Almost a third of private hospitals are providing substandard care, according to the Care Quality Commission (CQC) which has published its analysis of the quality and safety of care provided by independent acute hospitals across England.
While the majority (70 per cent) of the 206 independent acute hospitals in England are providing “good” or “outstanding” care for their patients, some 30 per cent have been rated as “requires improvement”.
In some cases, CQC found that a lack of formalised governance procedures meant that hospitals were not effectively monitoring the work of consultants who operate under “practising privileges” – where a consultant clinician works in a hospital but is not a direct employee.
“Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes.”
Professor Ted Baker, Chief Inspector of Hospitals, Care Quality Commission
There were also failures to check whether clinicians were only working within their agreed scope of practice, which meant that there was a risk that poor practices were not always picked up or challenged in the way they should be.
Other issues highlighted by CQC include a failure by some hospitals to adequately monitor clinical outcomes to evaluate the effectiveness of the services they were providing, and a lack of preparation for the possibility that a patient’s condition could deteriorate.
The regulator found that most patients have prompt access to effective treatment and experience personalised care from highly skilled and caring staff. Of the 206 hospitals inspected, 89 per cent were rated as good and 11 per cent were rated as outstanding for how “caring” their services were.
The majority of hospitals were also rated as good (86 per cent) or outstanding (7 per cent) for how “responsive” they were. Patients were more likely to have named consultants and the hospitals managed their flow of patients well, which meant that there were few cancellations or delayed admissions or procedures.
NHS care
Comparisons with NHS hospitals’ own CQC ratings are difficult as the private sector generally does not provide emergency treatment.
Read more: Junior doctors in private hospitals ‘left in charge of up to 96 beds each’
Professor Ted Baker, chief inspector of hospitals at the CQC, said: “Much of the care and treatment we have seen at independent acute hospitals is good – and we found that effective leadership at a local level, good staff engagement and a close oversight of the services being provided played a key role in ensuring high quality care.
“However, our inspections also identified concerns around the safety and leadership of some services, often as a result of a lack of safety checks and poor monitoring of risks. Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes. Where we found failings, we have been clear that improvements must be made, using our enforcement powers where needed to protect people.
“As the independent quality regulator we hold all providers of healthcare to the same standards regardless of how they are funded. Having inspected all independent acute hospitals in England we now have a comprehensive picture of the quality of care they are providing for the first time – and, importantly, people can use our reports to help them make choices about their treatment.
In response to the findings, the Royal College of Surgeons (RCS) has called for independent providers of healthcare to raise safety standards. In particular the RCS has called for private hospitals to publish data the NHS normally publishes on unexpected deaths, never events, and serious injuries to patients, as well as data on the outcomes of treatment. This would enable effective monitoring and greater transparency in the sector, it said.
RCS president, professor Derek Alderson, said: “This report shows that the majority of private hospitals are providing high quality care to patients and some are outstanding. However, it also exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety.
“In particular, we are concerned that inspectors found proven safety procedures such as the WHO surgical checklist were not always fully embedded in private practice. They also found that too often safety was viewed as the responsibility of the individual clinician rather than a corporate responsibility and there was a lack of effective oversight of the practising privileges of consultants.
“The recent Ian Paterson case demonstrated that there is no room for complacency and further actions should be taken to minimise harm to patients in both the NHS and private sector. We must continue to promote a culture, in all types of healthcare, where patient safety concerns are not brushed aside.”
More data
Labour wants private hospitals to publish data on patient outcomes, as already occurs with NHS hospitals, to ensure patient harm is minimised through a culture of openness.
Shadow Health Secretary Jonathan Ashworth said: “It is completely unacceptable for NHS patients in private hospitals to receive anything but the safest and highest quality of treatment.
“For too long private sector treatment has remained unaccountable and opaque. This cannot be allowed to continue and the Government must ensure private hospitals operate with greater transparency.
“We still have no accurate picture of how well cancer patients are treated in the private sector for example. The Secretary of State insists patient safety is at the heart of his agenda and must now act with a firm hand to ensure private hospitals publish data in line with NHS hospitals.”
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