Private hospitals need to be more transparent about patient safety

Since the publication of the Francis report in February last year, the government has rightly focused fresh attention on patient safety in NHS hospitals. 

As Jeremy Hunt said in his speech in the US earlier this year, the approach is based on two pillars.

‘The private hospital sector carries out 1.6 million operations each year – a quarter are funded by the NHS’

First, tighter and more rigorous regulation by the Care Quality Commission, accompanied by new resources for the regulator and a new set of regulations. 

Second, a drive to make NHS hospitals report patient safety incidents more openly and to make data about these incidents available to patients, the public and regulators.

But the same approach has not been applied to the private hospital sector, which carries out 1.6 million operations each year – a quarter of which are now funded by the NHS.

• In response: Private hospitals should not be singled out on patient safety
• Make some room for private hospital patients
• Hospital death data ‘distraction’

Public and private compared

A recent report by the Centre for Health and the Public Interest identified the comparative lack of transparency about the performance of private hospitals compared with the NHS, and the risks that this poses to patient safety.

NHS trusts are required to notify all deaths and patient safety incidents to the National Reporting and Learning System, which analyses these to provide hospital level data with a view to helping identify trends and emerging risks.

‘Private hospitals are only required to notify serious incidents to the CQC’

On the other hand, private hospitals are only required to notify serious incidents to the CQC (and in the case of NHS funded patients, to commissioners). But the CQC does not publish the statistics, so no analysis is available.

Finding out how many patients have died unexpectedly in private hospitals over the past four years, and how many serious patient safety incidents have taken place involved submitting a Freedom of Information request to the regulator.

And because the Health and Social Care Information Centre doesn’t produce standardised hospital mortality indicators for private hospitals it is not possible to interpret the significance of the fact that 802 unexpected deaths and 921 serious incidents have been reported in private hospitals over the past four years.

Data not available

Moreover, mortality and patient safety incident data is not available for each private hospital, as is the case for all NHS hospitals. 

Put simply, the Keogh review into the 14 NHS hospital trusts where there were patient safety concerns could not have been conducted in the private hospital sector, as there is no statistical way of determining which private hospitals may pose a risk.

There is a similar lack of information on how many patients are transferred to the NHS following treatment in private hospitals, and why.

‘It’s not possible to establish the reasons behind patient transfers and whether this is a cause for concern’

The great majority of private hospitals do not have intensive care beds so when something goes wrong in an operation or if complications arise patients are transferred to intensive care in the NHS. 

We do know from parliamentary questions that about 6,000 patients are transferred each year, but it is not possible to establish the reasons behind this, or again, whether this is a cause for concern. 

The data on how much these admissions cost the NHS each year are not available either.

Knowledge gap

It is also surprising to find on the NHS Choices website that the quality accounts of many of the major private hospitals that provide services to NHS patients are missing.

The Health Act 2009 is unusually specific in making it a legal requirement for all NHS hospitals and all private hospitals which deliver a certain proportion of NHS care to publish their quality accounts on the NHS Choices website each year by 30 June.

As there is no list of which hospitals are required to publish these accounts in order to comply with the regulations, it was not possible to determine whether any regulations are breached.

‘For patients seeking information about a hospital, there are gaps in what they can find out’

For patients seeking information about a hospital before they have elective surgery there is now a huge gap between what they can find out about an NHS trust compared with a private hospital.

As part of the health secretary’s push for greater visibility of patient safety incidents, NHS Choices now lists a wide range of patient safety indicators for NHS hospitals, ranging from bed sores to safe staffing levels, but most of these indicators are not available for the private hospitals listed.

The Private Healthcare Information Network, which is run by the private hospital sector, only compares private hospitals with each other, and mostly does not give the statistics on which the comparisons are based.

Insufficient information

This is an issue which has caused concern for a range of organisations. The CQC admits that it knows comparatively little about the private hospital sector compared with the NHS.

In its examination of the private hospital sector, the Competition and Markets Authority found that there wasn’t sufficient publicly available information to permit informed patient choice.

And BUPA, which funds many private patients, has summed up the consequences of this by saying: “The lack of published, comparable data on private hospitals and consultants not only weakens choice, but creates a significant patient safety risk.

‘The lack of data weakens choice and creates significant patient safety risk’

“It prevents the regulators – like the CQC and General Medical Council – from monitoring provider activity and identifying outliers as they are able to do in the NHS.”

The growing number of NHS patients treated in private hospitals means the taxpayer is now the second largest source of income for the private hospital sector.

If the government is right that a culture of patient safety demands transparency and openness, there is no good reason why the same reporting requirements that have been imposed on the NHS should not also apply to private hospitals.

Professor Colin Leys is emeritus professor of Queen’s University, Canada, and honorary professor of Goldsmiths, University of London. He is co-author with Professor Brian Toft of Patient Safety in Private Hospitals – the Known and the Unknown Risks