Should I wait to have my surgery on the NHS or should I go private and reduce the waiting time to have my surgery?

This is a very difficult question to answer. I will now give you my opinion as a plastic and reconstructive surgeon working both in the NHS and private sectors. And having worked in many NHS hospitals in the UK as well as many private hospitals in the UK . The answer is it depends on the complexity of the procedure and the risks.

For all elderly people with significant other health issues such as diabetes, high blood pressure, the need for blood thinning injections etc, the best place to have any form of surgery is in the NHS. Without a doubt. This group of patients are highly susceptible to complications And they can easily deteriorate. NHS hospitals are equipped with managing these issues as this is generally a large bulk of their cohort. If the care needs to be increased such as HDU (High Dependency Unit) or ICU (Intensive Care Unit), there is generally a smoother transfer of care and if patients require other specialties again these are more accessible by the on-call system.

The downfall of such a system is the lack of administrative efficiency. For example, if you are waiting to be discharged and everything has gone smoothly, in a lot of cases you may be waiting for the paperwork to be completed by various people, junior doctors completing discharge letters, pharmacy organising your medication etc. The complex organisational system of managers introducing extra cogs and extra tick boxes that are standardised for all patients delays the whole process of admission and discharge. This can be frustrating and unfortunately is what most patients judge the care on the hospital by. Our doctors and nurses are stretched and prioritise emergency care and care in the theatres. As this is what will  influence the actual long-term quality of life. It’s these parameters that determine quality of care and outcome measures that are used both for hospital and surgeon success rate. Patient satisfaction is important however in view of the fact that NHS is not a business as such and there  will always be a constant flow of patients, gaining business is not an issue . There is no competition there is not a need to provide glossy website and shiny fluffy sofas (which are actually an infection risk anyway) . You also have to accept for nonemergency, non cancer  or situations that are not considered a priority patients will be waiting awhile.

What are the issues of having surgery in a private hospital?

Provided things go smoothly and there are no complications, the general experience of admission and discharge is more predictable and overall is smooth. There is greater administrative support particular by the non-doctor team.

However, older private hospitals were built to deal with the well-to-do group of people that were generally fit and well and required procedures with minimal burden both pre surgery and post surgery. Patients generally walk in and walk out of the hospital. With the advent of increasing waiting lists in the NHS, more complex patients have been diverted through either patient choice to pay for their care or through NHS contracts to these hospitals. Many of these hospitals were not designed or equipped to deal with complex issues therefore if there are complications, patients will be waiting to be transferred to an NHS hospital via an ambulance. This wait can lead to the loss of valuable time that could be used to treat the patient. And have detrimental outcomes. The old private hospitals are generally used to taking care of patients performing the same procedures, therefore resources or variation in the procedure may put pressures on the hospital and again patients are referred to or transfer to the NHS for seemingly straightforward situations. For example infection after an arm reduction requiring 3 days of antibiotics intravenous.

I have already said it’s the patients experience in the waiting rooms , eg.providing coffee, that can determine the judgement of a hospital environment and whether future patients return or come to the hospital. This front facing setting tends to be the emphasis for many private hospitals. And as a business this is what they focus on. I’ve worked in  private hospitals where they have the glossy websites and “free coffee” with matching booklets, logos and furniture, however when you you operate you are given instruments that are 20 years old. Needless to say I no longer operate in such hospitals and would rather have my patient go without a coffee if it means me being provided with the best surgical equipment so the operation can go smoothly.

For the younger group of patients who are fit and healthy and require a surgical procedure that is considered simple and straightforward and less resources required with low risk they would certainly benefit from having the procedure performed within the private hospital. From a plastic surgery point of view these can range from simple lumps and bumps and cysts  and day cases. These procedures on the NHS the waiting list can be over a year.

The  newer hospitals do have these facilities. Particularly as there is a general overview of privatisation, new hospitals are being built to deal with complex scenarios so things are changing but slowly, as it is extremely expensive to set up such a facility. Therefore the hospital fee will be high

So,  if you have multiple illnesses with limited mobility I would recommend maintaining your treatment within the NHS provided the wait does not compromise or cause deterioration. If you are young, fit and healthy and have to wait over a year to have a benign lump or a bunion treatment or have your carpel tunnel syndrome  on your hand, anything that doesn’t involve entering the cavities of the body whether it be the abdomen or thorax or anything that isn’t a long procedure ( shorter than 90 minutes), the private hospitals location may be a good option from a patient experience point of view.

This is a very simplistic overview however it is an early starting point in helping you make your decision.

Good luck