When Christine Booker, 79, went into a private hospital for a hip operation in February last year, it promised to be a straightforward procedure that came only weeks after she had celebrated her 60th wedding anniversary with her husband Peter, 84.
But what should have been a routine op resulted instead in a tragic series of events and Christine’s death.
An inquest heard how, during the procedure, the surgeon at the Winterbourne Hospital in Dorchester drilled a hole in her hip socket in order to screw an artificial replacement joint into place.
But blood flowed from the drill hole and it only stopped after the surgeon inserted the screw. As a result, Christine, from Wareham, Dorset, lost half a litre of blood – considered high for such a routine procedure.
Within hours of the surgery, Christine’s blood pressure plummeted because of internal bleeding and she fell unconscious. Staff at the private hospital tried to resuscitate her, but in the end had to call an ambulance to rush Christine to the nearby NHS Dorset County Hospital.
Christine Booker, 79, with her husband Peter, 84. Christine died after attending a private hospital for a routine hip operation in February last year
That’s because, as is typical of private hospitals (including those that provide ops for NHS patients), the Winterbourne Hospital did not have the facilities to provide emergency treatment.
Instead, it relies on nearby NHS facilities to step in when patients develop serious post-surgical complications.
However, the Dorset County Hospital did not run an interventional radiology service (which provides imaging such as X-rays or ultrasound to guide surgeons) out of normal working hours – and such imaging was necessary to stem Christine’s internal bleeding.
So she was flown 27 miles by air ambulance to the Royal Bournemouth Hospital, arriving three hours after her initial collapse.
There she underwent embolisation – a procedure to stop the bleeding by blocking blood vessels – but died the following day of shock from blood loss, the inquest recorded.
Both the Dorset coroner, Brendan Allen, and Christine’s daughter, Simone Evans, argued the lack of an out-of-hours radiology service at the NHS Dorset County Hospital exposed Christine to an ‘increased risk of death’. The coroner had no criticism of the private hospital itself.
Clearly, the NHS treatment delay may have worsened her survival chances, yet Christine’s case – and hundreds like it every year – pose a broader and increasingly urgent question: should our hard-pressed NHS really be expected so readily to take on patients from profit-making private hospitals whenever their operations go wrong?
Christine was one of more than 740 patients in 2023 who were rushed from private hospitals to NHS units by ambulance because their condition deteriorated beyond the private facilities’ ability to cope.
And that number is set to grow because private hospitals are taking on more procedures on behalf of the NHS as it struggles to cope with workloads and waiting lists.
In August 2022, hip patient Geoffrey Hoad, 86, died after waiting for more than 14 hours for an ambulance to transfer him from a private hospital to an NHS unit less than a mile away
Meanwhile, increasing numbers of people are digging deep into their savings rather than endure lengthy NHS waiting lists.
A record 73,000 people paid for their own private hospital treatment (rather than use medical insurance) in 2023, according to data from the Private Healthcare Information Network (PHIN). Private hospital admissions are also higher than ever – nearly 900,000 last year – says PHIN.
Sadly, Christine’s story is by no means unique. In 2022, Carol Hatch, 73, from Leeds, suffered a series of professional errors after hernia surgery at the city’s Spire private hospital.
Her operation should have been straightforward – surgery to repair a hiatus hernia that was causing acid reflux and heartburn. After all, Carol had had the very same operation seven years earlier for a previous hiatus hernia.
However, as the coroner’s report later pointed out, she became seriously unwell during the night after the surgery. Even though her notes said she had been ‘crying in pain’ at around 10 pm, no one took any observations on her in the early hours of the morning. It was not until 7am that her surgeon returned and saw the extent of her deterioration.
Even then, several hours passed before an ambulance was called to rush Carol to St James’s University NHS Hospital in Leeds, since the private hospital did not have adequate facilities for her emergency.
Tragically, Carol died after six weeks in intensive care because of septic shock – dangerously plummeting blood pressure caused by infection – and consequent organ failure.
