Conflict of interests?

By Robin Stride

Consultants’ business relationships with private hospitals are being questioned in a new report voicing concerns about the possible influences on patients’ treatment.

The Centre for Health and the Public Interest (CHPI) think-tank claims those receiving fees for use of equipment they own in the independent sector is ‘problematic’ from the perspective of patient care, as it has the potential to corrupt a specialist’s clinical decision-making.

Its report, ‘Pounds for Patients? How private hospitals use financial incentives to win the business of medical consultants’, states: ‘Put simply, in the worst-case scenario, a patient could be given treatment which is unnecessary or even harmful because the consultant gains financially.’

Doctors’ shares in private hospitals are also put under the microscope. The CHPI cites US research showing ‘that where consultants own shares in the facilities in which they treat patients, the number of healthcare procedures carried out on patients in them is higher than in hospitals where consultants do not own shares.

‘This is also the case when consultants own the equipment which is used to treat or diagnose patients – when consultants own equipment it is used more often on patients than when they are not owned by consultants.’

The report, authored by CHPI director David Rowland, warns if NHS consultants have shares in private hospitals, this has the potential to influence decisions about where patients, possibly unaware of a doctor’s financial interests, are treated.

Some consultants who refer patients to private hospitals have received non-monetary gifts from the operators worth over £1,000 and this ‘might be considered to be likely calculated to induce patient referrals to private hospitals’.

While the Competition and Mar­kets Authority (CMA) 2014 private healthcare order permits ‘proportionate and reasonable’ hospitality, the CHPI questions if £1,226 rugby match tickets given to ten referring consultants, for instance, might be seen as an inducement to refer.

The think-tank claims evidence shows that both the CMA’s and NHS England’s regulations to prevent financial incentives distorting patient care are ineffective. 

The CHPI recommends the Dep­artment of Health should take the lead in this issue, as the CMA is ‘not mandated or competent to act to address the potential harm caused to patients as a result of over-treatment or the wasteful use of scarce public healthcare resources’ and should not be responsible for the law governing financial incentives.

It wants fines and, in extreme cases, custodial sentences for legal breaches and a US-type system prohibiting conflicts of interest rather than attempting to manage them.

Doctors defend investing in equipment

Consultant joint ventures facilitator Dr Tony Lopez, chief executive of Incorporated Health, responded: ‘It’s perfectly reasonable for NHS and private consultants to co-fund essential services, equipment and even hospitals and clinics.  

‘There is simply too much reliance by the UK healthcare market on foreign investment, including some of the largest established private network groups and new entrants. Many consultants are well-funded or can access suitable investment capital and vehicles and have a useful intimate knowledge of the market.’

He said the CMA’s 2014 order had safeguards to materially limit equity and ensure ‘related party’ declarations on NHS trust registers and hospital/facility websites.  

The Federation of Independent Pract­itioner Organisations expressed surprise at some CHPI assumptions, saying the GMC required doctor transparency about interests they had in facilities treating patients. 

‘FIPO upholds the premise that the only contractual relationship that matters is that between the treating consultants and the patient in front of them for whom they have a duty of care. It is difficult to understand how the assertions of “over-treatment” have been quantified.’ 

‘Privately funded healthcare services’

A CMA investigation, titled as above, was this month launched into suspected anti-competitive arrangements relating to the private healthcare sector ‘which may infringe’ the Competition  Act 1998. This is unconnected to our ‘Conflict of interests?’ story .

After reviewing parties’ responses, it will decide in October whether to proceed with a case. The CMA said: ‘No assumption should be made at this stage that the Competition Act has been infringed.

‘The CMA has not reached a view as to whether there is sufficient evidence of an infringement of competition law for it to issue a statement of objections to any of the parties under investigation. 

‘Not all cases result in the CMA issuing a statement of objections.’