A nose for a bargain? Go private

If you decide to jump the NHS queue and pay for surgery, you find yourself in a jungle. Be a `consumer' and shop around

So this is how normal people breathe! For the first time in 30- something years the flow of air up my left nostril is unimpeded. The nasal twang I had always associated with my Scouse origins has diminished, and other people's slumber is no longer disturbed by my occasional snoring.

I underwent my nose job - definitely not cosmetic, but structural - seven weeks ago. It was my first encounter, as a customer, with private medicine. I am delighted with the result, but disturbed by what I discovered en route to normal service being resumed in what my surgeon described as "the most congested nostril I have ever seen".

When I was a baby I was dropped nose first on to a coffee table. I grew up as one of those adenoidal little girls who never quite made it to the top of the NHS waiting list to have them - my adenoids - whipped out, as was the fashion.

My accident had pushed the septum (the central partition inside the nose) to one side, and my nose had never developed normally as a result. I finally got an appointment at a London teaching hospital after a three- month wait. The problem, I was told by the consultant ear, nose and throat surgeon, could be rectified with a simple operation. "I'll put you on the waiting list," he said.

The waiting list was nine to 12 months long, possibly longer if the winter of 1996-97 turned out to be a bad one and non-emergency operations were cancelled. I was half-way to the door of his office before I asked tentatively what it would cost to have it done privately.

"Do you have private health insurance?" he asked. I didn't. Suddenly I was transformed into a much more interesting patient. My consultant's eyes really did light up as he replied: "About pounds 2,000. Here is my card with the numbers for my private rooms. Call me tomorrow."

I rang the next day, expecting to speak to the surgeon's secretary about fees. But I got Mr X himself on the line, his manner only a little more oily than the day before, and he called me "Elizabeth" at every opportunity. "Well, Elizabeth, I've done a few calculations and the cheapest package I can come up with is pounds 2,500. We can't do it as a day case, Elizabeth, so you will have to stay overnight in hospital, and of course that pushes up the price.

"And you may need some plastic surgery to prevent your nose `dropping' after we take out the cartilage, Elizabeth, and then there are the drugs you'll need afterwards. It is pounds 860 up front payable to the hospital, Elizabeth, and then the rest after the operation."

He urged me to book my bed immediately because hospitals filled up fast before Christmas. "Face lifts and tummy tucks for the party season," he said. I felt I had no choice .

But how could the price have jumped by pounds 500 overnight? I told a doctor friend, who said I had probably been marked out as a potential "private" the moment I walked into the consultant's room. I was advised to ring round some private hospitals and get quotes, and to negotiate if necessary.

The cost started to fall immediately: pounds 2,200 at one hospital; pounds 1,600 plus surgeon and anaesthetist's fees at another (about pounds 2,000); between pounds 1,200 and pounds 1,600 at the third I tried.

I made an appointment with a consultant at the last, a private hospital in south-west London. The surgeon said he could do the operation as a day case, no problem. When I asked him about the plastic surgery I needed to prevent my nose "dropping" he laughed and said that only happened in about one in 1,000 cases.

What about the expensive drugs I would need afterwards? Some ephedrine nose drops would help, he admitted, "but salt water splashed up your nostrils a few times is probably the best thing."

I was sent to the accounts office to finalise the fees. This was not straightforward. The financial officer consulted her book of "package deals" and said that, unfortunately, there was no set price for the three procedures I needed, and that they wouldn't do it as a day case anyway. "But Mr Y said he could do it as a day case," I said.

She was adamant that this was not possible. "Well, what would it cost with an overnight stay?" She could not tell me that either, because "we don't know what would be used in the operating theatre", etc. Her solution was for me to pay a pounds 1,100 deposit and settle the extras after the operation. But what extras, and how much more for them? She didn't know, but consoled me with the prize of an itemised bill after my operation. "People really like that, you know," she said soothingly. "It lists everything."

I had heard about bills dished out by private hospitals: pounds 12 for a sticking plaster, pounds 7 for a piece of gauze, and pounds 20 for a bottle of talcum powder. Sainsbury's provide you with an "itemised bill", but at least you know in advance what you are paying per item. Time to get tough. "I've come to this hospital because you told me you can do this operation more cheaply than anyone else - but you can't tell me how much more cheaply." I stormed out.

She followed me, saying that she would talk to her boss. By the time I reached home, there was a message from the hospital offering a pounds 1,200 package deal for a day-case operation, plus pounds 400 to cover the costs of the surgeon and the anaesthetist. It was a pounds 900 saving on that first quote from Mr X, and I had a feeling of triumph at beating a system that I'd never have thought of challenging.

The Government prides itself on having transformed NHS patients into consumers of health care in the past decade. In the private sector they have always been consumers, but have behaved like patients. Perhaps it is time for a change?

The medical establishment - the British Medical Association and the General Medical Council - fiercely opposes consumer guides, such as The Good Doctor Guide, that aim to tell patients who the best doctors are in a particular speciality. The fact that 1,000 doctors have agreed to be included in the third edition of the guide, the first national edition of which was published this week, suggests that some of them at least agree that this is the least a patient is entitled to, despite the threat of disciplinary action. Which of those "good doctors" gives the best value for money is surely the next thing we need to know.

`The Good Doctor Guide', by Catherine Vassallo, is published by Simon & Schuster at pounds 14.99.