Imagine it's Saturday night and you're at the local emergency room: you've injured your finger and you're facing a long and painful wait surrounded by vomiting, drunk and bloody children. If you knew you could sneak down the driveway, be ushered through a nice (deserted) waiting room, into the arms of a calm, fully trained doctor or nurse, for a price, would you do it? For most, the answer to this is yes, depending on the price. Those with stricter principles (or no money) might say "never". But what if the injured was his four-year-old daughter?
That's the opinion of the founders of Emergency Plus, the UK's first private 24-hour emergency service. The unit is situated in a converted supermarket in the leafy village of Byfleet in Surrey, just off the M25. I admit I visited with goosebumps, fully prepared to violently oppose the whole enterprise as part of a private trend that will further bleed NHS workers and divide our society into first and third class citizens. I had visions of a bunch of charlatans grabbing money, walking you through the door with your painful wound, taking your credit card from your trembling hand, then stitching you up and massively charging you hidden extras.
However, the brainchild of local businesswoman Angie Liston (with private backers), Emergency Plus is far less threatening than she imagined. It was conceived out of Liston's desperation at having to wait in the emergency room with his young son and a burned foot. In business terms, it is a bold move considering that the competition is a monopoly, a household name and offering the same service for free. But the concept of private emergency treatment is not new: it works in countries like the USA, Australia and South Africa, where all medicine is private. And Emergency Plus has a rather vulnerable "target customer base". If you're bleeding to death on the esplanade, you don't care how much it costs to get in. Even if you don't think you're going to die, with a basic £25 'consultation fee' most people on incomes would be willing to cough up to avoid waiting six hours in traffic for an ambulance
The practice manager, Dr. Johan DuPlessis, a South African, took me on a tour and assured me that they would simply give us 'choices'. The waiting room is filled with rugs, flower pots, copies of Country Life and free coffee. There's even a health food store if you're hungry. Not that you will spend much time waiting. "I can," says DuPlessis, "go from one to five doctors in an hour." The unit is said to be able to serve upwards of 200 "clients" a day, although the maximum so far has been about 30. Five doctors are on staff, none of them clumsy, sleep-deprived interns working eight hours a day. guards, as well as nine nurses. And in case of massive accidents (likely), there is a bank of 3,000 doctors to call upon. I can't guarantee you won't have to wait, but they sure do.
The facility isn't really a full emergency room, although they have all the gurneys, swabs, and defibrillators to handle, at least initially, trauma. The "clients" they want to attract are those who do not need hospital support (such as major operations or intensive care). DuPlessis interrupted my vision of a smiling receptionist turning away car accident victims and assured me that the Hippocratic Oath still applies at Byfleet. In extreme emergencies, his staff would stabilize patients before transferring them to a local hospital.
But posing as a "24-hour doctor and emergency service" is "taking a big risk", according to Mr CA Perez-Avila, consultant in accident and emergency medicine at the Royal Sussex Hospital. Although she believes that "anything that gets patients with minor injuries out of a busy emergency room is a good thing," Pérez-Ávila sees a minefield of potential disaster when it starts marketing itself as an emergency service: "What what could look like a minor case of abdominal pain could quickly turn out to be a ruptured ectopic pregnancy," he says, "in which case you quickly need blood transfusion equipment and other resources that only a hospital can provide." The time it takes to get to an ambulance, instead of calling 999 to call 911, can mean the difference between life and death.
So while such a clinic appears to offer options to patients, this option can be dangerous for those who need a "full spectrum of emergencies and major accidents".
The preferred target group for Emergency Plus is those who are not in urgent need of emergency care, who can afford to "take their health into their own hands". So you can enter the clinic at 3am and have a vasectomy (£195 for the operation, plus £200 for the on-call surgeon). In fact, 24 hours a day you can get a cholesterol test, have a mole removed, go for a "well woman" (or man) check, get an injection or have your leg stitched up. In affluent Surrey teeming with businessmen not known for their social awareness, who need and can afford out-of-hours services, this is certainly a shrewd business idea.
However, the introduction of payment also brings with it other gray areas. What would happen, I asked, if I had a heart attack right now on my front door, was resuscitated and transferred to a local hospital? Would I be charged for Emergency Plus even if I didn't choose to come here? The answer is a qualified yes. Assuming he survives, he would get a nice letter with a bill for the equipment used, plus transport to hospital (£515.93 - happened to a man last week). What if he can't pay? Then he would be treated like any other "bad debtor". Of course the board would use their discretion (I guess they wouldn't charge my grieving family if I didn't make it). Well, this is business.
The local community does not seem to have any doubts about the new clinic. "I think that's good," says a nearby pharmacist. "I would pay to use it rather than wait for a crash." Local GPs of course refer people to the clinic, the clinic refers people to the local dentist and even those who cannot afford to use it do not see it as an insult. "You can still go to St Peter's [in nearby Chertsey] or Guildford," says an older woman. For most people, it's all about affordability. And the prices don't seem excessively high. Break your leg the easy way and you'll be billed for around £85; your finger will need six stitches, that will be £45. An asthma attack will cost you around £68. You are informed of the costs of each step. But who, in front of a good doctor set up with anesthetic, would say, "Forty-five pounds! That's ridiculous! I'm taking myself to the emergency room to wait five hours."
Choice, then, is a murky concept when it involves pain and fear. However, many of my concerns were allayed by following official NHS policy. For example, what happens if a "client" brings in a child with a suspicious injury? If they pay for the treatment, does that change the relationship with the healthcare provider? I was assured that Emergency Plus would follow NHS procedure here, just as they would if a mentally ill person sought treatment for self-inflicted injuries. But if this is the future of emergency medicine and such kits proliferate, others may not be so reliable. There is plenty of room for abuse: unnecessary procedures, for example low-quality care or simply too high prices.
This entity is regulated by West SurreyHealthThe authority, which has "free access" to all clinical records, although the quality of treatment is self-regulated. It seems unlikely that overburdened health authorities have the resources to inspect and regulate the national expansion of emergencies. And they intend to reproduce. There are plans for two more units near Byfleet and eventually a national network. Since no insurance company will cover a medical emergency, such companies are forever destined to be the privilege of those with money. However, if they really only deal with minor injuries and offer a range of sophisticated services (such as complementary medicine and nutritional advice), they differ little from existing dispensaries, many of which struggle to find 'clients'. That said, if I opened my finger I could still hold on, but if it was my son I'm sure I'd be in the local ER before you could say "hypocrite".