The independent regulator of healthcare in England, the Care Quality Commission (CQC), has warned of its major concerns regarding the way that private surgeons with practising privileges at private hospitals are managed.
Following inspections of 206 private sector hospitals, the CQC reported “substantial variation in the quality and effectiveness of governance arrangements and a number of examples of poor practice”.
In a report published this week, the regulator warned, “There is a real danger that poor practices are not picked up or challenged in the way they should be. This can have a significant impact on the safety of services, in particular where familiarisation and subsequent informality in processes may mean that systematic and robust safety procedures are not sufficiently in place to protect patients from harm.”
The CQC highlighted its “major concern” over the way consultants with practising privileges were managed. These consultants are granted rights to admit and treat patients in a private hospital but are not employees of the company.
This was the basis of the relationships of rogue surgeons David Jackson with BMI the Chaucer Hospital and Ian Paterson with Spire Healthcare in the West Midlands. Paterson was jailed for 15 years last year following his conviction on 17 counts of wounding with intent and 3 counts of unlawful wounding.
The CQC said private hospital managers can be reluctant to challenge consultants. The report said: “It is essential that providers demonstrate that they are proactively auditing and monitoring consultants’ work, and have real oversight of services in order to protect patients and ensure they are being treated safely and effectively. In many cases they could not.”
Additionally, it highlighted a “lack of a culture of learning from incidents” in some private hospitals.
It is estimated that more than 500,000 cases of NHS funded elective care were treated in private sector hospitals in 2017; around 6% of all NHS elective admissions.
The CQC warned some private hospitals “were not set up to anticipate and handle emergency situations”. Where private hospitals had no critical care services, the regulator reported it “sometimes found a dependence on 999 NHS emergency services if an inpatient deteriorates”.
Around 40% of private hospitals were rated as requiring improvements on safety, with one rated as inadequate. Regarding governance and leadership, 30 % of the private hospitals were rated as requiring improvement and 3 % were rated inadequate.
Chief Inspector, Professor Ted Baker said “Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust.”
I obtained hundreds of thousands of pounds in compensation for clients who were former breast surgery patients of David Jackson, a significant number of whom, were treated privately. Mr Jackson was essentially left to his own devices and hospital management did not allow itself to become alert to the substantial harms that he was doing to patients for many years. The recent Ian Paterson case demonstrates that things have not significantly changed; further oversight needs to be invested in by private hospitals to minimise harm to both private patients and NHS patients receiving care in the private sector. Private hospitals should be required to report similar safety and quality data, to NHS hospitals, to enable active monitoring. For example, the outcomes of cancer patients being treated in private hospitals are unknown and cosmetic surgery, which takes place almost entirely in the private sector, needs to be better regulated.