Kevin McLoughlin, the senior coroner for West Yorkshire, issued a ‘prevention of future deaths report’, which is issued when a coroner believes action should be taken to prevent similar deaths.
This report criticised the Spire Hospital in Leeds for ‘failure to appreciate the urgency of the situation in a patient who was displaying symptoms of septic shock’. The coroner added his concern that the staff involved had not been reported to their professions’ disciplinary regulators by hospital management.
In its response to the report, the Spire Hospital said Carol’s death was ‘regrettably avoidable’.
In December 2021, Christina Ruse, 79, died after developing complications following a hip replacement
But it added that the problems highlighted ‘had already been identified and addressed’ and there were no disciplinary grounds to refer the night doctor involved to the General Medical Council (GMC). Meanwhile, it said, the night nurse’s agency employer considered the case ‘a learning opportunity rather than a disciplinary referral’.
Alarmingly, the practice of private hospitals rushing patients to NHS units (which the industry calls ‘unplanned transfers’) is increasingly common. Latest figures from the PHIN, which is commissioned by the Government to monitor the sector’s activity, show that there were more than 740 of these ‘unplanned transfers’ to NHS emergency care in 2023 – up from less than 600 in 2020.
It means that around one in 1,000 private healthcare patients needs an emergency post-op transfer. But analysis by the health-policy think-tank the Centre for Health and the Public Interest (CHPI) suggests the true figure may be much higher – around one in 250 for some private centres.
Such unplanned emergency transfers are fraught with the risk of things going wrong with patients’ conditions, care and medication.
A report in the journal Critical Care in 2015 found up to 70 per cent of such transfers resulted in ‘adverse safety incidents’.
PHIN spokesman Alistair Moses told Good Health that most unplanned transfers involve urgent emergencies, though some patients are sent back into the NHS because either the health service had wrongly assessed their treatment needs or the private unit found it didn’t have the services to treat them.
Meanwhile, private hospitals are taking ever more admissions. In 2022, the total was 835,000 surgical patients. PHIN says the 2023 figure is likely to be a record 881,000, thanks to NHS patients being siphoned into private hospitals.
The Independent Healthcare Providers Network (IHPN) said in March that private operators carried out a record 1.67 million procedures on NHS patients in 2023, which is nearly a third higher than in 2019.
This amounts to around 10 per cent of all patients’ elective procedures, such as hip and knee replacements.
In August 2022, hip patient Geoffrey Hoad, 86, died after waiting for more than 14 hours for an ambulance to transfer him from a private hospital to an NHS unit less than a mile away.
The retired company secretary from Wingfield, near Diss in Norfolk, had hip surgery under general anaesthetic, without complications, at the private Spire Hospital in Colney, near Norwich. But three days later, while recovering at the facility, his condition deteriorated.
Spire Norwich does not deal with emergency treatment and an ambulance was called to transfer him to the NHS Norfolk and Norwich Hospital, which is a five-minute drive.
Private hospitals are taking on more procedures on behalf of the NHS as it struggles to cope with workloads and waiting lists
But it took paramedics more than 14 hours to arrive.
An inquest heard that the ambulance service had told Spire staff there was a delay of six hours, but the delays worsened and, despite eventually being admitted for emergency care, Geoffrey deteriorated further and died from a heart attack later that day.
The county’s senior coroner, Jacqueline Lake, said at the inquiry: ‘Waiting over 14 hours [for an ambulance] is not acceptable by any stretch of the imagination, and these delays are continuing.’
However, she said that the Spire Hospital was ‘fully aware’ of the pressures on the ambulance service and resulting delays, yet ‘Spire is continuing to rely on an NHS service which is clearly under great pressure and is clearly struggling to meet its time targets, and delays are continuing. I have concerns that the risk of death continues’.
