The Portland syndrome: you pay the money and take the risk

As a leading private hospital is damned for its neglect of a woman who died after giving birth, the Government signals that failing NHS hospitals could be handed to private managers. What is going on?

Jo Dillon
Sunday 20 January 2002 01:00
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It's been the childbirth equivalent of dinner at The Ivy or, if you prefer, staggering out of the Met Bar at 2am. The Portland Hospital in London, where mothers-to-be can enjoy champagne delivered by room service, be spruced up for photos at an in-house beauty salon, request a Caesarean for cosmetic reasons and have epidurals on tap, has effectively been an A-list baby farm.

It charges around £6,000 for childbirth, and celebrity children delivered there include Brooklyn, son of Victoria and David Beckham, Woody, first-born of DJ Fatboy Slim and Zoe Ball, and Princesses Beatrice and Eugenie, daughters of the Duke and Duchess of York. Fashionable, centrally located and ultra-private, the hospital has been first choice for the most privileged of mothers.

Last week, though, a very different, darker account of the Portland Hospital emerged, an account that is likely to have consequences not just for this particular private hospital, but for whole of the private health sector. It was an account of neglect and bad practice – and it cost a mother her life.

Laura Touche – a direct descendant of the former United States President Thomas Jefferson and the wife of Peter Touche, grandson of the founder of the accountancy firm Deloitte & Touche – died nine days after giving birth by Caesarean section at the Portland to twin boys, Alexander and Charles, in February 1999. She was just 31.

Last week an inquest into her death found that neglect by staff at the exclusive clinic had contributed to her death by natural causes. Though the midwife Grace Bartholomew was held responsible for the lack of monitoring of the patient, the hospital itself was also criticised. Medical and nursing standards, training and discipline were held by the coroner, Dr Susan Hungerford, to be "rightly the source of public concern".

Mrs Touche should have been checked every 15 minutes after leaving the operating theatre. But no checks were made for two and a half hours. When she complained of an agonising headache, her blood pressure was found to be too high and she was rushed to Middlesex NHS Hospital, and from there to the specialist National Hospital for Neurology and Neurosurgery, where she died on 15 February.

Dr David Bogod, a consultant obstetrician at Nottingham City Hospital, advised Mrs Touche's husband throughout the inquest. Mr Touche had thought his wife would get the highest possible standards of care by going private, but the doctor said: "Laura would have received better care in the worst example of a failing NHS trust."

The Touche case – said to have cast light on a "catalogue of errors" in the private health sector – has prompted renewed calls for non-NHS hospitals to be better regulated. The campaign group Action for the Proper Regulation of Private Hospitals (Aprop) wants swift change to protect private patients from negligence and inadequate care. But its members fear the Government's proposed regulatory body, the National Care Standards Commission, will be "toothless". They believe the powerful private health sector lobby has triumphed again.

Aprop's chairman John Nambie said: "The Touche case, as ghastly as it is, has illustrated, very well, certain things. One is that if you go into a private hospital you are more at risk than you are in an NHS hospital where there is a team of doctors and nurses for every individual speciality, whereas in a private hospital you are at the mercy of a single Registered Medical Officer.

"Again, it illustrates that these hospitals usually have no intensive care facilities – certainly not to NHS standards – and that is why people have to be moved urgently from private hospitals in the event of complications."

Mr Nambie also complained of a lack of accountability in some private hospitals and a tendency to settle claims out of court in an attempt to "cover up" when things go wrong. "These people back-track, obfuscate, prevaricate, change notes, lie, you name it."

The Touche case was not a tragic one-off. Research by Brian Williams, professor of public health medicine at Nottingham University, published in 2000, found that at least 1,000 patients a year were being transferred from small private hospitals to NHS intensive care units when operations went wrong. A trade union source said that NHS workers had got "sick and tired of having private patients shifted into the NHS to sort things out when they go wrong".

The story of Laura Touche has fuelled concern about standards and equipment in the private health sector at a time when the Government is planning to increase use of its facilities to ease the strain on the NHS. It has also bolstered political disquiet in the week that Alan Milburn, the Secretary of State for Health, fronted the Prime Minister's focus on public services.

Mr Milburn – to the outrage of Labour MPs opposed to virtually any involvement by the private sector in the provision of services – announced that failing hospitals (around 12 are expected to be in the first wave) are to be put in the hands of private-sector managers. Meanwhile, the high-flying hospitals are to be released from the shackles of Whitehall control to become self-governing concerns capable of deciding for themselves how they spend their money.

The controversial proposals have caused a rumpus among Labour backbenchers. They have been branded a blueprint for the break-up of the NHS, though Mr Milburn and Tony Blair insist almost weekly that the Labour government is committed to a free-at-the-point-of-use National Health Service.

The Government argues instead that the NHS can no longer remain a monolithic nationalised industry. Ministers want more independence for successful hospitals, greater capacity – whether in the NHS itself or for the NHS through private health care – and an end to doctrinal barriers to reform.

Critics would not be silenced. Unison, the trade union, which has tirelessly campaigned since the general election on a "keep public services public" platform, dismissed the plans as a "Railtrack for the NHS".

The Touche case has been grist to their mill. A spokesman for the GMB trade union said: "This is one of the serious concerns about the Government opting to have capacity in the private sector. At least if you are in the NHS environment and having what is a routine operation, if there are complications those complications can be dealt with immediately and on site. If you have complications in a private hospital you have to be rushed across town."

If Mr Milburn's plans are to go ahead, individual Labour MPs with failing hospitals in their constituencies will be forced to sell the idea of private management to voters.

"The mistake Mr Milburn has made is that until now the party has been standing back watching what has been a fairly abstract argument. Now we will be able to identify hospitals where private managers will be going in," the GMB spokesman said. "We are going to mount a campaign against this."

The two sides in the public-private debate, for the first time, seem genuinely lined up against one another. The death of Laura Touche has put those standing with Mr Blair and Mr Milburn at an early disadvantage.

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