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Private hospitals should have to report same safety data as NHS does, think tank says

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5291 (Published 26 August 2014) Cite this as: BMJ 2014;349:g5291
  1. Ingrid Torjesen
  1. 1London

UK private hospitals should be obliged to report patient safety incidents and information on their performance in the same way as NHS organisations do, the think tank the Centre for Health and the Public Interest has said.

In a new report the centre argues that the safety of private hospitals, which now generate 28% of their income from treating NHS patients, cannot be assessed and compared directly with that of NHS organisations without this information.1

The report, published on 20 August, said that figures obtained from the healthcare regulator the Care Quality Commission (CQC) showed that between October 2010 and April 2014 802 patients died unexpectedly and there were 921 serious injuries in private hospitals in England.

Most private hospitals have no intensive care beds, and some have no dedicated resuscitation teams, so the NHS acts as a “safety net” for private hospitals, the report added. Each year around 6000 patients are admitted to the NHS from private hospitals, and in 2012-13 more than 2600 of these were emergency admissions.

A recent report by the Competition and Markets Authority found that the data available on the performance of private hospitals were “poor” and “insufficient to promote competition between private healthcare facilities.”2 In that investigation the CQC stated that it “currently has access to relatively little information that relates to private healthcare compared to some of the other sectors that it regulates.”3

The Centre for Health and the Public Interest’s report also said that it was not possible to establish whether all private hospitals providing NHS care were fulfilling their legal obligation to publish “quality accounts,” which enable the public to see how they are performing. The Health Act 2009 required all providers of NHS services, including private providers, to publish these on the NHS Choices website by 30 June each year, and those from NHS organisations must be audited externally.

The centre said that it had searched for the quality accounts of nine private organisations and found that only five had filed them in 2013-14, while three did in 2012-13 and just one in 2011-12. Private providers earning less than £130 000 [€160 000; $215 000] in annual income and with fewer than 50 staff are exempt from the requirement to publish quality accounts. Information on how much income each hospital provider generates is unavailable because it is protected by commercial confidentiality, but the centre said it suspected that only two of the nine organisations it looked at were likely to have been exempt.

Its report makes several recommendations, including, most importantly, that private providers should be subject to the same requirements as NHS organisations to report patient safety incidents and to report on their performance.

Consent forms given to patients in private hospitals should detail not only risks inherent in the procedure offered but also any that stem from the hospital’s facilities, equipment, and staffing, the centre suggested.

The report said that surgeons and anaesthetists in private hospitals usually worked in isolation, without assistant surgeons and anaesthetists in training. It recommended that regulations should require an onsite registrar level surgeon or doctor for every specialty for which NHS patients are treated, for an anaesthetist to be on call, and for medical records to be kept on the ward. It said that evidence from CQC inspections showed that the notes of some patients were kept off site with the consultant rather than in the hospital where they were treated. “This has been identified as poor practice and a risk to patients if something goes wrong,” the report said.

The centre called on the Department of Health to carry out a review of the nature and cost of admissions to the NHS from private hospitals and to ensure that the NHS had the power to recoup costs resulting from a failure by a private hospital.

Colin Leys, one of the authors of the report and honorary professor at Goldsmiths University of London, said, “The public and regulators have access to more information than ever before about how NHS services are performing, but this report shows that the same cannot be said for private hospitals. The government has recognised the crucial role of transparency in making hospitals safer, but reporting requirements should apply wherever patients are treated. With the taxpayer now providing over a billion pounds a year to private hospitals, this is too important to be left to the industry to address.”

A CQC spokesman said, “The Care Quality Commission will soon start inspecting independent hospitals using the new style inspections that are being carried out in the NHS. CQC will expect from independent health [providers] equivalent information about performance that it receives from NHS hospitals.”

Notes

Cite this as: BMJ 2014;349:g5291

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