When Laura Touche chose one of the country's most exclusive private hospitals to give birth to her twins by elective Caesarean, there was no reason to suppose that she would receive anything but the best treatment money could buy.

The Portland was the hospital of choice for a clutch of well-heeled expectant mothers. But more importantly to Touche and her husband Peter, it would provide them with monthly scans (not available on the NHS) and a particular obstetrician. As her husband was later to comment on the £3,000 cost of the delivery: "We thought it was worth it because we wanted to make sure the twins would have the best possible care."

As an inquest heard last week, however, the couple's expectations were rudely shattered when Touche died of a brain haemorrhage nine days after her "completely uncomplicated and straightforward" delivery of Charles and Alexander, now nearly three.

In a comparatively rare move, the inquest jury ruled that she had died partly as a result of neglect, after hearing that staff failed to monitor her blood pressure for two and a half hours after she gave birth, and dispatched her to a private room instead of a recovery ward. Standard NHS practice is to check blood pressure every 15 minutes for the first hour, every half hour for the second, and then hourly for the next three. The vital checks only began when Peter Touche alerted the one medical officer on call, who then spent 35 minutes "scrabbling around" for the relevant drug - a common occurrence, the inquest heard.

The delay was too long. Despite being rushed to two NHS hospitals, the 31-year-old never recovered, leaving her husband with the nagging belief, given force by the jury's verdict, that if she had been treated at an NHS hospital she would still be alive.

Seven million people - one in eight of the population - paid for private healthcare last year. And such are the waiting lists on the NHS, the government is planning to send even more patients to private hospitals. But Laura Touche's case suggests that paying for treatment isn't always advisable. Is it possible that going private could be bad for your health?

At present, private hospitals are regulated in a haphazard way through the 1984 Registered Homes Act, putting them on a par with nursing homes. Though this is set to change in April with the establishment of the National Care Standards Commission (NCSC), private hospitals' clinical records are not scrutinised. As the Independent Healthcare Association (IHA), which represents 211 of the UK's 248 private hospitals, told the Commons health select committee: "There is frequently an undue emphasis on hotel standards, such as decor, and not sufficient emphasis on inspecting standards of treatment and care."

While the IHA's members must have one medical officer - frequently of junior doctor level - in the hospital at all times, there is no requirement that there be more than one at night, irrespective of the size of the hospital. That doctor will be able to call on more senior staff, but often they will either be working at an NHS hospital or at home.

The situation is in stark contrast to the NHS where, while consultants can remain at home when on call, other senior staff such as registrars or fellow junior doctors will be present in all but the smallest hospitals. That presence can prove vital, both in terms of advice and in providing additional support should a patient arrest and require intensive care treatment.

Around 90% of private hospitals also have no adequate backup facilities for intensive-care treatment. Carl Waldmann, a consultant anaesthetist at the Royal Berkshire Hospital, who has been inspecting private hospitals for Bupa, says "very few" of them even have agreements with local NHS hospitals on transferring critical patients.

"It's very expensive to run an ITU (intensive care unit), and the majority of private hospitals don't have them," he says. "That's adequate for routine operations, such as hernias or varicose veins, but private hospitals have a responsibility to assess the risk of patients and only take on those who wouldn't require this type of treatment - and they should have contracts with nearby NHS hospitals so they can be transferred in an emergency."

Staffing issues can also be crucial. Nursing staff in private hospitals are frequently less well practised in dealing with emergencies, simply because they occur less frequently due to the nature of the operations carried out, and consultants who spend the majority of their week working for the NHS are unlikely to be immediately available if something dramatic occurs. "Some private hospital chief executives do not understand what intensive care is", says Waldmann. "The feeling is that intensive care will just happen. What they don't appreciate is that if doctors are working in NHS hospitals, they can't just drop their patients there and rush over."

The lack of adequate medical cover, and the lack of a consultant's presence, came to the fore at the inquest in November of Lady Mariota Napier, a 56-year-old Scottish barrister who died at the London Clinic in central London in May after a routine gall-bladder operation.

Following keyhole surgery, doctors failed to detect a bleeding duodenal ulcer and, after an evening visit, failed to visit her until the next morning. From 6.30am to 12.30am she was visited twice by the junior doctor and once by the consultant anaesthetist, who treated her for septicaemia. But it wasn't until after 2pm, by which time she had suffered a massive heart attack and the resuscitation team was performing heart massage, that her consultant, Donald Shanahan, arrived after operating at another private hospital in Ilford, Essex. It was treatment the coroner, Dr Paul Knapman, described as "hands-off", and which prompted him to write to the secretary of state, Alan Milburn, calling for the NCSC to stipulate a "formal structure or requirement in respect of urgent availability of specialist consultant input in most private hospitals". The commission is not believed to be addressing this issue.

For Eloise Napier, the eldest of Mariota's three daughters, the experience confounded all her expectations of private healthcare."If she'd been in an NHS hospital, she might well have received better attention or the signs that she was failing might have been picked up earlier. Maybe she would have still died, but she might not have done, and she certainly would have had a much better chance of life than she had."

It's a sentiment backed by the LibDem MEP Baroness Nicholson, whose husband Sir Michael Caine died following a bowel cancer operation at the King Edward VII hospital in central London in January 1999. At the inquest, at which the coroner recorded death by misadventure, it emerged that on the night, Caine's tracheotomy tube became dislodged, prompting a heart attack. There was no one in the hospital qualified in intensive-care procedures, and no registrar on duty. A local GP, who had never worked at the hospital before, had to be drafted in.

"I'd never go private myself now," the LibDem peer says. "I didn't believe he'd get worse treatment than on the NHS, and he did. These hospitals are more like five-star medical hotels than hospitals. I don't actually think they should have intensive-care units, since they're manifestly incapable of dealing with something as routine as taking the blood pressure of a new mother, but if they do, they should be better than the NHS standard, have staff there, and all the relevant drugs. The most common drug wasn't even available when Michael fell ill."

Many of these issues will be addressed when the report of the NCSC is published in April. It is expected to include a requirement that private hospitals without ITU units have contracts with NHS hospitals, permitting them to transfer patients, and to stipulate that there is one resident medical officer on call at all times.

But the commission may not go far enough to convince those who best understand the workings of the private sector - the doctors - to put themselves in its care. "I'm not insured, but if I was and I was having a routine operation, I would go private," says Waldmann. "For a more serious one, I wouldn't, unless I knew the surgeon, knew the anaesthetist and I knew they had intensive- care facilities, or a contract with a nearby NHS hospital."