OK. I'm obviously not privvy to that information. My first reaction is to ask about economies of scale - whatever it was that affected location, numbers of people wanting similar surgery (which would affect cost of consultants). In your case it was specialised surgery which might well cost less if done in one centre, as opposed to distributed around non specialist centres (costs being expenses for consultants as well as consultant and specialist fees). I'm also fairly certain that the surgery you underwent would have involved a long period of consultation with you in the first place to ensure that this was what you really wanted to do. Do the private places factor in these costs?

If it was like for like then that's shocking. My experience is that private clinics for whatever pick people up after profiling and consultation is done by the NHS, thus raising costs for the NHS. However, you say equivalent, so maybe it was like for like.

In which case, how could the NHS costs have been reduced?