Before You Sign: Ten Questions for Private Vascular Consent

Private vascular procedures are offered in the UK by a range of providers, from established private hospitals to smaller clinics. Some patients approach them with a clear diagnosis; others are exploring CCSVI-adjacent questions after reading widely or after a private scan. Whatever the route, the consent conversation is the point at which care should become transparent. In UK law and professional guidance, consent is not a formality. It is a continuing process based on information a reasonable person would want, including material risks and reasonable alternatives. The 2015 Montgomery ruling in the UK Supreme Court reinforced this patient-centred standard. The ten questions below are designed to make that conversation easier to hold.

1. What problem is this procedure meant to address?

Ask the clinician to state the diagnosis or working diagnosis in plain language, and to explain what the procedure is intended to change. If the answer refers to a scan finding alone, ask how that finding relates to your symptoms. A narrowed vein on imaging is not automatically the cause of a neurological symptom, and a procedure aimed at a scan finding rather than a clinically defined problem deserves careful scrutiny.

2. What is the evidence that it works?

Request the evidence in ordinary terms. Is this procedure recommended by NICE or a UK specialist society for your condition? Is it offered within the NHS, and if not, why not? If the evidence comes mainly from small studies, case series or patient accounts, ask how the clinician weighs that against the possibility of placebo response and natural fluctuation in symptoms. A good consent conversation should distinguish between promising reports and established benefit.

3. Who will perform the procedure, and what are their credentials?

Ask for the name of the operator, their GMC number and whether they are on the specialist register for the relevant specialty, such as interventional radiology or vascular surgery. Ask how many procedures of this type they perform each year, and whether a second qualified clinician will be present. For private care in England, check that the provider is registered with the Care Quality Commission; equivalent regulators operate in Scotland, Wales and Northern Ireland.

4. What exactly will be done, and where?

Ask for a plain description of the procedure: the access point, the imaging used, whether a balloon or stent is planned, and what device will be used. Ask whether the device is UKCA-marked or CE-marked for this purpose. Confirm the site where the procedure will take place and whether it has arrangements for emergency transfer if a serious complication occurs.

5. What are the material risks for me?

Risks vary with anatomy, history and the specific procedure. Ask about bleeding, infection, vein injury, thrombosis, contrast dye reactions, radiation exposure and the chance of restenosis. If a stent is proposed, ask about stent migration, fracture, the need for long-term antiplatelet medication and the difficulty of removing a stent later. The clinician should tell you not only the percentage risk but what that risk would mean for you.

6. What are the alternatives, including doing nothing?

A proper consent discussion includes the option of conservative management, medication, further NHS investigation, a second opinion, or simply waiting to see whether symptoms change. Ask what would happen if you declined the procedure today. If the only alternative presented is 'no treatment', ask whether that is accurate or a simplification.

7. What is the realistic chance of benefit, and how will we know?

Ask how success is defined: symptom improvement, scan appearance, or both. Ask what proportion of patients experience meaningful benefit, over what time period, and how that compares with a placebo or sham procedure in the studies cited. Be wary of promises expressed only as anecdotes. A cautious clinician will be comfortable saying that benefit is uncertain.

8. What follow-up is included, and who pays for it?

Private procedures can create ongoing costs. Ask what scans, consultations, medication checks and complication reviews are included in the quoted price. Ask who will manage anticoagulation or antiplatelet therapy, and what happens if you need NHS care for a complication. If follow-up is not included, ask for an estimate of the annual cost.

9. What happens if something goes wrong?

Ask about the provider's complication policy, out-of-hours cover and indemnity insurance. If you are treated privately and later need NHS emergency care, the NHS will treat you, but records and costs may need to be sorted out afterwards. Ask for the name of the person to contact if you develop symptoms after discharge, and ask how complaints are handled. Private providers in the UK should have a complaints procedure and, in many cases, access to the Independent Sector Complaints Adjudication Service.

10. How will my NHS records be updated?

Good communication with your GP is part of safe care. Ask whether a discharge summary and procedure report will be sent to your GP, whether imaging will be shared, and how you can obtain copies. Ask what information will be recorded about the consent discussion itself. You are entitled to see your medical records and to ask for corrections.

Making the conversation work

Take these questions in written form. It is reasonable to ask for answers by email before you sign, and to ask for time to reflect. Consent can be withdrawn at any point, including on the day. If you feel rushed, or if a clinician is unwilling to discuss evidence and risk in plain language, that is useful information in itself. A calm, unhurried consent conversation is not an obstacle to private care; it is part of what makes care safe and respectful.