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As we emerge from the COVID-19 pandemic and the NHS continues its uphill battle towards recovery, private clinics are becoming an option for patients across Scotland and the industry is constantly growing and developing to meet demand. As the regulator for private healthcare, Kevin Freeman-Ferguson, our Head of Service Review, gives his thoughts on how the industry is changing and what the next couple of years have in store.

Looking towards the future

As the regulator of private healthcare in Scotland, we are always looking towards the future – not only do we have to be aware of all the current developments in the industry, but we also need to be a step ahead in order to make sure that services are providing high quality care and have systems, processes and procedures in place to keep patients safe at all times. Private healthcare is constantly changing – just like other commercial sectors, it adapts to market forces to offer new services whenever it identifies an unmet need. For example, the unprecedented demand on the NHS caused by the COVID-19 pandemic has led to private care providers offering new services to patients waiting to see specialists, with a growing number aimed at people who are looking for a diagnosis of neurodiversity, such as autism, ADHD, dyspraxia and others, as well as mental health services.

Regulating private healthcare is paramount to patient safety – we have inspected over 500 private clinics across Scotland, from those offering cosmetic treatments, through to private dentistry, health screening services, private psychiatric hospitals and hospices, among others. Our inspections and their reports ensure that patients who turn to these services, due to NHS waiting lists or because they have private health insurance, or for other reasons, are being seen by the best professionals, who keep their safety and wellbeing front and centre.

Similarly, we are also noticing that the way people are using independent healthcare is changing, as well as those choosing to have health insurance and paying a monthly fee, there is a growing number opting to pay for a single operation or treatment in the independent sector. To me, this demonstrates that we as a whole continue to rely on the NHS, but will occasionally seek out particular treatments, like a specific surgical procedure or a consultation with a psychiatrist.

New challenges

These changes mean that as a regulator of independent healthcare, we are busier than ever. Many of the services that we inspect are providing specialist or emergent treatments and procedures. This means that in order to regulate them and to ensure that our inspections are thorough, we need to obtain a wide range of additional clinical input to support our work. We are tackling this by tapping into the full range of clinical expertise available within Healthcare Improvement Scotland, as well as developing a drawing on clinical experts from outside of our own organisation. 

The last couple of years has also seen a rise in healthcare being offered online, which brings with it a unique range of challenges, such as ensuring that people are protected, when in many cases, care is provided on the basis of a clinical questionnaire that relies on the honesty and transparency of the patient filling it in. While this will be reviewed by a prescriber, it is unlikely they will have a face-to-face consultation with a healthcare professional. While this can be done well, the system is easy to manipulate if good controls are not in place.  We also must make sure that aspects of the service that are carried out by computers, like identity checks and the algorithms that support diagnosis, are clinically sound and working as expected. I am happy to say that this is a challenge that we are working to rise to, through our collaboration with other regulators, as well as the providers in the sector to develop good practice.

Interestingly, while the COVID-19 pandemic has had a significant impact on how patients are using independent healthcare services, it hasn’t really impacted the way in which we carry out our inspections. To ensure that a provider follows the necessary guidelines and prioritises patient safety, we still need to physically attend the site.

Future developments

As we look ahead to the next couple of years, the biggest regulatory change will be the addition of pharmacists and pharmacy professionals to the definition of an independent clinic, which will close a small regulation gap if a pharmacy professional is working from somewhere other than a registered pharmacy giving us the powers we need to continue keeping patients safe. We will also continue working with our Scottish Government colleagues on modernising the regulatory framework so that is it better equipped to deal with services that do not engage with us or who are intent on evading regulation. Fortunately, due to how closely we work with Scottish Government, we are always well prepared for any changes, especially as more often than not, we consult on them and support with information where we can.

Kevin Freeman-Ferguson is the Head of Service Review at Healthcare Improvement Scotland.