Lawyer Anne Saunderson from Fosters Solicitors, who represented Mr Hoad’s family at the inquest, said: ‘This is not the first time that HM Coroner has issued warning notices in relation to a death involving significant delays in the provision of ambulances to transfer patients from Spire Norwich hospital to local NHS hospitals.’
Indeed, the case echoes two remarkably similar inquests in which Spire Hospital patients in Colney died after their conditions deteriorated and they faced long ambulance delays.
In December 2021, Christina Ruse, 79, died after developing complications following a hip replacement. She had opted to go private because of a lengthy NHS waiting list, but there were complications after her surgery.
Again, staff called an ambulance to take her to A&E at Norfolk and Norwich NHS hospital, but it took an hour and a half to arrive. In this time, Spire surgeons had rushed her back into theatre to try to stem bleeding that was making her blood pressure plunge and the ambulance did not wait.
Another had to be called after her operation and Christina finally arrived at the NHS hospital three hours after the original call. Sadly, she died the following day.
Her inquest ruled she had died from blood loss and multiple organ failure.
Only ten months previously, in February 2021, 71-year-old Barbara Hollis died after having knee replacement surgery at the same hospital.
After the op, her condition deteriorated significantly. Spire staff said at her inquest that they had told emergency services that ‘immediate clinical intervention was needed’.
Nevertheless, there was a 96-minute delay before she got to hospital and a high-dependency unit bed. Barbara died during the early hours of the next day.
She had developed a fat embolism – a clot of fat in her blood vessels – as a consequence of surgery, and died subsequently of a heart attack, according to her coroner’s report.
The East of England Ambulance Service NHS Trust told the inquest it had introduced new procedures to cope with increases in demand for unplanned transfers and subsequent delays in responding to patients.
David Rowland, director of the Centre for Health and the Public Interest (CHPI), says that much more must be done to protect private hospital patients when things go wrong with their surgery.
‘Transferring unwell patients from a private hospital to an NHS hospital is a known patient safety risk which all patients treated in the private sector face – including the increased numbers of NHS patients treated in private hospitals,’ he says.
‘Despite numerous tragedies, and despite the fact that politicians and regulators are fully aware of this risk, nothing has been done to address it.’
Back in 2017, the CHPI published a report on patient safety in private hospitals that made this stark recommendation: ‘Private hospitals will not be truly safe unless they have adequate facilities to deal with situations where a patient’s life becomes endangered following an operation, ending the hazardous transfer of patients to NHS hospitals.’
Indeed, in 2018, the then Health Secretary, Jeremy Hunt, wrote to the chief executives of all private hospitals that provide surgery, warning that they had to improve their emergency procedures urgently when their operations go wrong.
Mr Hunt said the fact that ‘many private providers lack appropriate escalation processes [to treat patients whose conditions are deteriorating] or transfer agreements is unacceptable’.
And he urged: ‘All healthcare providers dealing with routine procedures need to have clear processes for managing deterioration and for escalation.’
However, since then, the number of private patients being rushed into the NHS has risen significantly.
A spokesman for the Department of Health and Social Care said: ‘NHS England has, under successive governments, commissioned care from the private sector; this can help the NHS respond to patients’ needs, and deliver the commitments set out in the NHS Constitution to provide timely treatment.
‘Commissioners of NHS healthcare services must ensure that the NHS provides the highest quality of services possible, on a financially and operationally sustainable footing, which delivers the best outcomes for patients.’
A Spire spokesperson told Good Health: ‘Transfer of patients out of our facilities is an extremely rare occurrence and significant delays are even rarer.
‘We continue to work closely with regional ambulance services and local NHS trusts on ways to ease delays for patients receiving care, recognising that this is a challenge for entire local healthcare systems.’
David Hare, chief executive of the IHPN, told Good Health: ‘Independent healthcare providers are treating increasing numbers of both NHS and private patients, and are proud of the safe, high-quality patient care they deliver – with a CQC [Care Quality Commission] rating over 92 per cent of acute independent hospitals as good or outstanding.’