Private hospitals should not be singled out on patient safety

The Centre for Health and the Public Interest recently published a report entitled Patient Safety in Private Hospitals: The Known and the Unknown Risks. Colin Leys, one of the report’s co-authors, wrote a comment piece in HSJ reflecting on the report’s findings.

The report and Professor Leys’ article contained a number of claims about private hospitals that are not borne out by the facts. Nobody is suggesting hospitals in the independent sector are perfect, and we acknowledge that independent provision into the NHS is a topic of debate.

‘There is no cause to claim that little is known about patient safety in private hospitals. If anything, the reverse is true’

But that should not be used as a smokescreen to make unfounded assertions backed up by selective use of the available evidence.

Just like NHS institutions, the Care Quality Commission regulates independent hospitals for quality and safety. Inspections of independent hospitals are no less rigorous than those of NHS institutions; if the CQC finds care failings it will take appropriate action and post a report on its website reflecting this.

The CQC also publishes an annual “state of care” report, covering independent and NHS health services. The latest of these found that 92 per cent of inspections in the independent sector met safeguarding and safety standards.

Patient reassurance

That is no cause for complacency, but also no cause to claim that little is known about patient safety in these institutions. If anything, the reverse is true, and any patient considering an independent hospital can be reassured of the overwhelmingly safe, effective and dignified care they offer.

Moreover, it is odd to assert, as the report did, that some patients treated in independent hospitals are moved to NHS facilities if they develop unexpected trauma. It is true that some independent hospitals do not have an accident and emergency department or intensive care unit – but the same is true of some NHS hospitals.

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Traumas in such institutions are handled similarly, so it seems strange to suggest there is something specifically wrong with practice in smaller independent hospitals.

Indeed, the Centre for Health and the Public Interest says that “around” 6,000 patients have transferred to the NHS from independent institutions. However, there is no evidence to suggest that readmission rates or the need for critical care support are higher after treatment in independent hospitals compared with NHS hospitals. In fact, such information, as is available, tends to suggest the opposite.

Information availability

Professor Leys also makes the point that independent hospitals are not required to report unexpected deaths and serious incidents to the National Reporting and Learning System, unlike the NHS. The sector has been working with NRLS to be able to submit data in exactly the same way, and receive the same lessons from incidents as the NHS does.

‘The sector has done a large amount of work to bring systems in line with those of the National Reporting and Learning System’

The sector has done a large amount of work to bring systems in line with those of the NRLS and, in some cases, has had to wait for the public sector to carry out agreed reporting trials to produce meaningful data.

However, we agree with the CHPI’s finding that the sector needs to do more on information availability. This corresponds with the findings of an Competition and Markets Authority investigation, which recently published its final report. That is why the sector established an independent data gathering and reporting project in 2008.

That project is now called the Private Healthcare Information Network. It is already publishing significant amounts of data, and will increase its activities in the next two years.

Patient complaints

Of course, sometimes things do go wrong. When they do it is critical that patients know how and where to get redress.

Patients in the private sector can complain to the provider of their healthcare and, if not satisfied with the response, they can take their complaint to the board of that provider. If that response is not satisfactory to the patient, the sector has established the Independent Sector Complaints Adjudication Service.

‘Placing the independent sector under the remit of the ombudsman would only place a burden on the taxpayer for a service carried out for private patients’

When the independent sector provides treatment to NHS patients, those patients can seek redress for complaints through the Parliamentary and Health Service Ombudsman.

Professor Leys’ report recommends that the independent sector falls under the remit of the ombudsman instead of ISCAS. This would only serve to place a burden on the taxpayer for a service carried out for private patients by the independent sector.

ISCAS is a system that works well for patients, so we see no reason for an arbitrary move into the public sector, especially as such a move would require legislation and detailed examination of exactly which patients would be covered by the expanded ombudsman.

The Association of Independent Healthcare Organisations welcomes discussion and debate about the future of healthcare. We accept that we need to improve information availability and reporting. One obvious but often forgotten point is that without independent sector provision the clinical pressure on the NHS would be significantly higher than it is currently.

The sector is committed to partnering with the NHS to deliver the healthcare that the country needs, but we will only find the best solutions to funding and delivery problems through a cool headed debate based on facts.

Fiona Booth is chief executive of the Association of Independent Healthcare Organisations