It is a difficult fact of life that sometimes operations designed to relieve patients of pain and discomfort do not work.
As Adrian Casey, president of the British Association of Spine Surgeons puts it: "Some patients are unlucky."
Even excellent surgeons – and there are very many of them working both in the NHS and private practice – cannot guarantee the desired outcome every time they perform surgery. Patients have to accept this.
Yet patients also trust that the hospitals where they go for treatment, whether in the public or private sector, have robust monitoring systems in place so they can be confident the surgeons working in them are providing a good standard of care.
That trust has been shaken by the case of surgeon Colin Campbell Mainds. At a hearing of a panel of the General Medical Council's Medical Practitioners' Tribunal Service in mid-March, Mr Mainds was found to have failed to provide "good clinical care" to some patients he performed spinal surgery upon at BMI Healthcare's Ross Hall hospital in Glasgow around 2009.
Mr Mainds was suspended and no longer practises at Ross Hall, but there is a broader question to be answered about the safety nets in place in private hospitals, especially those used by the NHS.
The NHS sends patients to Ross Hall in order to meet waiting times targets. As early as 2005, the chairman of the Scottish Committee for Orthopaedics and Trauma wrote to BMI Ross Hall seeking reassurances that arrangements for audit and clinical governance of total joint replacements were as robust as those in place in the wider NHS.
This raises the question of whether checks and balances in private hospitals are up to the standard of those that exist within the NHS.
BMI Healthcare insists it has always had robust systems in place to monitor individual consultants. It says it is "very willing" to provide data to the voluntary Scottish Arthroplasty Register, which monitors the outcomes of joint replacements, but is prevented from doing so, apparently because of changes to the way the data is collected. This is hardly reassuring to patients. To help build trust in their ability to maintain high standards of care, private hospitals should participate fully in such schemes as this one and the voluntary national system for auditing the work of spine surgeons that has recently been developed. If they are prevented from doing so, the monitoring bodies must act to ensure that they can.
Yet contributing to such registers is just one of the checks and balances that might highlight concerns about a surgeon's work. Within NHS hospitals, surgeons typically work as part of a team, sharing rotas and clinics with their peers. Colleagues present their results to one another on a regular basis. This makes it likely that a pattern of worrying outcomes would be picked up quickly. Could working as an independent, self-employed practitioner in a private hospital make it less likely that such a pattern would be speedily identified?
If the Scottish Government is willing for the NHS to send patients to private hospitals in order to meet waiting times targets, it must take action to ensure those hospitals have monitoring systems which are as robust as those in NHS hospitals. These are serious issues which require urgent examination.