Tag Archives: private

Private hospitals’ business model is archaic, unsafe and indefensible | Colin Leys

Jeremy Hunt’s call for private hospital companies to improve their safety and quality standards after a damning report on the sector by the regulator marks a long overdue – though still tacit – acknowledgment that the private sector’s business model is based on an archaic and dangerous concept of medical practice. Usually in private hospitals an independent surgeon operates alone and is off-site and not available for post-operative care as soon as their patient is back on the ward. If anything goes wrong, the nearest NHS hospital is an ambulance dash away. This model poses distinct risks to patients.

This is increasingly concerning as a growing share of all NHS-funded surgery (almost 600,000 hip and knee replacements a year) is now carried out in private hospitals – NHS patients now account for roughly half of all their admissions.

Hunt’s action was not in fact prompted by the Care Quality Commission’s recent report, but by a letter sent to him by a coroner in Manchester, to which the health secretary was obliged to reply by 15 May. In the letter, which the coroner also sent to the Centre for Health and the Public Interest, he called for action following the death of Peter O’Donnell, who died in an NHS hospital from complications following a routine hip replacement at a private hospital. O’Donnell’s deteriorating condition was not noted early enough, due to inadequate monitoring; and a single junior resident medical officer, provided and appraised by an outside agency and working literally 24/7, was in sole charge, says the coroner.

Further, there was no formal protocol governing communication with the surgeon requiring him to come back to see his patient if his condition deteriorated; and there was no agreed protocol for transferring an unwell patient to the nearest NHS hospital. To make matters worse, two nurses were found to have altered O’Donnell’s case notes after he was transferred, the coroner revealed.

The reason why the coroner wrote to the secretary of state, rather than to the private hospital concerned, is that what happened to O’Donnell has happened before. There have been many other similar such deaths, and they result from the basic weaknesses of the private hospital business model, as a recent report by the CHPI which was extensively cited by the coroner, pointed out.

O’Donnell’s sister has said that if they had known the risks of being treated in a private hospital, they would not have agreed to the NHS sending him to one. The same sentiment has been bitterly expressed by some of the victims of Ian Paterson, the breast surgeon sent to prison last year after wilfully injuring hundreds of women while practising at a private hospital in Solihull.

So Hunt’s letter sent to private hospital company chief executives on Tuesday warning them to raise their standards is very welcome (even if belated). The question is whether his call for change will go to the root cause of the risks posed by the private hospital sector, or whether a series of notional “improvements” will be taken as sufficient. Of the six issues listed in Hunt’s letter only one touches on the key problem: the lack of a financial incentive for private hospitals to ensure that patient safety is genuinely prioritised.

A consultant at an NHS hospital is employed there, and the hospital is liable for everything that happens to his or her patients. But consultants who practise at private hospitals are not technically employees. This allows the hospitals to avoid liability when something goes wrong. If blame is established, it is the consultant’s insurers who pay. The private hospital thus has no financial incentive to minimise risk – for example by having two or three resident medical officers on the wards, with some seniority, or by paying anaesthetists to be on call, let alone by directly employing surgeons, instead of relying on NHS consultants, whom they do not even need to pay – all measures that would significantly raise their costs.

On the contrary, because private hospitals’ profits come mainly from the private patients the consultants bring to the hospital, bosses have an incentive not to look too closely at what the consultants do. That is not to say that they are indifferent. But responsibility for ensuring that consultants operate safely is entrusted to a medical advisory committee drawn from the consultants who work there.

Hunt does note: “When something goes wrong, the private hospital provider is able to point to the fact they were not an employee, and thereby avoid liability.” But he doesn’t say that this needs to change. And he fails even to mention the manifestly unsafe long-hour shifts of resident medical officers, even though this was among the issues raised by the Manchester coroner. Hunt’s letter could be read as offering the private sector an opportunity to make a series of marginal changes, leaving its risk-laden but profitable business model unchanged.

The private hospital companies, most of which are foreign-owned, and some of which have paid multimillion-dollar fines for fraud in the US, hope to become an accepted alternative to the NHS for routine elective surgery while continuing to use NHS-trained surgeons, continuing to let them work alone, and continuing to rely on the NHS to cope when things go wrong – while still being allowed to avoid liability. It is these distinctive features of the private sector in the UK that have led some to call it the “red light district” of medicine. Allowing patients – including the large and growing number of NHS-funded patients – to run the risks involved, now that they have been officially acknowledged, is impossible to defend.

Colin Leys is an honorary professor at Goldsmiths University London, co-author of The Plot Against the NHS and former chair of the Centre for Health and the Public Interest

Private hospitals warned over failing safety and quality standards

Private hospitals have been given two weeks to come up with a plan to “get their house in order” on safety and quality or else face tough sanctions imposed by the government, the Guardian has learned.

On Tuesday, Jeremy Hunt will write to the chief executives of 206 private hospitals across England following a damning report into the sector by the safety regulator last month.

The Care Quality Commission found that two in five private hospitals are failing to meet safety standards intended to protect the public from harm, intensifying concerns among ministers over patient safety.

Thousands of patients are thought to be moved during emergencies to the NHS every year from private hospitals, which rarely have intensive care beds or dedicated resuscitation teams, with the state then left to pick up the pieces.

