Private hospitals must publish outcome data to prevent another Ian Paterson, warn surgeonsBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1722 (Published 10 April 2019) Cite this as: BMJ 2019;365:l1722
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Professor Alderson, on behalf of the Royal College of Surgeons, makes what is in reality a very tardy call for the improved analysis of private hospital outcomes. Over a number of years assisting the CQC in inspections of both NHS and private hospital surgical facilities, it's become obvious to me that both individual and intra-departmental self-scrutiny is little more than token in most private hospitals. Surgeons still work in their own bubbles, and minutes of clinical meetings are either non-existent or skeletal. When a mishap occurs, it'll be more than likely addressed by a senior nurse than a surgeon.
This is the stuff upon which the Paterson scandal emerged. It's of little use for the RCS to blame Paterson as "a rogue individual" or to call for 'process' improvements such as the mandatory publication of outcomes. Yes, the latter can be helpful, but high quality in surgery does not start with the imposition of outside rules. It should commence with an absolute personal committment to the highest levels of quality and outcome by individual surgeons themselves, followed by in-house peer review. That simply does not happen in most private hospitals at present. Nor is it likely to, because the modus operandi of a private hospital is to maximise activity and profit. Is it likely that the Medical Director of a private hospital, more often than not appointed and paid by the hospital management, will insist on colleagues spending the necessary time on analysing their complications, or on the hospital providing the facilities? That seems fanciful.
It's clear from the Paterson case that he was performing inappropriate surgery for years. Had there been effective in-house clinical governance, his activity would, by implication, have been halted years earlier. It seems there was not. What the Royal College of Surgeons should be doing is not insisting on more and more rules and regulations from on high. It needs to go back to its Fellows and talk to them about the fact that professionalism involves self-scrutiny and peer scrutiny. It needs to insist on this in the strongest terms, and on the publication of the adequate minutes reflecting such scrutiny, which are presently mostly nowhere to be found.
Competing interests: No competing interests