Private patients in NHS hospitals: comparison of two sources of information

Background The use of National Health Service (NHS) hospitals to treat priv ate patients is debatable on the grounds of equity of access. Hospital Epis odes Statistics (HES) annual reports are the only routine source of informa tion on the scale of this activity. The accuracy of the information is doub ted. This enquiry tested the completeness of HES data against information o btained directly from private patient unit managers. Method Managers of the 71 pay bed units in NHS hospitals in England were as ked to supply from local resisters and accounts the numbers of in-patients and day cases admitted in 1995-1996, Their reports were matched with the nu mbers of first consultant episodes for private in-patients and day cases sh own for those hospitals in the HES data file for that year. Results Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62 572 against 54 131; 13 per cent more in-patient admissions, 39 776 against 35 319; and 21 per cent more day cases, 22 796 against 18 812. More total admissions were reported by managers of 38 pay bed units than we re recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases, Reasons f or the under-reporting of private patients in HES included the use of separ ate patient administration systems for private patients with a failure to f eed data to HES, and the omission of some provider units altogether by a mi nority of trusts from the returns made to the Department of Health. Conclusion Overall, HES underestimates the amount of private patient activi ty reported directly by NHS hospitals. No method of validating private pati ent data is currently available. An amendment to an existing statistical re turn would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by providers to the HES proce ssing agency should be reinforced.