In a letter seen by the Guardian, the health and social care secretary is calling for fairer remuneration for NHS organisations if they have to deal with the consequences of poor care or mistakes made in the independent sector.

Private healthcare groups are understood to be particularly fearful of the introduction of a compensation scheme for patients who have to be transferred as a result of negligence, as it could hit their profits.

Hunt’s warning comes during a national inquiry into the sector, expected to be published next summer, after the case of Ian Paterson, the breast surgeon who was jailed for 15 years last year for carrying out unnecessary operations in NHS and private hospitals.

In his letter, Hunt threatened those independent hospitals rated inadequate with the same robust and rapid action currently restricted to failing NHS hospitals, including special measures, enforced changes to leadership teams and extra oversight.

Of the 206 independent acute hospitals inspected in the CQC’s first comprehensive analysis of the sector, 62% were given a “good” rating overall and 8% were described as outstanding. However, 30% of private hospitals were deemed to need improvement. Four that were previously rated inadequate had improved.

However, the CQC said it was particularly concerned about safety, with 41% of hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

Hunt told the chief executives he expected greater transparency when patient safety mistakes had been made, for example by publishing patient outcomes by clinician as well as details of avoidable deaths, bringing the sector into line with the NHS.

The health secretary also called for better governance procedures to make sure private hospitals took responsibility for the work and standards of private consultants, even if they were not technically employees.

Ministers are concerned that some private hospitals currently avoid liability by saying a clinician is not an employee if something goes wrong. They also want clearer processes in place for managing a patient if their health deteriorates in private care and they have to be transferred to the NHS in an emergency.

Hunt wrote: “Like many of my predecessors on both sides of the political divide, I believe that the independent sector can play a useful role in adding capacity, promoting innovation and offering patients choice.

“However, if the sector is to partner with the NHS and benefit from our world-leading medical training, we need urgent assurances that the independent sector will get its house in order on safety, as well as a commitment to take rapid action to match the NHS’s world-recognised progress on transparency.”

Jeremy Hunt


Jeremy Hunt: ‘We need urgent assurances the independent sector will get its house in order on safety’. Photograph: Wiktor Szymanowicz/Rex/Shutterstock

Whitehall insiders told the Guardian that if the providers failed to come up with an action plan within the two-week deadline, the Department of Health would press ahead with developing new policies to clamp down on poor practice without their cooperation.

Some measures could be brought in within weeks but the whole package is likely to take several months to put in place. Health department officials believe they can proceed without legislation as they have a range of other mechanisms at their disposal.

These could include leveraging the independent sector’s reliance on securing NHS contracts and treating NHS patients, as well the CQC’s licensing regime that enables hospitals to practice.

Labour is expected to be broadly supportive of the plan. Jonathan Ashworth, the shadow health secretary, has previously criticised the government for not doing enough to ensure private hospitals are as transparent about the quality of care they are providing as NHS hospitals.

Although the CQC report found most of the hospitals were providing good quality care to patients, the regulator raised serious concerns about safety and leadership.

The commission said the lack of effective oversight of consultants working for these hospitals but not formally employed by them was a major concern. It also found that some private hospitals had failed to learn from incidents and that there was a weakness around reporting. Also that where systems were in place, they were not as robust as required.

One example highlighted operating theatres, where inspectors saw informal practices and instances where the World Health Organization surgical checklist was not being followed rigorously.

The CQC said that where problems were identified, private hospitals were quick to make improvements, but acknowledged that there was still scope for action to be taken to address concerns in vital areas.

The report provided the first comprehensive analysis of the quality of care provided by independent acute hospitals since the CQC introduced an inspection programme in 2015.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.

Two-fifths of private hospitals in England are failing safety standards

Two-fifths of private hospitals in England fail to meet expected safety standards, according to a report by health inspectors.

While most independent acute hospitals provide good quality care, inspections by the Care Quality Commission (CQC) raised concerns over the safety and leadership of some services.

The regulator also said “a lack of effective oversight” of consultants with practising privileges was a “major concern”.

The issue had been “brought into sharp focus” by the case of the rogue breast surgeon Ian Paterson, who carried out unnecessary operations in NHS and private hospitals, it added.

The Royal College of Surgeons (RCS) said the report “exposes the poorer practices of some independent providers and underlines the need for a renewed focus on improving patient safety”.

Of the 206 independent acute hospitals inspected, 62% were given a “good” rating overall and 8% were described as “outstanding”. However, 30% of private hospitals were deemed to need improvement.

The CQC said it was particularly concerned about safety, with 41% of private hospitals rated as requiring improvement in this area and 1% as inadequate. Almost a third were rated as requiring improvement and 3% as inadequate in terms of how well they were led.

In his foreword, Professor Ted Baker, chief inspector of hospitals at the CQC, wrote: “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.

“In particular, we found that monitoring of medical governance such as scope of practice of individual consultants was not consistently robust. Such a failure of effective governance was brought into sharp focus with the recent case of the surgeon Ian Paterson.”

Consultants operating under practising privileges are not employees of a hospital but regulation sets out that they should be considered in the same way as other staff. In some cases the CQC found a “lack of robust and effective oversight of practising privileges”, with many consultants treated “as ‘customers’ bringing business to the hospital” meaning providers “could be reluctant to challenge them”.