Current concerns over silicon breast implants raise an important question for the future of the NHS: what happens when private surgery goes wrong? Should the NHS pick up the bill?

People paying for private surgery often think they are getting better care than on the NHS. But the truth is not always so simple. If things go wrong patients may find it difficult to get access to their doctor – if your private doctor only does private work on Tuesday afternoons, what happens when things go wrong on a Wednesday? In my experience people often waste time fruitlessly trying to get hold of their doctor through the private hospital when what they really need to do is go to their local NHS Accident and Emergency Department. But why should the NHS pick up the bill for botched worked done privately for profit?

Or what happens if something unexpected happens during surgery? What if your private bowel surgeon accidentally damages your bladder? In an NHS hospital there will be a urologist on call to help. In the private hospital there may not be. You may end up making do with the wrong sort of specialist botching the job. Or what if you develop a heart problem during your hernia operation? There may not be a cardiologist to help at the private hospital. There will on the NHS.

Reforms of the NHS will encourage a much greater role for private healthcare, run for profit. It may be that the system will generate profit for the private sector whilst the NHS picks up the tab for things that go wrong.

As Lucy Reynolds points out in the Guardian, the removal of legal aid for clinical negligence and restrictions on ‘no win no fee’ representation will make it harder for patients and show that patient rights and patient safety are not at the centre of the government’s thinking.