Private healthcare in the UK has historically been about high-volume, relatively low-risk services such as outpatient consultation, imaging, and elective surgery, with most institutes leaving acute medical care to the public sector.

However, in recent years, we have seen the burgeoning of comprehensive private hospitals modelled on the best that North America and Europe have to offer – centred on the famous Harley Street in central London and extending across Belgravia, Marylebone and Fitzrovia.

Alongside the growth in the hospitals themselves is the realisation that high-net-worth individuals (HNWIs) are typically looking for a level of service and discretion over and above simply jumping the queue by going private.

Similarly, in recent years, commercial air travel has evolved, with long-haul operators shifting the ratio of cabins towards offering fewer seats overall with greater numbers of premium, business and first class seats. Airports are offering private entrances, concierge check-ins, and fast-track security. For true HNWIs, private charter offers a completely bespoke end-to-end service with private terminals and dedicated cabin crew serving Michelin star-quality meals. It is therefore natural that aeromedical services should seek to marry up these two evolving markets to offer a premium product.

We decided that scrubs or flight suits would not give the right image, and opted for tailored shirts and trousers in navy blue

The same high standards – but aeromedical

For an air ambulance operator, HNWIs are looking for one of two things: a planned flight to receive elective care with a consultant of their choice, at a private hospital of their choice; or a rapid-response rescue mission.

They want the flight to give them everything they would expect from a private charter or a first-class commercial airline seat, with the highest-quality medical care seamlessly integrated. For a rescue mission, they may be willing to accept some level of compromise on the luxury aspect – but not too much!

When we set up SkyCare, we opted to purchase a brand new Pilatus PC-12 with the executive cabin fit, and then added Spectrum Aeromed systems configured for rapid reroll. On weeks where there is reduced demand for air ambulance flights, the aircraft is chartered by HNWIs for business and pleasure across the UK and continental Europe. We’re therefore confident that the level of luxury in the cabin is right for our customers, whether they need the stretcher or executive seat.

We chose the tail livery ‘SkyCare VIP’ to emphasise a position at the high end of the market that suits HNWIs, while offering our regular customers a built-in upgrade at a competitive price.

A recent mission required an aircraft with a much longer reach than the PC-12: from London to China. Although clinically suitable for a commercial escort, the client felt uncomfortable travelling such a long distance without complete control over the process. When they approached SkyCare, they had already chartered a Gulfstream G700 and required a doctor to join the flight. In this instance, the challenge was visas – there is no reciprocal entry agreement with China for UK citizens and the process takes seven to 10 days minimum.

The clinical needs of HNWIs are similar to other patients, but the approach taken to their care may be markedly different from those in the public healthcare system.

We have a doctor with a China visa so were able to respond and have them join the flight within 48 hours. The client did not wish to be disturbed during the flight, so the doctor was simply required to be available for consultation while ready to step in with treatment in the event of a deterioration.

This variation on the traditional commercial medical escort approach provided the experience the client was looking for, with the added advantage that the G700 had a cabin altitude of 3,000–4,000ft throughout.

A close eye on aesthetics

The equipment required for HNWIs is not technically different from any air ambulance or commercial escort flight equipment. However, the reality of hard-working aircraft, teams, and equipment is that everything can look quite shabby after a few hundred missions. Even though the underlying technology is robust, appearances do matter, and beaten-up equipment and bags do not inspire the client with confidence.

We opted for a policy of buying new, and making sure our equipment is kept in high-quality carry bags. We do not currently keep separate inventory for HNWIs, but as we grow this aspect of the business we will start to purchase new equipment for HNWI work and rotate older but functional inventory to the general air ambulance service.

Alongside equipment that looks good, it’s important for the clinical team to look the part. After considering various ideas, we decided that scrubs or flight suits would not give the right image, and opted for tailored shirts and trousers in navy blue with an embroidered team logo. We added epaulettes with clinical roles, so that doctors, nurses, and paramedics are easily identifiable. This uniform looks smart and does not look out of place on an air ambulance, commercial escort, or bespoke charter flight.

Same needs, different approach

The clinical needs of HNWIs are similar to other patients, but the approach taken to their care may be markedly different from those in the public healthcare system. HNWIs may task their personal assistant or a concierge service to directly engage a private physician, which may present a barrier to obtaining medical information. They are likely to have a close relationship with their private doctor, with clinical advice and treatment plans fed to them via WhatsApp to get a second opinion – with connectivity at altitude now almost ubiquitous.

The choice of drugs, combinations, and doses given is unlikely to be technically incorrect, but may be unusual compared with those used in public healthcare services, or based on guidelines that are the norm in the US or Middle East rather than Europe. There is often therefore work to be done to understand the client’s medical condition, current treatments, and personal preferences. There is an art to walking the line between giving the client what they want and continuing to uphold gold-standard good medical practice.

HNWIs are a special case, requiring a high degree of discretion

In the cabin, we can offer them any champagne they like, but the menu of medical treatments must be set by the aeromedical team, with reasonable limits on what the client can choose.

Patient confidentiality is second only to patient safety regardless of the customer’s means and background, but HNWIs are a special case, requiring a high degree of discretion. Details or photos shared by the medical team with friends and family could lead to an international political incident and reputational damage for all involved, and even sharing the tail number of a privately owned aircraft could be enough to cause serious problems for the client. Absolute discretion is therefore paramount, and, for the medical teams, experience working within high-end private medical practice gives invaluable insight into how to behave in this context.

Finally, working with HNWIs is an opportunity for health professionals who enjoy aeromedical work to discover another aspect of practice that is both challenging and rewarding – very few ‘normal’ individuals will ever enjoy a flight on a Gulfstream G700! For aeromedical providers, it is an opportunity to develop within an expanding market where quality prevails and bottom-line price is rarely a driver. And, as for clients of all backgrounds and budget, provision of healthcare in a form that works for them is the bedrock of all that we do in the aeromedical industry.