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September 13, 2014

Private Eye Issue 1374
Filed under: Private Eye — Dr. Phil @ 8:16 pm


Last month’s report by the Centre for Health and the Public Interest on patient safety risks in private hospitals made depressingly familiar reading. Over 802 people died ‘unexpectedly’ in private hospitals in the last 4 years and there were 921 serious injuries, but it’s very hard for patients or polticians to meaningfully compare this with safety in the NHS because private hospitals are still not required to make data on hospital deaths and safety incidents publicly available (Eyes passim).

Coding in private hospitals is often poor too but even without accurate data, the risks are obvious in an emergency. The majority have no intensive care beds, some have no dedicated resuscitation teams, and surgeons and anaesthetists usually work in isolation – without assistant surgeons and anaesthetists in training present. There is often very little experienced cover at night, with typically one very junior doctor covering and entire hospital, and there are gaps in after-care too if things go wrong.

The private hospital sector now gets over a quarter of its income from treating NHS-funded patients, so there is no excuse for not having comparable data available to patients about hospital performance and safety. The NHS still serves as a ‘safety net’ for the private sector. Thousands of people are regularly transferred to NHS hospitals following treatment in private hospitals, with over 2,600 emergency NHS admissions from the private sector in 2012-13. The NHS is not reimbursed for this, even if the emergency care follows a failure by a private hospital.

Regulation of private healthcare in England is the responsibility of the Care Quality Commission (CQC), but the CQC can only make judgements on the data available (or lack of it). Records of clinical negligence claims against private providers are not publicly available, as they are in the NHS. And the Care Act somehow exempts private providers from the new criminal offence for providing false or misleading information to the regulators.

Patients using the private sector have no statutory rights to support complaints or to receive independent advice and support, nor recourse to the Health Service Ombudsman. And taking legal action for clinical negligence against a private provider is even tougher than in the NHS, where everything is overseen by the NHS Litigation Authority. A claimant against a private provider may have to try to prove whether it is the hospital or the individual surgeon or sub-contractor who is liable.

As well as picking up the tab for complications of private healthcare, the NHS can also be left with the legal bill for negligence claims. Vanguard Healthcare was approached by Musgrove Park Hospital in Taunton in February 2014 to help clear a backlog of cataract patients. The initial contract was to do 600 cataract operations but the contract was pulled after four days when 62 operations had been done. Of those that received the treatment, 31 subsequently reported complications including an 84-year-old man who has been left blind. If negligence is proven, it is the NHS as commissioners of the care, rather than the private providers of the surgery, who foot the bill.

Doctors, however, can be held to account wherever they operate. Surgeon David Sellu is currently in prison for unlawful killing of Jim Hughes at the Clementine Churchill Hospital in Harrow. Mr Hughes suffered a perforated bowel following a knee operation, and Sellu was judged not to have acted swiftly enough to save him. Mr Hughes deteriorated on a Friday afternoon, when there was no staffed operating theatre ready and no anaesthetist on hand. Sellu could have called 999 and put Hughes in an ambulance, but decided to observe him at the Clementine. There was only one junior doctor on after hours in the 141-bedded hospital. Vital does of antibiotics were missed and Sellu got further delayed in theatre. Like all doctors sometimes do, he took on too much (Hughes was not his patient originally) and made errors under pressure, for which he and the Hughes family are paying heavily.

The Sellu case, and others like it, will probably make surgeons more defensive and risk averse, but it should also make them responsible for telling patients the truth about the extra risks of having surgery in a private hospital when an emergency happens. These risks need to be measured, published and – if significant – included on the consent forms.