it 'may contain hot water'. We also looked at the shiny floor, the fire alarms, fire testing, the safety of the tap water, the evacuation procedures. We thought we had it sorted.

'What about defenestration?' the man asked. Blank looks all around. 'What exactly is defenestration?' 'Big windows like these could blow out in a blast. Is it safety glass?' We agreed to get back to the architect we had used to provide the floor plan that the HCC had required. (Sorry, did I not mention that they need the floor plan in their file, alongside a copy of the lease and planning consent?)

Were we sure the building had the right planning approval? 'But I thought that was the responsibility of the local planning department?' How naive! Did I not appreciate that the HCC is there to protect the interests of patients who might be in a building with potentially the wrong planning use. B1 office use is not the same as D1 public service use. Point taken.

I have to admit that I was really impressed by the man from the HCC. He seemed a very unassuming chap, and yet had a huge breadth of knowledge as well as an understanding of defenestration.

I asked him what qualifications you needed to be able to make a valid judgement about my bank statements, my personal medical records, the floor plan of the building, the lease and our business plan. (We also had to provide him with a business plan, a copy of the last two years' audited accounts and a signed disclosure allowing him to access the company bank account.) He had been a nurse and then a manager in the NHS before. Well, that explains it. Of course, I am sure he had needed extra training on how to evaluate our Patients Guide, which we had to produce as part of the statutory requirements, and similarly our Statement of Purpose, which explains what we do.

We had worked hard on the written policies on complaints, emergencies, fire, health and safety, but we were told they were incomplete. I was told that the full list was in appendix C of the Standards of Care Act. I counted them - 35. It was just as well we looked, since we might have been at risk from an unguarded compliment or gift. We are now mercifully protected by our compliments and gifts policy, which we feel covers all eventualities, as does the risk assessment for COSHH. COSHH? You know, substances hazardous to health. We didn't think we had any of these but we hadn't read the small print. Apparently Tippex can be very hazardous if accidentally swallowed, but now it's covered with a two-page risk assessment.

We got most of the documentation sorted and the HCC came back to have another look. We had installed the emergency call button in the disabled toilet, 'which had to be accessible to the collapsed person lying on the floor', and bulked up the Statement of Purpose, which now includes loads of information about to whom to complain if we aren't matching up.

'What do you do that is so risky?', I hear you ask. I see patients as a medical practitioner as described under section 2(4) of the Standards of Care Act (2000). What that boils down to is being a doctor. I talk to my patients and I suggest things to help them. I don't do surgery or operations. I don't even take blood or carry out intimate examinations, but that's no matter because what I do needs regulation. Because we don't want another Shipman, do we? No, absolutely not.

I am sure we won't have another Shipman, especially now that diamorphine has been banned from every hospital in the whole country on his account, and we have these terrific regulations.

I asked the HCC inspector how they were getting on with the inspection of NHS GPs, but they aren't bothering with them yet. Nor with any of the more than 40,000 physiotherapists practising in the country. Presumably it's based on a risk analysis, just the same as our kettle. The clever people in the HCC have done a risk analysis and they think that the 30,000 NHS GPs are low risk, so they focus on the few dozen private sector people like me. And all for œ78million, which is what the HCC will cost this year. If it prevents one death then that has to be worth it, doesn't it?

Tony Blair doesn't understand this at all. He thinks that Britain is in danger of developing a 'wholly disproportionate' concern about risks. 'Health and safety laws have saved lives by cutting accidents and improving the environment', he said in a speech to the Institute for Public Policy Research in London earlier this year. But he believes that too often public bodies seek to do everything to avoid blame. 'In the end, risk is inescapable', he said. 'The government cannot eliminate all risk. But too often our reflex as a society is to regulate and to introduce new rules.' What is he talking about?

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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